Webster F, Perruccio A V, Jenkinson R, Jaglal S, Schemitsch E, Waddell J P, Venkataramanan V, Bytautas J, Davis A M
Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada.
Arthritis Program, Division of Orthopaedic Surgery, University Health Network, Institute of Health Policy, Management & Evaluation, University of Toronto, 399 Bathurst Street, EW1-449, Toronto, Ontario M5T 2S8, Canada.
Osteoarthritis Cartilage. 2015 Jun;23(6):860-7. doi: 10.1016/j.joca.2015.02.013. Epub 2015 Feb 21.
Numerous studies report large and significant improvements in basic mobility and activities of daily living following total hip or knee replacement (TJR). Nevertheless, quantitative research has shown minimal increase in participation in activities that benefit overall health. This study explored why people do or do not engage in activities following hip or knee TJR.
This was a longitudinal qualitative study. Sampling was guided by constructivist grounded theory and data collected using open-ended, semi-structured interviews. Participants were recruited using maximum variation sampling based on age, sex and joint replaced (hip or knee). Data were analysed using a constant comparative approach and coded for thematic patterns and relationships from which overarching themes were constructed.
Twenty-nine patients participated in interviews prior to, and 8 and 18 months post following TJR. A high degree of variability with regard to participants' return to activities was found and five emergent themes were identified that accounted for this variability. These themes highlight the importance of issues beyond medical factors alone, such as socio-cultural factors that partially determine participants' participation in activity following TJR.
Findings suggest that multi-faceted experiences impact participation in activity following TJR. These experiences include changes in identity and lifestyle that preclude a 'return to normal'. There is an urgent need for supports to increase people's activity post-TJR in order to facilitate enhancement of post-surgery levels of engagement. Approaches that take into consideration more personalized interventions may be critical to promoting healthy aging in people with TJR.
大量研究报告称，全髋关节或膝关节置换术（TJR）后，患者的基本活动能力和日常生活活动有显著大幅改善。然而，定量研究表明，有益于整体健康的活动参与度仅有极小幅度的增加。本研究探讨了髋或膝关节TJR术后患者参与或不参与活动的原因。
这是一项纵向定性研究。抽样以建构主义扎根理论为指导，通过开放式、半结构化访谈收集数据。根据年龄、性别和置换关节（髋关节或膝关节）采用最大差异抽样法招募参与者。使用持续比较法分析数据，并对主题模式和关系进行编码，据此构建总体主题。
29名患者在TJR术前、术后8个月和18个月接受了访谈。研究发现参与者恢复活动的情况差异很大，并确定了五个新出现的主题来解释这种差异。这些主题凸显了仅医疗因素之外的其他问题的重要性，比如社会文化因素，这些因素在一定程度上决定了参与者在TJR术后参与活动的情况。
研究结果表明，多方面的经历会影响TJR术后的活动参与度。这些经历包括身份认同和生活方式的改变，这些改变使得无法“恢复正常”。迫切需要提供支持，以增加TJR术后患者的活动量，从而促进术后参与水平的提高。考虑更具个性化干预措施的方法对于促进TJR患者的健康老龄化可能至关重要。
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