Barriers and facilitators of decision-making in home-based rehabilitation exercise among older adults following total knee arthroplasty: A qualitative study.

Abstract

ObjectiveTo explore the decision-making experiences regarding home-based rehabilitation exercises among older adults following total knee arthroplasty, and to identify its barriers and facilitators based on dual-process theory.DesignA qualitative descriptive design was employed in this study.SettingThree tertiary hospitals in China.ParticipantsA purposive sample of 21 older adults who had undergone total knee arthroplasty was recruited.Main measuresData were collected through semi-structured telephone interviews and analysed using thematic analysis.ResultsThe findings identified three themes and 10 subthemes. Barriers comprised two themes with six subthemes: intuitive avoidance responses from the impulsive system (pain-triggered exercise avoidance, willingness constrained by physical conditions, overprotection driven by fear and uncertainty and preference for immediate comfort) and external support constraints (inadequate post-discharge rehabilitation guidance and limited family support availability). Facilitators comprised one theme with four subthemes: rational adherence of the reflective system (perceived threat of poor prognosis, reassurance from life proverbs, goal-directed willpower activation and use of negotiation strategies).ConclusionsHome-based rehabilitation exercise is essential for functional recovery following total knee arthroplasty. Exercise decision-making involves cognitive conflicts between impulsive responses and reflective evaluations. Healthcare professionals should mitigate impulsive barriers through comprehensive pain management and by prescribing safe and effective ranges of joint motion, while enhancing reflective engagement through individualised goal setting, positive cultural framing and negotiation strategies that help regulate automatic responses. Age-friendly follow-up services and family support should be strengthened to address exercise-related decision-making conflicts.