Orthopaedic Surgeons' Attitude Toward Physical Activity for People after Total Hip or Knee replacement: Northern vs Southern European country

Abstract

Background: Regular physical activity (PA) is a key factor of lifestyle behavior enhancing general health and fitness, especially in people after total hip or knee replacement (THR and TKR). Orthopedic surgeons can play a primary role in advocating the benefits of an active lifestyle. Aim of the study was 1) to assess the attitude of orthopaedic surgeons towards PA for people after THR/TKR and 2) to compare the attitude between a Northern European (the Netherlands) and a Southern European (Italy) country and analyze which factors influence the attitude towards PA. Methods: A cross-cultural study. An (online) survey was distributed among orthopaedic surgeons in Italy and the Netherlands. Exploratory factor analysis was employed to determine the underlying factor structure of the questionnaire. Chi-square and Mann-Whitney tests were used to compare surgeons’ and clinics’ characteristics, and questionnaires’ factors score, respectively. A linear regression analysis was conducted to assess which surgeon characteristics influence attitude towards PA. Results: A cohort of 159 surgeons (103 Italians and 56 Dutch) were analyzed. The median score of overall orthopaedic surgeons’ attitude towards PA was 57 (out of 72). Dutch surgeons showed a more positive attitude compared to Italian surgeons (p < 0.01). Main difference was found in the “Physical activity concern” factor, where Italian surgeons showed more concern about the negative effects of PA on the survival of the prosthesis. The regression analyses showed that “Country” and “Type of clinic” were associated with the surgeons’ attitude. Conclusions: Overall, the orthopaedic surgeons’ attitude towards PA for people with THR and TKR was positive. However, Dutch surgeons seem to be more positive compared to the Italian. The country of residence was the item that most influenced attitude. Further investigations are needed to untangle specific factors, such as cultural, socioeconomic, or contextual differences within the variable “country” that may influence orthopaedic surgeons' attitudes towards PA. Educational pathways of orthopaedic surgeons should involve the more recent knowledge about the benefits of PA and sport, since they have the potential to promote physically active lifestyle in people after THR and TKR and as such, enhancing the health of their patients.