Experiences and Perceptions of Patients Participating in Prehabilitation and Early Rehabilitation for Hip and Knee Arthroplasty: A Systematic Review and Narrative Synthesis of Qualitative Evidence

Manca Opara Zupančič,1 Žiga Kozinc,1,2 Stefan Löfler,2 Karl Miedler,3 Nejc Å arabon1,21Faculty of Health Sciences, University of Primorska, Izola, Slovenia; 2Ludwig Boltzmann Institute for Rehabilitation Research, St. Pölten, Austria; 3Department of Orthopaedics and Orthopaedic Surgery, Landesklinikum Zwettl, Zwettl, AustriaCorrespondence: Nejc Å arabon, Faculty of Health Sciences, University of Primorska, Izola, Slovenia, Email nejc.sarabon@fvz.upr.siObjective: To synthesize qualitative evidence on patients’ experiences and perceptions of prehabilitation and early rehabilitation in the context of hip and knee arthroplasty.Methods: A systematic review was conducted across PubMed, Scopus, and Web of Science, with the databases searched from inception to March 2026. Eligible studies included individuals referred for or undergoing total hip or knee arthroplasty and reporting qualitative data on experiences with prehabilitation or early rehabilitation. Titles, abstracts, and full texts were screened by one reviewer and independently checked by a second reviewer, while data extraction was performed independently by two reviewers. Methodological quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Findings were synthesized using a primarily descriptive narrative approach with thematic organization into facilitators and barriers; a formal qualitative meta-synthesis was not conducted. The review protocol was not registered.Results: Twelve studies were included: 11 focused on prehabilitation and two on early postoperative rehabilitation. The included studies involved patients undergoing total hip arthroplasty, total knee arthroplasty, or both procedures. Patient experiences were grouped into five thematic domains: symptoms and physical condition, understanding and information, behavior, psychological well-being, and intervention delivery. Reported facilitators included improved symptoms and physical function, greater understanding and preparedness for surgery, better pain coping, improved psychological well-being, and positive experiences with different delivery formats. Reported barriers included increased pain, information overload, language barriers, limited individualization, restricted interaction, and varying delivery preferences. The evidence base was heterogeneous in terms of intervention content, delivery mode, patient populations, and depth of qualitative reporting.Conclusion: Prehabilitation and early rehabilitation were generally perceived positively, but several barriers were identified. The findings highlight the importance of symptom monitoring, individualized exercise prescription, clear tailored education, and flexible delivery formats. However, the findings should be interpreted cautiously because the synthesis was primarily descriptive, the included studies were heterogeneous, and the evidence was substantially stronger for prehabilitation than for early rehabilitation.Keywords: prehabilitation, early rehabilitation, hip arthroplasty, knee arthroplasty, patient experience, qualitative research