Pellegrini Christine A, Ledford Gwendolyn, Hoffman Sara A, Chang Rowland W, Cameron Kenzie A
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
Department of Exercise Science, University of South Carolina, Discovery I, 915 Greene Street, Suite 403, Columbia, SC, 29208, USA.
BMC Musculoskelet Disord. 2017 Aug 1;18(1):327. doi: 10.1186/s12891-017-1687-x.
Most knee replacement patients are overweight/obese, yet are commonly excluded from evidence-based weight loss programs due to mobility limitations and barriers faced around the time of surgery. The purpose of this study was to identify knee replacement patient preferences for weight loss programs and qualitatively understand previous motives for weight loss attempts as well as strategies used to facilitate behavior changes.
Patients who were either scheduled to have knee replacement or had one recently completed within the last 3 months were recruited to participate. Patients completed a brief weight loss program preference questionnaire assessing preferred components of a weight loss program (i.e. self-monitoring, educational topics, program duration). Qualitative interviews were completed to identify motives for and strategies used during past weight loss attempts. All interviews were transcribed, de-identified, and analyzed using constant comparative analysis.
Twenty patients (11 pre-operative and 9 post-operative) between 47 and 79 years completed the study (55% male, 90% White, and 85% with a BMI ≥25 kg/m). Patients reported a preference for a weight loss program that starts before surgery, is at least 6 months in duration, and focuses both on diet and exercise. The majority of patients preferred to have a telephone-based program and wanted to track diet and physical activity on a smartphone application. The most common motive for weight loss mentioned by patients related to physical appearance (including how clothing fit), followed by wanting to lose weight to improve knee symptoms or to prevent or delay knee replacement. Strategies that patients identified as helpful during weight loss attempts included joining a formal weight loss program, watching portion sizes, and self-monitoring their dietary intake, physical activity, or weight.
This study provides a preliminary examination into the motives for weight loss, strategies utilized during past weight loss attempts, and preferences for future weight loss programs as described by knee replacement patients. These results will help guide the development and adaptation of future patient-centered weight loss programs as well as help clinicians recommend targeted weight programs based on the specific preferences of the knee replacement population.
大多数膝关节置换患者超重或肥胖，但由于手术前后行动不便及面临的障碍，他们通常被排除在循证减肥项目之外。本研究的目的是确定膝关节置换患者对减肥项目的偏好，并定性了解以往减肥尝试的动机以及促进行为改变所采用的策略。
招募计划进行膝关节置换或在过去3个月内刚完成置换手术的患者参与研究。患者完成一份简短的减肥项目偏好问卷，评估减肥项目的偏好组成部分（即自我监测、教育主题、项目持续时间）。通过定性访谈确定过去减肥尝试的动机和所采用的策略。所有访谈均进行转录、去识别化处理，并采用持续比较分析法进行分析。
20名年龄在47至79岁之间的患者（11名术前患者和9名术后患者）完成了研究（55%为男性，90%为白人，85%的体重指数≥25kg/m²）。患者报告倾向于选择在手术前开始、持续时间至少6个月且同时关注饮食和运动的减肥项目。大多数患者更喜欢基于电话的项目，并希望通过智能手机应用程序跟踪饮食和身体活动。患者提及的最常见减肥动机与外貌（包括衣服是否合身）有关，其次是希望减肥以改善膝关节症状或预防或延缓膝关节置换。患者认为在减肥尝试中有用的策略包括参加正式的减肥项目、注意食物分量、自我监测饮食摄入、身体活动或体重。
本研究对膝关节置换患者描述的减肥动机、过去减肥尝试中采用的策略以及对未来减肥项目的偏好进行了初步调查。这些结果将有助于指导未来以患者为中心的减肥项目的开发和调整，并帮助临床医生根据膝关节置换人群的具体偏好推荐有针对性的减肥项目。
