Patient preference and adherence · 2026
Longitudinal Changes in Exercise Adherence and Associations with Rehabilitation Outcomes After Total Knee Arthroplasty: A Prospective HAPA-Informed Study.
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Wang Jiao, Chen Shanbin, Li Yuanyuan, Yuan Yuan, Liu Jiahui, Wang Suiyuan
Аннотация
BACKGROUND: Exercise adherence is important after total knee arthroplasty (TKA), but its postoperative pattern and behavioral correlates remain unclear.
OBJECTIVE: To characterize exercise adherence and examine its associations with HAPA-related factors and rehabilitation outcomes.
METHODS: This prospective study included 128 patients undergoing unilateral TKA. HAPA-related variables were assessed preoperatively. EARS, VAS, HSS, and range of motion (ROM) were assessed at 1, 3, and 6 months. Linear mixed-effects models, correlations, and regression were used.
RESULTS: EARS scores changed over time (P<0.001), increasing from 17.78±3.27 at 1 month to 18.43±3.64 at 3 months and remaining stable at 6 months (18.36±3.68). Compared with 1 month, EARS was higher at 3 months (difference=0.651, 95% CI 0.340-0.962) and 6 months (difference=0.601, 95% CI 0.290-0.912; both adjusted P<0.001); 3- and 6-month scores did not differ. VAS decreased, whereas HSS and ROM increased (all P<0.001). At 6 months, action self-efficacy (B=0.248, 95% CI 0.065-0.431) and maintenance self-efficacy (B=0.209, 95% CI 0.032-0.387) were independently associated with higher EARS scores. EARS correlated with VAS (r=-0.360), HSS (r=0.326), and ROM (r=0.361; all P<0.001).
CONCLUSION: Exercise adherence improved mainly during the first 3 months and then stabilized. Self-efficacy was associated with adherence, while higher adherence was associated with less pain and better function. These findings do not establish causality.
OBJECTIVE: To characterize exercise adherence and examine its associations with HAPA-related factors and rehabilitation outcomes.
METHODS: This prospective study included 128 patients undergoing unilateral TKA. HAPA-related variables were assessed preoperatively. EARS, VAS, HSS, and range of motion (ROM) were assessed at 1, 3, and 6 months. Linear mixed-effects models, correlations, and regression were used.
RESULTS: EARS scores changed over time (P<0.001), increasing from 17.78±3.27 at 1 month to 18.43±3.64 at 3 months and remaining stable at 6 months (18.36±3.68). Compared with 1 month, EARS was higher at 3 months (difference=0.651, 95% CI 0.340-0.962) and 6 months (difference=0.601, 95% CI 0.290-0.912; both adjusted P<0.001); 3- and 6-month scores did not differ. VAS decreased, whereas HSS and ROM increased (all P<0.001). At 6 months, action self-efficacy (B=0.248, 95% CI 0.065-0.431) and maintenance self-efficacy (B=0.209, 95% CI 0.032-0.387) were independently associated with higher EARS scores. EARS correlated with VAS (r=-0.360), HSS (r=0.326), and ROM (r=0.361; all P<0.001).
CONCLUSION: Exercise adherence improved mainly during the first 3 months and then stabilized. Self-efficacy was associated with adherence, while higher adherence was associated with less pain and better function. These findings do not establish causality.