Lim Chia Voon, Harithasan Deepashini, Ahmad Mohd Azzuan Bin, Mesbah Normala, Kumar Saravana, Singh Devinder Kaur Ajit
Physiotherapy Programme and Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Physiotherapy Programme and Centre for Rehabilitation and Special Needs Studies (ICaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Geriatr Orthop Surg Rehabil. 2025 Apr 23;16:21514593251335882. doi: 10.1177/21514593251335882. eCollection 2025.
Total knee replacement (TKR) is a common surgical intervention for older adults with chronic knee osteoarthritis (KOA). Given the prevalence of comorbidities in this population, health priorities may vary, influencing decision-making regarding TKR. Despite the increasing number of TKRs, no scoping review has systematically examined the determinants shaping older adults' decisions using a biopsychosocial (BPS) model. Searches were undertaken in commercially produced and grey literature sources. Eligible studies included English-language qualitative and quantitative studies that investigated determinants influencing older adults' decision towards TKR. Two independent reviewers screened the results. The data were then independently extracted, which was then collated and synthesized, using the BPS model. Out of 999 abstracts screened, 23 studies met the inclusion criteria. The included studies took place in Australia, Canada, Germany, Japan, Kuwait, Sweden, Taiwan, Turkey, the United Kingdom and the United States. Ten studies used qualitative study designs while thirteen used varying quantitative study designs. Under BPS model, these determinants were grouped into biological determinants: baseline physical health, disease severity, and pain symptoms; psychological determinants, including coping strategies, feelings of loss, mental stress, depression, and anxiety; and social determinants: support networks, financial resources, health insurance, and access to referral systems and surgery. The decision for TKR in older adults with chronic KOA is shaped by an intricate interplay of biological, psychological, and social factors. The most consistent determinants included the desire for pain relief and the ability to regain physical function. Religion and spirituality significantly influence stress and anxiety in older adults and transportation system also presents significant challenges for TKR surgery. A multifaceted strategy that improves the structures, processes, and outcomes of decision for TKR surgery is required among older adults with chronic KOA. Future research with large, representative samples and a focus on the BPS framework is needed to further explore this complex decision-making process.
全膝关节置换术（TKR）是针对患有慢性膝关节骨关节炎（KOA）的老年人的常见外科手术干预措施。鉴于该人群中合并症的普遍性，健康优先事项可能会有所不同，从而影响TKR的决策。尽管TKR的数量在增加，但尚无范围综述系统地使用生物心理社会（BPS）模型来研究影响老年人决策的决定因素。在商业生产的文献来源和灰色文献来源中进行了检索。符合条件的研究包括调查影响老年人对TKR决策的决定因素的英文定性和定量研究。两名独立的评审员筛选了结果。然后独立提取数据，然后使用BPS模型进行整理和综合。在筛选的999篇摘要中，有23项研究符合纳入标准。纳入的研究在澳大利亚、加拿大、德国、日本、科威特、瑞典、中国台湾、土耳其、英国和美国进行。10项研究采用定性研究设计，13项采用不同的定量研究设计。在BPS模型下，这些决定因素分为生物决定因素：基线身体健康、疾病严重程度和疼痛症状；心理决定因素，包括应对策略、失落感、精神压力、抑郁和焦虑；以及社会决定因素：支持网络、财务资源、医疗保险以及转诊系统和手术的可及性。患有慢性KOA的老年人进行TKR的决策受到生物、心理和社会因素的复杂相互作用的影响。最一致的决定因素包括缓解疼痛的愿望和恢复身体功能的能力。宗教和灵性显著影响老年人的压力和焦虑，交通系统也给TKR手术带来重大挑战。对于患有慢性KOA的老年人，需要一种多方面的策略来改善TKR手术决策的结构、过程和结果。需要对具有代表性的大样本进行未来研究，并关注BPS框架，以进一步探索这一复杂的决策过程。
