Background: Osteoarthritis (OA) is a highly prevalent chronic joint disease worldwide causing pain, disability, and loss of function. It is typically seen mostly in the elderly as a result of wear and tear and progressive loss of articular cartilage. Among the joints affected by OA, the knee joint is most commonly affected [1, 2]. The treatment of knee OA begins with conservative treatment and progresses to surgical treatment options when conservative treatment fails. Functional exercise following TKA is considered a crucial process to achieve optimal postoperative outcomes (8). The American Physical Therapy Association (APTA) recommends initiating functional exercise interventions within 24 hours after surgery in patients undergoing total knee arthroplasty (TKA) and emphasizes the importance of postoperative exercise [3, 4]. Despite the significant impact of exercise on post-TKA recovery, evidence suggests that poor adherence to exercise is common among post-TKA patients, limiting the effectiveness of recovery and potentially leading to complications such as increased pain and muscle weakness.

Objectives: The aim of this study was to determine the factors affecting home exercise program adherence after total knee arthroplasty (TKA) and to investigate their relationship with adherence.

Methods: The study included 70 participants with a mean age of 64.20±7.63 years who underwent TKA surgery for osteoarthritis (OA). Pain was assessed using visual analog scale (VAS), mental health was assessed by Mini Mental State Examination, comorbidity was assessed by Modified Charlson Comorbidity Index (MCCI), physical functionality was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quality of life was assessed by Short Form 36 (SF 36), Knee range of motion was assessed by goniometric measurement, depression level by Beck Depression Inventory (BDI), kinesiophobia by Tampa Kinesiophobia Scale (TKS), fatigue severity by Fatigue Severity Scale (FSS), functional muscle strength by Five Times Sit and Stand Test (5TSST) and adherence to home exercise program by Exercise Adherence Rating Scale (EARS). Spearman’s correlation analysis was used to determine the relationship between demographic variables, the scales and tests used in terms of EARS scores and to evaluate the correlation coefficient and significance levels. Multiple linear regression analysis was performed to find statistically significant independent variables affecting the EARS score. The results were presented as regression coefficients and their significance, overall significance of the model and “R ² ” value.

Results: In the regression analysis conducted with statistically significant variables determined by correlation analysis, the stepwise variable elimination method was used, and the final model included FSS, postoperative VAS, TKS, and having TKA surgery on the contralateral knee. According to this model, each 1 point increase in FSS, PO VAS and TKS score causes a decrease of 2.24, 1.25 and 0.2 points, respectively, in the EARS Total score. FSS has a explanatory power of 39.2%, post operative VAS has 9.9%, TKS has 3.1%, and having TKA surgery on the contralateral knee has 2%, and the total of 4 variables explains 54.2% of EARS Total score. As a result of the F test (F=21.42), the model as whole was found to be significant at significance level of p<0.001.

Conclusion: It was concluded that postoperative fatigue, kinesiophobia, postoperative pain factors, and having TKA of the contralateral knee explained 54.2% of the variance associated with adherence to the home exercise program. In the light of our findings, it is necessary to manage fatigue, pain and kinesiophobia to improve adherence to home exercise program after TKA.

REFERENCES: [1] Umehara, T., & Tanaka, R. (2018). Effective exercise intervention period for improving body function or activity in patients with knee osteoarthritis undergoing total knee arthroplasty: a systematic review and meta-analysis. Brazilian journal of physical therapy , 22 (4), 265-275.

[2] Bakaa, N., Chen, L. H., Carlesso, L., Richardson, J., & Macedo, L. (2021). Reporting of post-operative rehabilitation interventions for Total knee arthroplasty: a scoping review. BMC musculoskeletal disorders , 22 (1), 602.

[3] Pozzi, F., Snyder-Mackler, L., & Zeni, J. (2013). Physical exercise after knee arthroplasty: a systematic review of controlled trials. European journal of physical and rehabilitation medicine , 49 (6), 877.

[4] Bakaa, N., Chen, L. H., Carlesso, L., Richardson, J., Shanthanna, H., & Macedo, L. (2022). Understanding barriers and facilitators of exercise adherence after total-knee arthroplasty. Disability and Rehabilitation , 44 (21), 6348-6355.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.