Understanding barriers and facilitators to healthy eating and physical activity from patients either before and after knee arthroplasty

Abstract

Purpose: We sought to identify patient-reported barriers and facilitators to healthy eating and physical activity among patients before or after knee arthroplasty.

Materials and methods: Twenty patients with knee osteoarthritis aged 40–79 years who had knee arthroplasty surgery scheduled or completed within 3 months were interviewed. Interview topics included perceived barriers and facilitators to healthy eating and activity before or after surgery. Interviews were coded and analyzed using constant comparative analysis.

Results: Interviews were completed with 11 pre-operative (67.1 ± 7.6 years, 45.5% female, BMI 31.2 ± 6.3) and nine post-operative patients (61.7 ± 11.7 years, 44.4% female, BMI 30.2 ± 4.7 kg/m²). The most commonly identified personal barriers to healthy eating identified were desire for high-fat/high-calorie foods, managing overconsumption and mood. Factors related to planning, portion control and motivation to improve health were identified as healthy eating facilitators. Identified personal barriers for activity included pain, physical limitations and lack of motivation, whereas facilitators included having motivation to improve knee symptoms/outcomes, personal commitment to activity and monitoring activity levels.

Conclusion: Identifying specific eating and activity barriers and facilitators, such as mood and motivation to improve outcomes, provides critical insight from the patient perspective, which will aid in developing weight management programs during rehabilitation for knee arthroplasty patients.

Implications for rehabilitation

• This study provides insight into the identified barriers and facilitators to healthy eating and physical activity in knee arthroplasty patients, both before and after surgery.

• Intrapersonal barriers that may hinder engagement in physical activity and rehabilitation include pain, physical limitations and lack of motivation; factors that may help to improve activity and the rehabilitation process include being motivated to improve knee outcomes, having a personal commitment to activity and tracking activity levels.

• Barriers that may interfere with healthy eating behaviors and knee arthroplasty rehabilitation include the desire for high-fat/high-calorie foods, overeating and mood; whereas planning and portion control may help to facilitate healthy eating.

• Understanding barriers and facilitators to healthy eating and physical activity can help guide rehabilitation professionals with their discussions on weight management with patients who had or are contemplating knee arthroplasty.

Keywords:

• Knee arthroplasty
• diet
• activity
• obesity

Acknowledgements

We thank Eleanor Abreu and the Northwestern University Physical Activity in Rheumatology Research Group for their insight and feedback on the project. Additionally, we thank all of the patients that participated in the interviews for their time and unique perspectives.

Disclosure statement

This study was funded by the Agency for Healthcare Research and Quality (K12HS023011) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (P60 AR064464). The authors report no conflict of interest.

Additional information

Funding

This study was funded by the Agency for Healthcare Research and Quality (K12HS023011) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (P60 AR064464).