Background/Purpose:  It is important that patient expectations are met after total hip (THA) or knee (TKA) arthroplasty in order to maximize outcomes and satisfaction.  Although patients state that return to leisure activities is a priority, few studies have focused on their expectations for return to these activities.  We conducted a scoping review to determine: 1) the types of studies that have been conducted on leisure activity expectations after THA/TKA, 2) how expectations have been measured, 3) if expectations are met, and 4) if expectations can be modified. 

Methods: Scoping reviews are used to determine the extent, range, and nature of the scientific literature when experimental studies are lacking.  This review was conducted using the 6-stage framework of Arksey and O’Malley (identify research question, identify relevant studies, select studies, chart data, report results, and consultation).  The review included cohort and experimental studies of patients, aged 18 years or more, who received primary THA/TKA due to arthritis, and included a pre-operative assessment of leisure activity expectations and data on if they were met or modified.  Electronic database searches (e.g., MEDLINE, CINAHL) were conducted by a medical librarian.  The studies were independently screened for eligibility by 2 researchers during 3 rounds of review (title, abstract, and full-text).  A descriptive analytical method was used to summarize the data according to published methods.  Cohen’s kappa coefficient with 95% CI was used to determine inter-rater agreement.

Results: Of the 242 articles identified, 169 titles, 60 abstracts, and 15 full-text articles were screened for eligibility.  The rater agreement for each round was 0.47 (CI 0.32, 0.63), 0.61 (CI 0.35, 0.86), and 1.0 (CI 1, 1), respectively.  The review included 5 studies. Four studies used a cohort design to determine if expectations were met after surgery (follow-up between 1 and 5 years).  Only 1 randomized controlled trial attempted to modify expectations prior to surgery using an educational class with hip- or knee-specific information.  Expectations were measured by questionnaire (self- or phone-administered) and presented as an overall score (summation of Likert scale responses) or in MET-hours per week. Only 1 study measured the expected dose (frequency, intensity, time, type) of activity.  Expectations exceeded post-operative ability at 5 years in 1 study, and were not met in another.  Two studies estimated that expectations were met in 10% to 43% of patients.  The randomized controlled trial reported that expectations could be modified.

Conclusion: This scoping review demonstrated that few studies focused on patient expectations for leisure activity after THA/TKA, and even fewer attempted to modify expectations.  Expectations were not consistently met, but they are capable of being modified. Future studies should assess the expected dose of activity that patients expect to achieve to ensure that they will be active enough to maintain health.  More studies are needed to test educational interventions in patients undergoing joint replacement.  Educating patients about appropriate activity expectations could improve the health and activity levels of this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-scoping-review-on-leisure-activity-expectations-after-total-hip-or-knee-arthroplasty-due-to-arthritis/