Bakaa Nora, Chen Lu Hsi, Carlesso Lisa, Richardson Julie, Shanthanna Harsha, Macedo Luciana
School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada.
Anesthesia, St. Joseph's Hospital, McMaster University, Hamilton, Canada.
Disabil Rehabil. 2022 Oct;44(21):6348-6355. doi: 10.1080/09638288.2021.1965232. Epub 2021 Aug 16.
The purpose of this qualitative study is to understand the perceived patient barriers and facilitators of post-surgical exercise adherence in patients undergoing TKA.
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.
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.
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 REHABILITATIONRehabilitation 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.
本定性研究的目的是了解全膝关节置换术（TKA）患者在术后运动依从性方面所感知到的障碍和促进因素。
我们采用了解释性描述方法。通过半结构化定性访谈收集数据。在术后8周对参与者进行访谈，以获取身体、心理、社会和环境方面的变化及信息。探讨的主题包括参与者的体育活动和运动经历、进行体育活动的动机、运动能减轻疼痛的信念、限制其参与运动能力的因素，以及自我调节在运动依从性中的重要性。
本研究在世界卫生组织的依从性框架内确定了4个主题：患者相关因素、病情相关因素、医疗保健系统和社会支持。具体而言，自我调节、运动知识、术后并发症、合并症、社会支持以及缺乏医疗保健提供者的指导被确定为影响运动依从性的个人和环境特征。
运动依从性是一个多维的、相互关联的概念，未来的研究应侧重于了解影响依从性的因素，特别是医疗保健系统。
对康复的启示
康复治疗师应通过实施诸如积极强化、设定目标以及增加关于运动益处的教育等策略，致力于培养患者在术后康复中的能力和信心。
应在术前和术后都实施提高运动依从性的临床策略。
医疗保健提供者应在手术前与患者明确讨论术后结果和期望（如并发症等）。
