How do patients, physiotherapists and orthopedic surgeons perceive delayed recovery during total knee arthroplasty rehabilitation? A qualitative study

Background. Although total knee arthroplasty (TKA) and its physiotherapeutic rehabilitation process are among the most frequently performed medical interventions, a substantial proportion (10-30%) of patients is not satisfied with their recovery. Early identification of delayed recovery would enable timely adjustments of the rehabilitation process. This study aimed to explore and compare the perceptions of patients, physiotherapists, and orthopedic surgeons regarding delayed recovery during TKA rehabilitation. Methods. Three focus group meetings were organized: patients (n=6), physiotherapists (n=6), and orthopedic surgeons (n=5). Focus group meetings were structured around three predefined topics regarding delayed recovery during TKA rehabilitation: (i) most important outcome domains, (ii) how and when delayed recovery can be identified, and (iii) most important prognostic factors of (delayed) recovery. To facilitate the discussion of the third topic, a rapid review of reviews was performed prior to the focus group meetings, to compile a list of prognostic factors consistently associated with TKA rehabilitation recovery, as reported in recent systematic reviews. Results. The focus group meetings showed that patients prioritized pain relief as most important outcome domain of TKA rehabilitation recovery, whereas physiotherapists prioritized physical function, and orthopedic surgeons patient satisfaction. According to the physiotherapists, delayed recovery can already be identified within the first six weeks after TKA, while orthopedic surgeons mentioned much longer periods before delayed recovery can be determined. All three stakeholder groups perceived patient expectations as an important prognostic factor of TKA rehabilitation recovery. Besides this factor, physiotherapists and orthopedic surgeons mostly prioritized other patient-related factors, whereas patients considered predominantly external factors as important prognostic factors of recovery during TKA rehabilitation. Conclusion. This study found similarities but mostly differences in how patients, physiotherapists and orthopedic surgeons perceive delayed recovery during TKA rehabilitation, and which prognostic factors they consider to be most important in this recovery. Our findings suggest that consensus is needed among clinicians on how and when TKA recovery should be considered as delayed. Future research should confirm that patient expectations are an important prognostic factor as well as a potential treatment target in TKA rehabilitation that could result in optimization of TKA rehabilitation outcomes.