Knowledge, attitudes, and practices toward postoperative rehabilitation among females with rotator cuff injury: a cross-sectional study

Abstract

Objective: Rotator cuff injuries are common shoulder disorders, particularly affecting middle-aged and older women, and postoperative rehabilitation plays a vital role in restoring function and preventing recurrence. To investigate the knowledge, attitudes, and practices (KAP) related to postoperative rehabilitation among female patients who had undergone rotator cuff repair surgery.

Design: A cross-sectional study.

Methods: This cross-sectional study was conducted between January and July 2024 at two orthopedic centers in Chengdu, China, using convenience sampling. Demographic data and KAP scores were collected using a validated self-administered questionnaire (Cronbach's α = 0.851). The primary outcome measures were knowledge, attitude, and practice scores, assessed using a validated KAP questionnaire. Data were analyzed using descriptive statistics, group comparisons via t-tests or ANOVA, Spearman correlation analysis, and structural equation modeling (SEM) to examine the relationships between knowledge, attitudes, and practices.

Results: A total of 499 female participants who met the inclusion criteria were enrolled with a response rate of 99.60%. Among the participants (mean age: 59.8 ± 7.2 years), the mean scores for knowledge, attitude, and practice were 14.59 ± 4.24, 35.17 ± 5.70, and 27.91 ± 4.71, respectively. Knowledge demonstrated positive correlations with practice (rs = 0.106, p = 0.018), while attitude showed strong correlation with practice (rs = 0.572, p < 0.001). SEM analysis showed that practice was directly influenced by knowledge (β = 0.084, 95% CI: 0.013-0.155, p = 0.021), attitude (β = 0.514, 95% CI: 0.441-0.587, p < 0.001), surgery (β = -0.170, 95% CI: -0.301 to -0.039, p = 0.011), training (β = -0.125, 95% CI: -0.207 to -0.044, p = 0.002), and therapy (β = -0.129, 95% CI: -0.212 to -0.046, p = 0.002). Additionally, income (β = 0.035, p = 0.010) had indirect effect on attitude. Knowledge (β = 0.067, p = 0.005), exercise (β = 0.097, p < 0.001), and therapy (β = -0.113, p < 0.001) had indirect effects on practice.

Conclusion: Females with rotator cuff injuries demonstrated adequate knowledge and positive attitudes but exhibited suboptimal practices towards postoperative rehabilitation. These findings suggest the need for targeted interventions to bridge the gap between knowledge and practice, with particular focus on enhancing positive attitudes, which were the strongest predictors of rehabilitation adherence. Healthcare providers should consider implementing comprehensive educational programs that address both knowledge transfer and behavioral change strategies to improve patient outcomes.

Keywords: Cross-sectional studies; Knowledge, attitudes, practice; Rehabilitation; Rotator cuff injuries; Rotator cuff repair.

Fig. 1

Mediation analysis. The blue squares represent the latent variables"Knowledge,""Attitude,"and"Practice."White rectangles denote observed variables, including demographic and contextual factors (e.g., income, education, exercise). Unidirectional arrows depict standardized path coefficients, representing the strength and direction of direct effects between variables, with positive values indicating positive associations and negative values indicating inverse relationships. Double-headed arrows represent covariances. Numbers on the arrows correspond to the standardized coefficients of these relationships, while circles (ε1, ε2, ε3) represent residual variances of the latent constructs, indicating unexplained variance. This model demonstrates the direct and indirect effects of observed variables on KAP domains and the interrelations among the constructs