Early Postoperative Rehabilitation Behavior After Total Joint Arthroplasty: A Theory-Informed Qualitative Study

Background: Early postoperative rehabilitation is important for recovery after total joint arthroplasty (TJA), but patients' engagement may be influenced by multiple psychological, cognitive, and social factors. This study explored the facilitators and barriers to early postoperative rehabilitation behavior using the Health Belief Model (HBM) and Social Cognitive Theory (SCT) as interpretive frameworks. Methods: A qualitative descriptive study was conducted with 18 hospitalized patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) and were interviewed on postoperative days 2-7. Interviews were conducted by an orthopedic clinical pharmacist and a postgraduate student in clinical pharmacy. Data were analyzed using thematic analysis and interpreted through the HBM and SCT frameworks. Results: Two overarching categories were identified: facilitators of rehabilitation behavior and barriers to rehabilitation behavior. Facilitators included positive health beliefs, such as perceived functional impairment and recognition of rehabilitation benefits; high self-efficacy and positive outcome expectations; social and environmental support from family members and healthcare professionals, together with positive observational learning; and clear rehabilitation goals with internal behavioral regulation. Barriers included strong perceived barriers, such as postoperative pain, psychological concerns, and other physical discomforts; low self-efficacy and negative outcome expectations; insufficient social support or concerns about lack of support after discharge; and difficulties in behavioral regulation, including pain avoidance and fatigue-related interference. Conclusion: Integrating HBM and SCT provides a complementary framework for understanding early postoperative rehabilitation behavior after TJA by linking health-related perceptions and perceived barriers with self-efficacy, outcome expectations, social and environmental influences, and behavioral regulation. The findings may inform theory-informed support strategies during the early in-hospital rehabilitation phase.