The Role of Health Psychology in Surgical Prehabilitation: Insights From REST, a Preoperative Sleep Intervention for Total Knee Replacement Patients

Background
Approximately 10%–34% of people experience chronic pain after total knee replacement (TKR) surgery. Prehabilitation approaches that address pre-operative risk factors for chronic post-surgical pain are a key area for research. To be effective, prehabilitation requires substantial engagement and behaviour change by patients, which can be challenging in the pre-operative period. Health psychology theory plays a valuable role in understanding how best to support behaviour change to achieve maximum patient benefit. This study provides insights from REST, a pre-operative sleep intervention for TKR patients.

Methods
In-depth semi-structured interviews were conducted with eight TKR patients who took part in the REST feasibility trial. An abductive analysis approach was used to identify the applicability of existing health psychology theories, and to explore new insights into the relationships between stages of behaviour change.

Results
Three thematic areas related to intervention engagement and enactment were identified: (i) health beliefs and readiness to change; (ii) from contemplation to enactment: the role of behaviour change techniques; (iii) and behavioural maintenance.

Conclusion
Findings highlighted three key stages of behaviour change that participants need to be supported in to benefit fully from prehabilitation intervention. Complex behaviour change interventions that include aspects of tailoring should consider the boundaries of acceptable adaption while maintaining core causal mechanisms, and include methods to explore real-world implementation and usability during the development process. These findings are important for surgeons and multidisciplinary teams to consider when developing new prehabilitation care pathways or when implementing evidence-based prehabilitation practices.