Being active with a total hip or knee prosthesis: a systematic review into physical activity and sports recommendations and interventions to improve physical activity behavior

Orthopaedic surgeons' attitude toward physical activity for people after total hip or knee replacement: Northern vs Southern European country

BACKGROUND

Regular physical activity (PA) is a key factor of lifestyle behavior enhancing general health and fitness, especially in people after total hip or knee replacement (THR and TKR). Orthopaedic surgeons can play a primary role in advocating the benefits of an active lifestyle. Aim of the study was 1) to assess the attitude of orthopaedic surgeons towards PA for people after THR/TKR and 2) to compare the attitude between a Northern European (the Netherlands) and a Southern European (Italy) country and analyze which factors influence the attitude towards PA.

METHODS

A cross-cultural study. An (online) survey was distributed among orthopaedic surgeons in Italy and the Netherlands. Chi-square and Mann-Whitney tests were used to compare surgeons' and clinics' characteristics, and questionnaires' scores, respectively. A linear regression analysis was conducted to assess which surgeon characteristics influence attitude towards PA.

RESULTS

A cohort of 159 surgeons (103 Italians and 56 Dutch) was analyzed. The median score of overall orthopaedic surgeons' attitude towards PA was positive (57 out of 72). Dutch surgeons showed a more positive attitude compared to Italian surgeons (p < 0.01). Main difference was found in the "Physical activity concern" factor, where Italian surgeons showed more concern about the negative effects of PA on the survival of the prosthesis. The regression analyses showed that "Country" and "Type of clinic" were associated with the surgeons' attitude.

CONCLUSIONS

Overall, the orthopaedic surgeons' attitude towards PA for people with THR and TKR was positive. However, Dutch surgeons seem to be more positive compared to the Italian. The country of residence was the item that most influenced attitude. Further investigations are needed to untangle specific factors, such as cultural, socioeconomic, or contextual differences within the variable "country" that may influence orthopaedic surgeons' attitudes towards PA.

Exploring needs, barriers to, and facilitators of rehabilitation exercise following revision hip replacement - A grounded theory study

PURPOSE

Evidence on rehabilitation after revision total hip replacement (THR) is inadequate and development of rehabilitation interventions is warranted. Even so, little is known about patients' experiences with revision THR rehabilitation. This study aimed to explore patients' rehabilitation exercise experiences after revision THR.

MATERIALS AND METHODS

Using constructivist grounded theory, we conducted semi-structured qualitative interviews with twelve patients with completed or almost completed rehabilitation exercise after revision THR. Data collection and analysis were a constant comparative process conducted in three phases; initial, focused, and theoretical.

FINDINGS

From the data, we generated a substantial theory of the participant's circumstances and ability to integrate rehabilitation exercise into their everyday life after revision THR. Four categories were constructed based on patients' experiences in different contexts: hesitance, fear avoidance, self-commitment, and fidelity.

CONCLUSIONS

This study highlighted that patients' expectations, past experiences, attitudes, trusts, and circumstances interact to influence engagement and adherence to rehabilitation exercise and described four categories relating to the integration of revision THR rehabilitation exercise into their everyday life. Clinicians should be aware of and account for these categories during rehabilitation exercise. Tailored individual rehabilitation exercise interventions and clinician approaches to optimize engagement and adherence are needed among patients with revision THR.