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Articles
Orthopaedics

Patient Preference and Adherence

Longitudinal Changes in Exercise Adherence and Associations with Rehabilitation Outcomes After Total Knee Arthroplasty: A Prospective HAPA-Informed Study

1 October 2026Original research1 min read

By Jiao Wang, Shanbin Chen, Yuanyuan Li and 3 others.

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Abstract
Keywords
Authors
Source

Abstract

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.

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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. Keywords: knee osteoarthritis, self-efficacy, health behavior, functional recovery, patient compliance

Keywords

Total Knee Arthroplasty Outcomes
exercise adherence
total knee arthroplasty
rehabilitation outcomes
Health Action Process Approach
postoperative rehabilitation
physical activity
knee arthroplasty
Open access

Authors

Jiao Wang
Shanbin Chen
Yuanyuan Li
Yuan Yuan
Jiahui Liu
Suiyuan Wang

Source

Published in Patient Preference and Adherence. The abstract is shown as published and remains the work of its authors; read the full article at the source.

doi.org/10.2147/ppa.s630194

Prognia lists this article for reference and education. It is not medical advice. Always read the original and follow current guidelines and local protocols before acting on it.

At a glance

Journal: Patient Preference and Adherence
Type: Original research
Published: 1 October 2026
Specialty: Orthopaedics
Read time: 1 min
Authors: 6
DOI: 10.2147/ppa.s630194

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