title: Physical activity and experience of total knee replacement in patients one to four years postsurgery in the dominican republic: a qualitative study.
abstract: OBJECTIVE
  Musculoskeletal disorders are the second leading cause of years lived with disability globally. Total knee replacement (TKR) offers patients with advanced arthritis relief from pain and the opportunity to return to physical activity. We investigated the impact of TKR on physical activity for patients in a developing nation.
  
  
  METHODS
  As part of the Operation Walk Boston surgical mission program, we interviewed 18 Dominican patients (78% women) who received TKR about their level of physical activity after surgery. Qualitative interviews were conducted in Spanish, and English transcripts were analyzed using content analysis.
  
  
  RESULTS
  Most patients found that TKR increased their participation in physical activities in several life domains, such as occupational or social pursuits. Some patients limited their own physical activities due to uncertainty about medically appropriate levels of joint use and postoperative physical activity. Many patients noted positive effects of TKR on mood and mental health. For most patients in the study, religion offered a framework for understanding their receipt of and experience with TKR.
  
  
  CONCLUSIONS
  Our findings underscore the potential of TKR to permit patients in the developing world to return to physical activities. This research also demonstrates the influence of patients' education, culture, and religion on patients' return to physical activity. As the global burden of musculoskeletal disease increases, it is important to characterize the impact of activity limitation on patients' lives in diverse settings and the potential for surgical intervention to ease the burden of chronic arthritis.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Derek S
authors.initials: DS
authors.lastname: Stenquist
authors.forename: Scott A
authors.initials: SA
authors.lastname: Elman
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
authors.forename: Laura M
authors.initials: LM
authors.lastname: Bogart
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Brownlee
authors.forename: Edward S
authors.initials: ES
authors.lastname: Sanchez
authors.forename: Adianez
authors.initials: A
authors.lastname: Santiago
authors.forename: Roya
authors.initials: R
authors.lastname: Ghazinouri
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000639:trends*; D001900:Boston / Q000208:ethnology; D015331:Cohort Studies; D004293:Dominican Republic / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000208:ethnology* / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods* / Q000523:psychology; D013997:Time Factors; D016138:Walking / Q000502:physiology / Q000523:psychology