Original research| Volume 97, ISSUE 9, SUPPLEMENT , S218-S225, September 2016

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Association of Psychosocial Factors With Physical Activity and Function After Total Knee Replacement: An Exploratory Study



      To examine the association between self-efficacy, social support, and fear of movement with physical activity and function at baseline and after 12 weeks of physical therapy.


      Nonrandomized cohort study, repeated-measures design.


      Outpatient rehabilitation clinic within the general community.


      Adults (N=49) undergoing outpatient physical therapy for total knee replacement (TKR).


      Not applicable.

      Main Outcome Measures

      Self-efficacy for exercise (SEE), fear of movement, leisure-time physical activity (LTPA), 6-minute walk test (6MWT), and Knee Outcome Survey–Activities of Daily Living Scale (KOS-ADLS) were assessed at baseline and 12 weeks.


      Mean functional change scores significantly increased at 12 weeks for the 6MWT (95% confidence interval [CI], 42.3–106.2), KOS-ADLS (95% CI, 12.7–23.3), and LTPA (95% CI, 6.5–26.1). Self-efficacy and fear of movement were not significantly associated with function at baseline or 12 weeks. Participants with lower SEE had 6 fewer metabolic equivalents per week of improvement in LTPA than those with high self-efficacy (95% CI, −27.9 to 14.8), and those with high fear of movement had 26.1m less improvement in the 6MWT than those with low fear of movement (95% CI, −42.2 to 94.5). Most participants reported having no family or peer support for exercise.


      Physical therapy for TKR improves physical function and self-reported physical activity. High fear of movement and low SEE may be associated with less improvement in physical activity and function over time.


      List of abbreviations:

      BMI (body mass index), CI (confidence interval), KOS-ADLS (Knee Outcome Survey–Activities of Daily Living Scale), LTPA (leisure-time physical activity), OA (osteoarthritis), SEE (self-efficacy for exercise), 6MWT (6-minute walk test), TKR (total knee replacement)
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