Adherence to exercise after joint replacement surgery: patients’ and health professionals’ perceptions

Abstract

Background: Following joint replacement surgery exercise rehabilitation is recommended for both the prevention of complications and the facilitation of functional recovery. Medical and psychosocial research however finds that adherence to exercise can be poor in patients with musculoskeletal conditions. The aim of this study was to explore patients’ and physiotherapists’ perceptions about factors they considered to influence rehabilitation adherence after total hip and total knee replacement surgery. Methods: A purposive sample of 8 joint replacement patients and 5 physiotherapists participated in separate semi-structured focus groups. A topic guide was developed in order to explore participants’ perceptions about facilitators and barriers of exercise adherence after surgery; and interviews were audio-taped and transcribed verbatim. In order to identify patterns and themes within the data thematic analyses was used. Once themes were formulated within each group (patients and physiotherapists separately) overarching themes were identified between groups. Findings: Six themes emerged: ‘fragility of the system’ (inconsistencies in the delivery of the health care service); ‘tailoring exercise’ (needs and limited capacity to tailor); ‘incongruent approach to rehab’ (views regarding participants’ role to rehabilitation adherence); ‘expectations’ (the importance of education and the impact of expectations); ‘barriers to rehab’ (physical, experiential and social); ‘what matters?’ (incongruence in what the successful outcome is considered to be). Conclusion: Inconsistencies in therapy service delivery, incongruent approaches to rehabilitation and personal barriers influence patient adherence. Current findings highlight factors for consideration by care providers in order to facilitate adherence to exercise after joint replacement surgery.