Designing Prehabilitation programs for spinal surgery – a qualitative study exploring patient perceptions of spinal surgery prehabilitation programs

Elective spinal surgery rates have increased over the last 20 years however; recovery outcomes remain suboptimal. Implementing prehabilitation before surgery has been identified as one way to improve recovery after spinal surgery. To date, there has been limited research identifying patients' perspectives on what the prehabilitation programs should look like for spinal surgery. This study aimed to explore patient perceptions of spinal surgery prehabilitation programs as part of their clinical pathway. Method This cross-sectional qualitative study recruited participants from lumbar spine surgery waiting lists at two public hospitals in XXXX, Australia. Thirty participants completed an online survey and 15 attended semi-structured interviews. Guided by reflexive thematic analysis participant perspectives on prehabilitation programs for spinal surgery were explored. Results The majority of online survey respondents indicated they were willing to participate in spinal surgery prehabilitation, preferring sessions 2 days per week, for 1 hours each. Four barriers and five facilitators to participation were identified along with five key preferences regarding program structure and program content. Conclusion Our study provides guidance on patient perspectives on prehabilitation programs before spinal surgery. The programs should be flexible multimodal programs that are tailored to an individuals' capacity and adapted to account for patients' motivation to attend prehabilitation. Access to physical therapists within a prehabilitation phase was an important facilitator feature according to patients. These insights will help to inform the design and implementation of multimodal prehabilitation for spinal surgery.