An increasing number of hospitals and physiotherapists are offering a pre-operative care pathway, also known as ‘prehabilitation’, for patients scheduled for spinal surgery, or hip or knee replacements.
The rationale is clear: patients who are physically and mentally better prepared before surgery recover faster and more successfully afterwards. This principle, which can be boiled down to ‘better in, better out’, is the foundation of modern pre-operative physiotherapy.
getback™ Clinical Director Geoffrey Mackay says that within this pathway, structured physical training, patient education and lifestyle optimisation all play a role.
‘A pre-operative care pathway is a structured physiotherapy program prior to surgery, designed to optimise the patient’s readiness for surgery.’
Mackay says the the main objectives of rehabilitation are to:
- improve physical capacity and resilience
- reduce psycho-social risk factors such as fear and catastrophising
- enhance self-management and lifestyle behaviour
- create realistic expectations regarding surgery and recovery
For spinal surgery patients, the pathway particularly targets individuals with:
- reduced strength or physical fitness
- fear of movement
- low levels of physical activity
To achieve meaningful physiological adaptations, the program typically lasts a minimum of six weeks.
Screening and patient selection
Mackay says the the pre-operative pathway is not appropriate for all patients facing spinal or joint surgery.
‘Selection is based on a combination of questionnaires and physical assessments, such as the Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK) and the IPAQ-SF, which relates to level of physical activity.’
‘These tools help to identify which physical and psycho-social factors are modifiable. Combined with physical testing, they allow clinicians to tailor the intervention and monitor progress over time.’
Physical training as the core of Prehabilitation
A key component of the preoperative care pathway for spinal surgery is improving:
- muscular strength and endurance
- functional trunk stability
- cardiovascular capacity
Mackay says that scientific evidence consistently shows that patients who enter surgery in better physical condition mobilise earlier after surgery, experience fewer post-operative complications and return more quickly to daily activities.
‘This is where training with our getback exercise therapy devices offer distinct advantages for pre-operative patients,’ he said.
‘Our devices provide patients with a safe, targeted and measurable training solution.’
Biomechanically guided and safe training
getback™ exercise therapy devices are designed to guide movement in a biomechanically correct and controlled manner.
Mackay says this is particularly important for spinal patients because it minimises compensatory movements, allows safe loading within pain limits and reduces fear of movement.
‘Those factors make our exercise therapy devices especially suitable for patients with pain-related anxiety or uncertainty prior to surgery.’
Baseline assessment and measurable progress
The pre-operative pathway relies on baseline measurements and re-evaluation. The getback system enables:
- objective measurement of strength and range of motion
- precise monitoring of progress over time
- individualised load progression
‘This ability to accurately measure changes in strength and movement support clinical decision-making and align well with our outcome-based care model,’ Mackay says.
Targeted training of core and spinal muscles
Mackay says that pre-operative training focuses on spinal extension and rotation capacity, trunk stability and hip and lower limb function.
‘The getback devices are specifically engineered for isolated and functional training of both deep and superficial trunk muscles, which is otherwise very difficult to achieve with free exercises.’
Motivation matters
Because patients can see and feel their progress with actual measured data, getback training often creates increased confidence in movement and more engagement in the rehabilitation process.
Mackay says this directly supports behavioural change, a key pillar of successful pre-habilitation.
‘A well-designed pre-operative care pathway is not an additional burden, it’s a strategic investment in recovery. By optimising how patients go into surgery, we consistently see improved post-operative recovery.’
