Exploring feasibility of health-related quality of life assessments and pain diaries in patients undergoing prehabilitation before total knee arthroplasty: a pilot study

Background: Prehabilitation prior to total knee arthroplasty (TKA) may mitigate deterioration in health-related quality of life (HRQOL) during the preoperative period and support recovery after surgery. However, little is known about the feasibility of systematically monitoring HRQOL and pain through patient-reported outcome measures (PROMs) in this context. This pilot study aimed to evaluate the feasibility of using validated HRQOL questionnaires and daily pain diaries during a prehabilitation programme for patients awaiting (TKA) and up to 12 weeks postoperatively. Methods: Twenty patients (mean age 73 ± 6 years) scheduled for primary unilateral TKA were randomly assigned to an intervention group (IG) or control group (CG). The IG participated in a 4- to 8-week individualised prehabilitation programme involving exercise and education. Feasibility was assessed through the completion rates of daily pain diaries and three HRQOL questionnaires (EQ-5D-5 L, SF-12 and KOOS KRQOL) collected at baseline, preoperatively, and at 6- and 12-weeks postoperatively. Results: HRQOL questionnaires demonstrated high completion rates across both groups (90%). In contrast, adherence to paper-based pain diaries was suboptimal and notably low (CG: 58%; IG: 47%), falling below the threshold for meaningful analysis. Consequently, pain trajectory over time could not be reliably assessed. No significant group-by-time interaction effects were observed for any HRQOL measure: EQ-5D-5 L (p = 0.67; F = 0.51), KOOS KRQOL (p = 0.72; F = 0.64), SF-12 PCS (p = 0.06; F = 0.50) and MCS (p = 0.36; F = 0.10). Conclusion: This pilot study confirms the feasibility and acceptability of HRQOL questionnaires in older patients undergoing prehabilitation before TKA. However, the low diary completion rates highlight the need for alternative pain-monitoring-approaches - such as electronic formats - to improve data quality in future trials. Preliminary findings suggest potential benefits of prehabilitation, warranting further investigation in larger studies. Trial registration: ClinicalTrials.gov Identifier; NCT05314985. Registered 20 July 2021. BASEC-Nr. 2020-03060.