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Major discrepancies in recommendations regarding long-term activity restrictions following knee replacement: a survey among Swedish physiotherapists.

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Τίτλος: Major discrepancies in recommendations regarding long-term activity restrictions following knee replacement: a survey among Swedish physiotherapists.
Συγγραφείς: Gustafsson K; Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden. kristin.gustafsson@liu.se.; Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden. kristin.gustafsson@liu.se., Jönsson T; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.; Department of Orthopaedics, Skåne University Hospital, Lund, Sweden., Ljung M; Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.; Department of Orthopaedics, Rehabilitation Unit, Vrinnevi County Hospital, Norrköping, Sweden., Ståhl C; Department of Orthopaedics, Ängelholm Hospital, Ängelholm, Sweden., Östlind E; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.; Dalby Healthcare Centre, Dalby, Sweden.
Πηγή: BMC musculoskeletal disorders [BMC Musculoskelet Disord] 2026 Jul 04; Vol. 27 (1). Date of Electronic Publication: 2026 Jul 04.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: BioMed Central Country of Publication: England NLM ID: 100968565 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2474 (Electronic) Linking ISSN: 14712474 NLM ISO Abbreviation: BMC Musculoskelet Disord Subsets: MEDLINE
Imprint Name(s): Original Publication: London : BioMed Central, [2000-
Ιατρικοί όροι (MeSH): Arthroplasty, Replacement, Knee*/rehabilitation , Physical Therapists*/standards, Sweden/epidemiology ; Physical Therapy Modalities/standards ; Practice Guidelines as Topic/standards ; Humans ; Surveys and Questionnaires ; Female ; Male ; Time Factors
Περίληψη: Background: There is currently limited evidence to support specific recommendations for long-term activity restrictions after knee replacement surgery. Consequently, physiotherapists´ guidance may vary, which could influence patients´ confidence, adherence to rehabilitation, overall recovery outcomes, and even contribute to the development of fear of movement. However, it is unclear to what extent such variation exists. This study aimed to explore and describe the recommendations given by physiotherapists regarding long-term activity restrictions following knee replacement.
Methods: An online survey was distributed to physiotherapy units in Swedish orthopedic specialist clinics and primary healthcare centers. For this study, responses to the question "Do you usually recommend any long-term restrictions? (For example, running, skiing, squatting, kneeling?) Please elaborate!" were analyzed using quantitative content analysis to systematically identify and quantify patterns.
Results: Of 233 physiotherapists who responded to the specific survey question, 66% (n = 151) reported that they provided specific recommendations regarding long-term activity restrictions following knee replacement. The most commonly non-recommended activities were running and jumping, followed by kneeling and squatting. However, the extent of these restrictions varied considerably, ranging from complete avoidance of certain activities to conditional approval based on intensity and frequency. Among those recommending long-term restrictions, 16% (n = 24) stated that the primary reason was to avoid compromising implant survival.
Conclusions: Considerable variability exists in physiotherapists´ recommendations regarding long-term activity restriction following knee replacement across both orthopedic clinics and primary healthcare settings. This variation reflects the current lack of evidence-based guidelines and highlights the need for consensus to support more consistent and confident communication with patients about long-term physical activity.
(© 2026. The Author(s).)
Competing Interests: Declarations. Ethics approval and consent to participate: The methods in this study were performed in accordance with the WMA declaration of Helsinki [33]. All participants provided written informed consent to participate by answering the survey. Since no personal data was collected in this study, ethical approval was deemed unnecessary according to national regulations stated by the Swedish Ethical review authority [34]. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
References: Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745–59. https://doi.org/10.1016/S0140-6736(19)30417-9 . (PMID: 10.1016/S0140-6736(19)30417-931034380)
Conley B, Bunzli S, Bullen J, et al. Core recommendations for osteoarthritis care: a systematic review of clinical practice guidelines. Arthritis Care Res (Hoboken). 2023;75(9):1897–907. https://doi.org/10.1002/acr.25101 . (PMID: 10.1002/acr.251013676254510952362)
Moseng T, Vliet Vlieland TPM, Battista S, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis. 2024;83(6):730–40. https://doi.org/10.1136/ard-2023-225041 . (PMID: 10.1136/ard-2023-2250413821204011103326)
Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–89. https://doi.org/10.1016/j.joca.2019.06.011 . (PMID: 10.1016/j.joca.2019.06.01131278997)
Price AJ, Alvand A, Troelsen A, et al. Knee replacement. Lancet. 2018;392(10158):1672–82. https://doi.org/10.1016/S0140-6736(18)32344-4 . (PMID: 10.1016/S0140-6736(18)32344-430496082)
W-Dahl A, Kärrholm J, Rogmark C, et al. The Swedish Arthroplasty Register Annual Report 2025. https://registercentrum.blob.core.windows.net/slr/r/Ledprotesregistret-A-rsrapport-2025_1-2-8P7uE2KKW.pdf . Accessed Jan 8 2026.
