The importance of developing homogeneous subgroups of patients with LBP based on constellations of reliable clinical findings is emphasized.

Purpose: To evaluate the effects of prehabilitation (enhancing physical capacity before total hip or knee joint arthroplasty) on pain and physical function of adults with severe hip and knee osteoarthritis (OA). Methods: Consecutive patients (n ¼ 650) from 2006 to 2008 with hip or knee OA awaiting total joint arthroplasty (TJA) attended a hospital outpatient clinic for a prehabilitation assessment. All participants completed self-report (Lower Extremity Functional Scale [LEFS] and visual analogue scale for pain [VAS]) and functional performance measures (self-paced walk [SPW], timed stair, and timed up-and-go [TUG] tests). A subset of 28 participants with severe disability participated in a structured outpatient prehabilitation programme. Between-group differences were assessed via independent t-tests; paired Student's t-tests and Wilcoxon signed rank tests were used to compare changes in pain and function following the prehabilitation programme. Results: A total of 28 individuals (16 female) with mean age 67 (SD 10) years and BMI 33 (8) kg /m 2 awaiting TJA (10 hips, 18 knees) participated in a prehabilitation programme of 9 (6) weeks' duration. Relative to baseline, there was significant improvement in LEFS score (mean change 7.6; 95% CI, 1.7-13.5; p ¼ 0.013), SPW (mean change 0.17 m/s; 95% CI, 0.07-0.26; p ¼ 0.001), TUG (mean change 4.2 s; 95% CI, 2.0-6.4; p < 0.001), and stair test performance (mean change 3.8 s [SD 14.6]; p ¼ 0.005) following prehabilitation. Conclusion: This study presents preliminary evidence that prehabilitation improves physical function even in the most severely compromised patients with OA awaiting TJA.Key Words: arthroplasty; exercise; osteoarthritis; physical therapy specialty; rehabilitation. RÉ SUMÉ 116From the

Objective Best practice guidelines recommend that aerobic exercise (AEx) be implemented as early as possible poststroke, yet the prescription of AEx remains limited in stroke rehabilitation settings. This study used theoretical frameworks to obtain an in-depth understanding of barriers and enablers to AEx implementation in the stroke rehabilitation setting. Methods A qualitative, descriptive study was conducted. Participants were recruited from 4 stroke rehabilitation settings in Ontario, Canada, that have participated in an implementation study to provide structured AEx programming as part of standard care. Six clinician focus groups (with 19 physical therapists and 5 rehabilitation assistants) and one-to-one interviews with 7 managers and 1 physician were conducted to explore barriers and enablers to AEx implementation. The Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR) informed content analysis for clinician and manager perspectives, respectively. Results Barriers specific to resource constraints and health care system pressures, combined with patient goals, led to interventions to improve function being prioritized over AEx. Successful implementation was enabled through an interprofessional approach and team engagement in the planning and implementation process. Health care providers described concerns about patient safety, but confidence and capability for implementing AEx were enabled by education, skill development, use of exercise tests, and consultation with individuals with content expertise. Participants described the development of supportive processes that enabled AEx implementation within team workflows and shared resources. Conclusion Strategies to support implementation of AEx in stroke rehabilitation should incorporate knowledge and skills; the provision of clinical decision-making tools; access to expert consultation; the roles and social influence of the interprofessional team and formal and informal leaders; and supportive processes adapted to the local context. Impact Results from this study will inform the development of a clinical implementation toolkit to support clinical uptake of AEx in the stroke rehabilitation setting.

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