title: Understanding why people do or do not engage in activities following total joint replacement: a longitudinal qualitative study.
abstract: OBJECTIVE
  Numerous studies report large and significant improvements in basic mobility and activities of daily living following total hip or knee replacement (TJR). Nevertheless, quantitative research has shown minimal increase in participation in activities that benefit overall health. This study explored why people do or do not engage in activities following hip or knee TJR.
  
  
  METHODS
  This was a longitudinal qualitative study. Sampling was guided by constructivist grounded theory and data collected using open-ended, semi-structured interviews. Participants were recruited using maximum variation sampling based on age, sex and joint replaced (hip or knee). Data were analysed using a constant comparative approach and coded for thematic patterns and relationships from which overarching themes were constructed.
  
  
  RESULTS
  Twenty-nine patients participated in interviews prior to, and 8 and 18 months post following TJR. A high degree of variability with regard to participants' return to activities was found and five emergent themes were identified that accounted for this variability. These themes highlight the importance of issues beyond medical factors alone, such as socio-cultural factors that partially determine participants' participation in activity following TJR.
  
  
  CONCLUSIONS
  Findings suggest that multi-faceted experiences impact participation in activity following TJR. These experiences include changes in identity and lifestyle that preclude a 'return to normal'. There is an urgent need for supports to increase people's activity post-TJR in order to facilitate enhancement of post-surgery levels of engagement. Approaches that take into consideration more personalized interventions may be critical to promoting healthy aging in people with TJR.
authors.affiliation: Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada. Electronic address: fiona.webster@utoronto.ca.
authors.forename: F
authors.initials: F
authors.lastname: Webster
authors.affiliation: Arthritis Program, Division of Orthopaedic Surgery, University Health Network, Institute of Health Policy, Management & Evaluation, University of Toronto, 399 Bathurst Street, EW1-449, Toronto, Ontario M5T 2S8, Canada. Electronic address: perrucci@uhnres.utoronto.ca.
authors.forename: A V
authors.initials: AV
authors.lastname: Perruccio
authors.affiliation: Division of Orthopaedics, Sunnybrook Health Sciences Centre and Division of Orthopaedics, Department of Surgery, University of Toronto, 2075 Bayview Avenue, MG 361, Toronto, Ontario M4N 3M5, Canada. Electronic address: richard.jenkinson@sunnybrook.ca.
authors.forename: R
authors.initials: R
authors.lastname: Jenkinson
authors.affiliation: Departments of Physical Therapy and Graduate Department of Rehabilitation Science, University of Toronto, 160-500 University Avenue, Toronto, Ontario M5G 1V7, Canada. Electronic address: susan.jaglal@utoronto.ca.
authors.forename: S
authors.initials: S
authors.lastname: Jaglal
authors.affiliation: Division of Orthopaedics, St. Michael's Hospital and Division of Orthopaedics, Department of Surgery, University of Toronto, 55 Queen Street East, Suite 800, Toronto, Ontario M5C 1R6, Canada. Electronic address: schemitsche@smh.ca.
authors.forename: E
authors.initials: E
authors.lastname: Schemitsch
authors.affiliation: Division of Orthopaedics, St. Michael's Hospital and Division of Orthopaedics, Department of Surgery, University of Toronto, 38 Shuter Street, 3rd Floor, Room 3005, Toronto, Ontario M5B 1A6, Canada. Electronic address: waddellj@smh.ca.
authors.forename: J P
authors.initials: JP
authors.lastname: Waddell
authors.affiliation: Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, 399 Bathurst Street, MP11-324, Toronto, Ontario M5T 2S8, Canada. Electronic address: viji.venkataramanan@uhnresearch.ca.
authors.forename: V
authors.initials: V
authors.lastname: Venkataramanan
authors.affiliation: Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, 399 Bathurst Street, MP11-326, Toronto, Ontario M5T 2S8, Canada. Electronic address: jessica.bytautas@uhnresearch.ca.
authors.forename: J
authors.initials: J
authors.lastname: Bytautas
authors.affiliation: Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Institute of Health Policy, Management and Evaluation, Departments of Physical Therapy and Graduate Department of Rehabilitation Science, University of Toronto, 399 Bathurst Street, MP11-322, Toronto, Ontario M5T 2S8, Canada. Electronic address: adavis@uhnresearch.ca.
authors.forename: A M
authors.initials: AM
authors.lastname: Davis
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000523:psychology / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000523:psychology / Q000534:rehabilitation*; D001294:Attitude to Health; D005239:Fear; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009864:Ontario; D015207:Osteoarthritis, Hip / Q000534:rehabilitation / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000534:rehabilitation / Q000601:surgery; D036301:Qualitative Research
keywords: Grounded theory; Osteoarthritis; Qualitative research; Total hip or knee replacement