Jette DU, Hunter SJ, Burkett L, et al. Physical therapist management of total knee arthroplasty. Phys Ther. 2020;100(9):1603–31. https://doi.org/10.1093/ptj/pzaa099 . (PMID: 10.1093/ptj/pzaa099325424037462050)
National Institute for Health and Care Excellence (NICE Guideline N. Joint replacement (primary): hip, knee and shoulder 2020. updated 19 December 2024. https://www.nice.org.uk/guidance/ng157 . Accessed Jan 8 2026.
Krysa JA, Ho C, O’Connell P, et al. Clinical practice recommendations for prehabilitation and post-operative rehabilitation for arthroplasty: A scoping review. Musculoskeletal Care. 2022;20(3):503–15. https://doi.org/10.1002/msc.1621 . (PMID: 10.1002/msc.162135165992)
Cronstrom A, Jonsson T, Limback G, et al. Stairway to heaven via the highway to hell: a qualitative study on patients’ experience of knee joint replacement surgery. J Orthop Surg Res. 2025;20(1):570. https://doi.org/10.1186/s13018-025-05989-5 . (PMID: 10.1186/s13018-025-05989-54047429112139267)
Bunzli S, O’Brien P, Klem N, et al. Misconceived expectations: patient reflections on the total knee replacement journey. Musculoskelet Care. 2020;18(4):415–24. https://doi.org/10.1002/msc.1475 . (PMID: 10.1002/msc.1475)
Singla R, Niederer D, Franz A, et al. The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression. Arch Orthop Trauma Surg. 2023;143(8):5303–22. https://doi.org/10.1007/s00402-022-04750-5 . (PMID: 10.1007/s00402-022-04750-53663749110374784)
Healy WL, Sharma S, Schwartz B, et al. Athletic activity after total joint arthroplasty. J Bone Joint Surg Am. 2008;90(10):2245–52. https://doi.org/10.2106/JBJS.H.00274 . (PMID: 10.2106/JBJS.H.0027418829924)
Thaler M, Khosravi I, Putzer D, et al. Twenty-one sports activities are recommended by the European Knee Associates (EKA) six months after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2021;29(3):694–709. https://doi.org/10.1007/s00167-020-06400-y . (PMID: 10.1007/s00167-020-06400-y33404817)
Mooiweer Y, Stevens M, van den Akker-Scheek I, et al. Being active with a total hip or knee prosthesis: a systematic review into physical activity and sports recommendations and interventions to improve physical activity behavior. Eur Rev Aging Phys Act. 2022;19(1):7. https://doi.org/10.1186/s11556-022-00285-1 . (PMID: 10.1186/s11556-022-00285-1352271918903715)
Crawford DA, Adams JB, Hobbs GR, et al. Higher activity level following total knee arthroplasty is not deleterious to mid-term implant survivorship. J Arthroplasty. 2020;35(1):116–20. https://doi.org/10.1016/j.arth.2019.07.044 . (PMID: 10.1016/j.arth.2019.07.04431471181)
Kornuijt A, Kuijer P, van Drumpt RA, et al. A high physical activity level after total knee arthroplasty does not increase the risk of revision surgery during the first twelve years: A systematic review with meta-analysis and GRADE. Knee. 2022;39:168–84. https://doi.org/10.1016/j.knee.2022.08.004 . (PMID: 10.1016/j.knee.2022.08.00436208528)
Teoli A, Ippersiel P, Bussieres A, et al. Understanding the impact of physical activity level and sports participation on implant integrity and failure in patients following unicompartmental and total knee arthroplasty: a scoping review. Osteoarthr Cartil Open. 2024;6(3):100498. https://doi.org/10.1016/j.ocarto.2024.100498 . (PMID: 10.1016/j.ocarto.2024.1004983905511811269905)
Aujla RS, Esler CN. Total knee arthroplasty for osteoarthritis in patients less than fifty-five years of age: a systematic review. J Arthroplasty. 2017;32(8):2598-603 e1. https://doi.org/10.1016/j.arth.2017.02.069 . (PMID: 10.1016/j.arth.2017.02.06928456563)
Lester D, Barber C, Sowers CB, et al. Return to sport post-knee arthroplasty: an umbrella review for consensus guidelines. Bone Jt Open. 2022;3(3):245–51. https://doi.org/10.1302/2633-1462.33.BJO-2021-0187.R2 . (PMID: 10.1302/2633-1462.33.BJO-2021-0187.R2353005328965786)
Straat AC, Smit DJM, Coenen P, et al. Large variability in recommendations for return to daily life activities after knee arthroplasty among Dutch hospitals and clinics: a cross-sectional study. Acta Orthop. 2022;93:568–73. https://doi.org/10.2340/17453674.2022.3168 . (PMID: 10.2340/17453674.2022.3168357271089210998)
Sharma A, Minh Duc NT, Luu Lam Thang T, et al. A consensus-based checklist for reporting of survey studies (CROSS). J Gen Intern Med. 2021;36(10):3179–87. https://doi.org/10.1007/s11606-021-06737-1 . (PMID: 10.1007/s11606-021-06737-1338860278481359)
Socialstyrelsen. About the Swedish healthcare system 2020. Updated 1 Sep 2020. https://www.socialstyrelsen.se/en/about-us/healthcare-for-visitors-to-sweden/about-the-swedish-healthcare-system/ . Accessed Jan 8 2026.
