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Many orthopaedic procedures have a high success rate for improving quality of life and patient\u2010reported outcomes, yet these procedures carry some level of risk, including postoperative complications. The stepped\u2010care model of health care delivery, when applied to musculoskeletal care, recommends implementing less\u2010intense and lower\u2010risk treatments with known efficacy, such as promotion and education of self\u2010management strategies and physical therapy, before more\u2010invasive and higher\u2010risk treatments such as surgery. This model of managing musculoskeletal disability can improve efficiency of care delivery and reduce medical costs at the health system level. Unfortunately, there is a documented lack of implementing an appropriate course of conservative care, especially physical therapy, prior to surgery across multiple orthopaedic disciplines including sports, spine, and trauma medicine and joint arthroplasty. Failure to respond to nonsurgical treatment has been suggested as a requisite component of the surgical appropriateness criteria, yet practical application can be elusive. Multiple barriers to adequate utilization of conservative treatment exist, including U.S. payment models that increase out\u2010of\u2010pocket expense for patients, negative patient perception of therapy, unreasonable patient expectations from therapy versus surgery, and communication barriers between patient, surgeon, and therapist. Surgeons should ensure that high\u2010quality guideline\u2010appropriate care is delivered early and adequately to their patients. Rehabilitation professionals have a responsibility to deliver high\u2010value care, properly documenting the type and extent of treatment to improve surgical decision\u2010making between surgeons and patients. Criteria to determine appropriateness for surgery should include a standardized and extensive assessment of failed therapies prior to certain elective surgeries. Improved collaboration between surgeons and rehabilitation professionals can result in improved outcomes for patients with musculoskeletal disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>V, expert opinion<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.asmr.2021.09.038","type":"journal-article","created":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T15:33:05Z","timestamp":1643383985000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":9,"title":["Nonoperative Care Including Rehabilitation Should Be Considered and Clearly Defined Prior to Elective Orthopaedic Surgery to Maximize Optimal Outcomes"],"prefix":"10.1002","volume":"4","author":[{"given":"Daniel I.","family":"Rhon","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine Brooke Army Medical Center San Antonio Texas U.S.A."},{"name":"Department of Rehabilitation Medicine The Uniformed Services University of Health Science Bethesda Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher J.","family":"Tucker","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Walter Reed National Military Medical Center Bethesda Maryland U.S.A."},{"name":"Department of Surgery The Uniformed Services University of Health Sciences Bethesda Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,1,28]]},"reference":[{"key":"e_1_2_3_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516673615"},{"key":"e_1_2_3_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-020-01424-4"},{"key":"e_1_2_3_4_2","first-page":"n1511","volume":"374","author":"Blom A.W.","year":"2021","journal-title":"Common elective orthopaedic procedures and their clinical effectiveness: 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