Preferences for postoperative exercise in patients after total hip or knee arthroplasty: a discrete choice experiment

Postoperative exercise is associated with important benefits for patients undergoing total hip or knee arthroplasty, yet adherence to prescribed exercise programs remains suboptimal. Understanding patient preferences is essential for designing patient-centered interventions. This study aimed to assess patient preferences for postoperative rehabilitation exercise programs and determine the relative importance of specific program attributes.

From March to July 2025, we conducted a cross-sectional survey using a discrete choice experiment (DCE) design at the Department of Joint Surgery, First Affiliated Hospital of the University of Science and Technology of China. A total of 295 patients who had undergone primary elective THA or TKA were included. The survey was administered from postoperative day 2 onwards, at which point participants had already commenced rehabilitation. Participants were asked to choose between hypothetical rehabilitation scenarios defined by five attributes: pain severity experienced during rehabilitation exercises, presence of a healthcare provider, exercise intensity, frequency, and duration. Conditional logit and mixed logit models were employed to estimate preference weights and investigate preference heterogeneity across subgroups.

Pain severity during rehabilitation exercises was identified as the most critical determinant of choice, with patients strongly preferring mild or moderate pain over severe pain (OR: 2.41, 95% CI: 1.76-3.07 and OR: 3.84, 95% CI: 2.88-4.79, respectively). This was followed by the presence of a healthcare provider (OR: 1.44, 95% CI: 1.24-1.63) and exercise intensity. Patients expressed a strong preference for rehabilitation programs characterized by mild-to-moderate pain, professional guidance, and moderate exercise intensity. Conversely, exercise frequency and duration had a relatively limited impact on decision-making. Subgroup analyses stratified by gender and age showed largely consistent preference patterns across populations, with variations in effect magnitude.

Patients prioritize safety-driven rehabilitation protocols that balance functional recovery with physical comfort, specifically favoring effective pain management and professional support. These findings provide empirical evidence to guide the development of patient-centered, precision-oriented rehabilitation pathways that may enhance long-term adherence and clinical outcomes.