Factors associated with postoperative physiological and psychological changes and rehabilitation exercise adherence...

Postoperative rehabilitation exercise adherence is critical for recovery after pediatric kidney transplantation, yet its associated psychosocial factors remain insufficiently characterized. This study aimed to examine postoperative psychological status and rehabilitation exercise adherence in pediatric kidney transplant recipients, identify distinct adherence patterns, and determine associated influencing factors to inform targeted intervention strategies.

A longitudinal study was conducted among 158 pediatric kidney transplant recipients (101 boys and 57 girls; mean age, 11.91 years; SD, 3.70) who underwent kidney transplantation between May 2008 and May 2024. Data were collected at 1, 2, 4, and 6 months postoperatively using the Rehabilitation Training Adherence Scale, the Pediatric Quality of Life Inventory 4.0 Transplant Module, and the Strengths and Difficulties Questionnaire. Latent class growth modeling and growth mixture modeling were used to identify adherence patterns. Group differences were examined using χ² tests and analyses of variance, and associated predictors were identified using multivariate logistic regression analyses.

Three distinct rehabilitation exercise adherence patterns were identified: a high adherence improvement-maintenance pattern (41.8%), a Moderate adherence with early improvement and slight decline pattern (29.7%), and a low adherence-stable pattern (28.5%). These patterns demonstrated substantial heterogeneity in postoperative rehabilitation exercise adherence among pediatric kidney transplant recipients.

Rehabilitation exercise adherence after pediatric kidney transplantation follows distinct longitudinal patterns and is influenced by clinical, demographic, and psychosocial factors. Early identification of recipients at risk of persistently poor adherence may facilitate targeted interventions to improve rehabilitation participation, quality of life, and psychological well-being, thereby promoting better postoperative recovery in this vulnerable population.