Understanding barriers and facilitators of exercise adherence after total-knee arthroplasty

Abstract

Purpose

The purpose of this qualitative study is to understand the perceived patient barriers and facilitators of post-surgical exercise adherence in patients undergoing TKA.

Material and Methods

We used an interpretive description approach. Data was gathered using semi-structured qualitative interviews. Participants were interviewed at 8 weeks post-operatively to capture physical, psychological, social and contextual changes and information. Topics that were explored included participants’ experience with physical activity and exercise, motivation to perform physical activity, beliefs that exercise will reduce pain, factors that limit their ability to engage in exercise, and the importance of self-regulation in exercise adherence.

Results

This study identified 4 themes within the WHO adherence framework: patient-related factors, condition-related factors, health care system, and social support. In particular, self-regulation, knowledge of exercise, post-operative complications, comorbidities, social support, and lack of guidance from health care providers were identified as personal and environmental characteristics that influence exercise adherence.

Conclusion

Exercise adherence is a multidimensional, interconnected construct and future research should focus on understanding the factors, particularly health care system, that impact adherence.

IMPLICATIONS FOR REHABILITATION

• Rehabilitation therapists should aim to foster competence and confidence in post-operative rehabilitation by implementing strategies such as positive-reinforcement, goal setting, and increased education regarding the benefits of exercise.

• Clinical strategies to improve exercise adherence should be implemented both pre-and-post-operatively.

• Health care providers should clearly discuss post-operative outcomes and expectations (e.g., complications, etc.) with patients prior to surgery.

Keywords:

• Exercise
• adherence
• rehabilitation
• total knee arthroplasty
• qualitative research

Disclosure statement

We affirm that the authors have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript, except as disclosed in an attachment and cited in the manuscript. Any other conflict of interest (i.e., personal associations or involvement as a director, officer, or expert witness) is also disclosed in an attachment.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, NB.