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“Fear of the Known and Unknown”: Factors Affecting Participation Following Knee Replacement Among Persons With Participation Restriction

Maxwell, Jessica, PT, DPT, PhD, OCS1,2; Vaughan, Molly, PT, DPT2; Ledingham, Aileen, PT, MS2; Felson, David, MD, MPH3; Keysor, Julie, PT, PhD2,3

Journal of Geriatric Physical Therapy: January/March 2018 - Volume 41 - Issue 1 - p 35–41
doi: 10.1519/JPT.0000000000000104
Research Reports

Background/purpose: Evidence suggests that more than 30% of patients post-total knee replacement (TKR) are living with participation restrictions, yet little is known about their perceptions of and factors contributing to these restrictions. The purpose of this study was to identify emergent or recurring themes behind participation restrictions after TKR.

Methods: Nineteen participants between 50 and 85 years old reporting participation restrictions 1 to 5 years post-TKR completed semistructured qualitative interviews about their participation experience after TKR. Participants provided background information in written questionnaires. Data collected from in-person interviews were analyzed qualitatively using a grounded theory approach.

Results: Participants discussed 3 major themes with regard to participation post-TKR: (1) limiting activities requiring long-distance walking due to continued knee impairments, (2) avoiding activities with negative or unknown outcome expectancies, and (3) using problem solving to identify strategies to participate in important activities.

Conclusions: An unknown or negative outcome expectancy, particularly with regard to activities requiring long-distance walking, may lead to participation restrictions in some patients post-TKR. As participants reported using self-efficacy and coping strategies to improve participation, further physical rehabilitation or interdisciplinary rehabilitation incorporating the identified strategies may be effective with some patients post-TKR.

1Springfield College, Springfield, Massachusetts.

2Boston University College of Health and Rehabilitation Sciences, Boston, Massachusetts.

3Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts.

Address correspondence to: Jessica Maxwell, PT, DPT, PhD, OCS, Springfield College, Springfield MA 01109 (

The authors declare no conflicts of interest.

Funding for this project was provided by the American College of Rheumatology, Rheumatology Research Foundation Rheumatology Scientist Development Award NIDDR H133B100003: National Institute on Disability, Independent Living and Rehabilitation Research, Administration for Community Living/US Department of Health and Human Services, Center on Enhancing Activity and Participation Among People with Arthritis.

Bernadette Williams York was the Decision Editor.

© 2018 Academy of Geriatric Physical Therapy, APTA
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