Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Dr. Harry Prapavessis


The purpose of this dissertation was to investigate the role of prehabilitation in post-operative recovery for patients undergoing total knee arthroplasty (TKA) for osteoarthritis. Study one was a meta-analysis that aimed to consolidate the body of knowledge regarding prehabilitation for TKA patients. Study two compared the Lower Limb Tasks Questionnaire (LLTQ) to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in terms of agreement and responsiveness. Study three investigated the effect of a six-week pre-surgical strength training program on post-operative outcomes (quadriceps strength, mobility, pain, self-reported function, health-related quality of life, arthritis self efficacy) for TKA patients. Finally, study four provided a preliminary insight into the implementation context of prehabilitation for TKA.

Study one demonstrated that prehabilitation had no effect on post-operative pain or self-reported function, but had a large effect on length of hospital stay (ES = -0.819; 95% CI: -0.985 - -0.653). Pre-operative exercise had no significant effect on quadriceps strength in the early post-operative phase (hospital discharge to 12 weeks after surgery), but did have a small effect on strength beyond 12 weeks (ES = 0.279; 95% CI: 0.018 – 0.540).

Study two found that the LLTQ activities of daily living (ADL) subscale had good agreement with the WOMAC global score [bias = -1.40 (SD = 10.00); 95% limits of agreement = -22.00% to +19.00%.] Conversely, the LLTQ sport/recreation subscale had very poor agreement with WOMAC [bias = -31.00 (SD = 17.00); 95% limits of agreement = -65.00% to +2.40%]. The statistical responsiveness of the WOMAC was superior to that of the LLTQ ADL and sport/recreation subscales (1.17, -0.63, and -0.01, respectively).

Study three showed that pre-surgical strength training had a large effect on quadriceps strength, F(3,18) = 0.89, p = 0.47, η2 = 0.13, and walking speed, F(3,18) = 1.47, p = 0.26, η2 = 0.20 before TKA. After TKA, there were no significant differences in any outcome measures between the prehabilitation and control groups. Furthermore, there were no significant correlations between self-reported and objective measures of function.

Finally, study four indicated that TKA patients are likely to participate in prehabilitation, particularly exercise-based programs.