Swedish Association of Local Authorities and Regions. National system for knowledge-driven management within Swedish healthcare 2025 [updated 7 Oct 2025. https://kunskapsstyrningvard.se/kunskapsstyrningvard/omkunskapsstyrning/nationalsystemforknowledgedrivenmanagementwithinswedishhealthcare.56857.html . Accessed Jan 8 2026.
Staff Pages Lund University. Sunet Survey - a survey tool 2026. updated 8 Mar 2026.  https://www.staff.lu.se/research-and-education/education-support/study-administration/study-administration-systems/sunet-survey-survey-tool . Accessed April 13 2026.
Ostlind E, Ljung M, Stahl C, et al. Primary care rehabilitation after Knee Replacement - a cross sectional study. Arch Physiother. 2025;15:184–91. https://doi.org/10.33393/aop.2025.3405 . (PMID: 10.33393/aop.2025.34054061249712224693)
W-Dahl A, Kärrholm J, Rogmark C, et al. Årsrapport 2024 - Svenska Ledprotesregistret 2024. https://registercentrum.blob.core.windows.net/slr/r/-rsrapport-2024-Svenska-Ledprotesregistret-Ze531aeCZ.pdf . Accessed Jan 8 2026.
Krippendorff K. Content analysis: an introduction to its methodology. SAGE Publications, Inc; 2019.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12. https://doi.org/10.1016/j.nedt.2003.10.001 . (PMID: 10.1016/j.nedt.2003.10.00114769454)
Straat AC, Kuijer PPF, Maarleveld JM, et al. Variation and Slower-Than-Recommended Recovery of Daily Life Activities Following Knee Arthroplasty With a Personalized eHealth Program: Results of the ACTIVE Trial Intervention Cohort. J Arthroplasty. 2025. https://doi.org/10.1016/j.arth.2025.11.031 .
DeFrance MJ, Scuderi GR. Are 20% of patients actually dissatisfied following total knee arthroplasty? A systematic review of the literature. J Arthroplasty. 2023;38(3):594–9. https://doi.org/10.1016/j.arth.2022.10.011 . (PMID: 10.1016/j.arth.2022.10.01136252743)
Du X, Shao Y, Xue J, et al. Prevalence and influencing factors of kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2025;20(1):332. https://doi.org/10.1186/s13018-025-05752-w . (PMID: 10.1186/s13018-025-05752-w4017017911959722)
World Medical Association Declaration of Helsinki. ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4. https://doi.org/10.1001/jama.2013.281053 . (PMID: 10.1001/jama.2013.281053)
Swedish Ethical Review Authority. Guide to the ethical review of research on humans: Swedish Ethical Review Authority; 2024. https://etikprovningsmyndigheten.se/wp-content/uploads/2024/05/Guide-to-the-ethical-review_webb.pdf . Accessed March 2 2026.
Contributed Indexing: Keywords: Knee Replacement; Physical activity; Physiotherapy; Recommendations
Entry Date(s): Date Created: 20260703 Date Completed: 20260708 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13339875
DOI: 10.1186/s12891-026-10142-2
PMID: 42399861
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1471-2474
DOI:10.1186/s12891-026-10142-2