Heterogeneity in decision-making engagement among total knee arthroplasty patients in China: a cross-sectional study

Although total knee arthroplasty (TKA) is effective in relieving pain and restoring function in patients with advanced knee osteoarthritis, postoperative recovery remains suboptimal for many patients due to insufficient engagement in care and rehabilitation. Patient participation in decision-making is a key determinant of treatment adherence and outcomes; however, heterogeneity in decision-making engagement among patients undergoing TKA has not been well characterised. This study aimed to identify latent profiles of decision-making engagement among Chinese patients undergoing TKA and to examine factors associated with different engagement profiles.

A cross-sectional survey was conducted between May and September 2024 at a tertiary hospital in Shanghai, China. Patients undergoing TKA completed questionnaires assessing sociodemographic characteristics, disease-related information and decision-making engagement. Latent profile analysis was used to identify distinct decision-making engagement profiles. Univariate analyses and multinomial logistic regression were performed to explore factors associated with different engagement profiles.

This study was conducted in a tertiary hospital in Shanghai, China, and included adult patients undergoing TKA.

Decision-making engagement profiles among patients undergoing TKA and factors associated with different engagement profiles.

A total of 316 patients were included in the analysis. Three distinct decision-making engagement profiles were identified: low engagement (71/316, 22.5%), moderate engagement (144/316, 45.6%) and high engagement (101/316, 32.0%), with mean total engagement scores of 97.82, 111.75 and 136.42, respectively. Household income, education level, area of residence and preoperative use of walking aids differed significantly across engagement profiles. Multinomial logistic regression showed that lower patient-perceived shared decision-making scores (OR=0.940, 95% CI 0.919 to 0.963; p<0.001) and lower informed awareness of medical decision-making (OR=0.846, 95% CI 0.782 to 0.915; p<0.001) were associated with lower engagement profiles. In addition, active decision-making role preferences were less frequently observed among patients in the Moderate-Level Engagement-Weak Communication Ability profile than in the High-Level Engagement-Stable profile.

Distinct decision-making engagement profiles exist among Chinese patients undergoing TKA. Lower patient-perceived shared decision-making scores, lower awareness of medical decision-making and passive decision-making role preferences were associated with membership in less engaged decision-making profiles. Targeted interventions focusing on decision literacy and communication support may help enhance patient engagement in TKA care.