Why surgical optimisation works better when patients actually engage with it

Every orthopaedic surgeon knows that patient preparation matters.

Better pre-operative function means better post-operative outcomes. Better education means fewer anxious phone calls. Better adherence means smoother recovery and lower complication rates.

The problem has never been the evidence. The problem is getting patients to actually do it.The gap between prescribing prehab and patients completing it

Pre-operative physiotherapy, prehabilitation, is well established in the literature. Patients who enter surgery with better strength, mobility, and realistic expectations tend to have shorter hospital stays, better functional recovery, and lower rates of post-operative complications.

The challenge is that most patients receive prehab as a prescription, not a program.

They're told to see a physio. They're given an exercise sheet. They're advised to lose weight or improve their fitness. And then they're sent home to manage it themselves, with the next touchpoint often being the pre-admission clinic weeks later.

In that gap, a few predictable things happen. Motivation drops. Pain flares. Life gets in the way. Patients aren't sure if they're doing the exercises correctly, or whether what they're experiencing is normal. Some do well. Many don't engage at all.

By the time they arrive for surgery, you're working with whatever baseline they've brought in, and you don't always know what that is until they're on the table.

What 90% retention actually looks like

Beyond The Clinic's Project Mobilise pilot included a surgical cohort, patients preparing for or recovering from hip or knee replacement surgery. The cohort was drawn from both public hospital and private specialist pathways.

The program combined structured digital guidance via the JointFit app with active physiotherapist support delivered via telehealth. Patients were onboarded into the program at the point of surgical decision, and supported through pre-operative preparation and post-operative rehabilitation.

The retention numbers are worth noting because they're significantly higher than most digital health programs achieve.

Onboarding rate was 88.2%. Of the 34 patients referred, 30 commenced the program. The 4 non-commencements were all from the public cohort, where contact and follow-up can be more challenging.

Program retention was 90.0%. Of the 30 patients who commenced, 27 remained engaged through the program window. The 3 withdrawals were also from the public cohort.

Among the combined public and private surgical cohorts, 57% achieved their pre-operative health goals, and the remaining 43% were making active progress. By six weeks post-operatively, 4 out of 5 patients showed improvement in pain compared with their pre-operative baseline.

Patient experience scores were strong. 86% rated the health coaches as very helpful. And across the cohort, 100% of patients reported feeling more confident prior to surgery.

That last figure is the one that matters most in practical terms. Confident patients are less anxious, more adherent, and more likely to follow post-operative protocols without needing reassurance at every stage.

Why the model holds attention when others don't

The difference between a 90% retention rate and the 20–40% completion rates typical of app-only programs comes down to a simple structural reality: people need accountability, not just information.

A PDF exercise guide doesn't create accountability. A generic app with no human touchpoint doesn't create accountability. A single physio appointment followed by "keep doing these at home" doesn't create accountability for most patients.

What works is pairing the convenience and structure of a digital program with the reassurance and guidance of a real clinician who knows their case.

The JointFit program tracks exercise completion via motion tracking, so both the patient and the physiotherapist can see what's actually being done. It delivers education in manageable chunks, tailored to the stage of the surgical pathway the patient is in. And it creates regular touchpoints where patients can ask questions, flag concerns, and get reinforcement from a qualified physio who's coordinating with the surgical team.

For patients, this removes the ambiguity. They know what to do, they know if they're doing it right, and they know someone's checking in. That's what drives the 90% retention figure.

For surgeons and surgical coordinators, it provides visibility into patient preparation that you typically don't have. You can see, in real time, whether a patient is engaging with prehab, whether they're hitting mobility milestones, and whether there are red flags that need addressing before admission.

What it means for practice workflow

Dr Jason Tsung, an orthopaedic surgeon at Southern Gold Coast Orthopaedics, uses the Beyond The Clinic platform to support his joint replacement patients.

He reports that it gives him confidence that patients are managing their care according to his protocols, with concerns escalated to him in real time rather than via anxious phone calls to the practice.

His team has noticed fewer routine calls from patients, because patients can access clear, stage-appropriate information through the app rather than ringing the clinic with every question about what's normal or what they should be doing next.

For surgical practices, this translates to reduced administrative burden. Patients who feel supported and informed are less likely to generate non-urgent contact with the practice team. And when they do make contact, it's usually because something genuinely needs clinical attention, not because they're uncertain or anxious about a normal part of the process.

The economics of better-prepared patients

The financial case for surgical optimisation is straightforward at a system level. Better pre-operative preparation reduces length of stay, lowers complication rates, and improves return to function. These outcomes reduce cost for hospitals and improve satisfaction for patients and payers.

For private surgical practices, the economics are slightly different but no less compelling.

Patients who are well prepared tend to be more satisfied with their outcome. They understand what to expect, they're less likely to experience preventable setbacks, and they're more likely to refer others or return for future care if needed.

Patients who aren't well prepared, or who feel unsupported through the process, are more likely to generate complaints, require additional follow-up, and leave negative reviews. In a sector where reputation and referral networks matter enormously, patient experience isn't a soft metric. It's a commercial one.

There's also a regulatory and quality dimension. As bundled payment models and outcome-based contracting become more common in Australia, the ability to demonstrate that your practice actively supports patient preparation and recovery will increasingly be a competitive advantage, or a requirement.

What surgical clinic partnership looks like with Beyond The Clinic

Beyond The Clinic's surgical pathway is designed to integrate into existing practice workflows without creating additional administrative burden for your team.

Patients are referred into the program at the point of surgical decision, typically after the consultation where surgery is booked. They complete the Joint Health Profile to establish a baseline, then onboard into the JointFit surgical program with guidance tailored to their procedure and timeline.

The program coordinates pre-operative preparation and post-operative rehabilitation, with the physiotherapy team escalating any clinical concerns to the surgeon as needed. You retain full oversight and clinical responsibility. The platform simply provides the infrastructure to keep patients engaged, informed, and progressing between your touchpoints.

Outcomes data flows back to your practice in a format that supports your quality reporting, and patients can grant access to their progress data so you have visibility into their preparation ahead of admission.

If you're exploring digital tools to support surgical optimisation, or if you're preparing for a future where demonstrating patient preparation is part of the contract, we'd welcome the conversation.

You can also read the full Project Mobilise Outcomes Report to see the pilot data in detail, including the surgical cohort results.

Key takeaways

• Prehabilitation improves surgical outcomes, but most patients don't complete traditional prehab programs consistently.
• Beyond The Clinic's surgical cohort in Project Mobilise achieved 88.2% onboarding and 90.0% retention, significantly higher than app-only programs.
• 100% of surgical patients reported feeling more confident prior to surgery, and 4 out of 5 showed pain improvement by 6 weeks post-operatively.
• The model pairs digital structure with active physiotherapist support, creating accountability that drives completion.
• Dr Jason Tsung reports fewer routine patient calls and improved confidence that patients are managing care according to protocol.
• For surgical practices, better patient preparation reduces administrative burden, improves satisfaction, and positions the practice for outcome-based contracting models.

Want to see how the surgical program works in practice? Book a demo or explore our surgical optimisation pathway.