Home-based rehabilitation after hip or knee arthroplasty among rural older adults in China: a qualitative study

Abstract

Older adults in rural China may face difficulties accessing continuous and professional rehabilitation after hip or knee replacement. This study explored their experiences of home-based rehabilitation, focusing on barriers, coping strategies, and healthcare support gaps. A descriptive phenomenological study was conducted from January to March 2025 in the orthopaedic outpatient clinics of two tertiary hospitals in Nantong, China. Twenty-one rural adults aged 60 years or older who had undergone primary hip or knee replacement within the previous 6 months were recruited using maximum variation sampling. Face-to-face semi-structured interviews were conducted, and data were analysed using Colaizzi’s seven-step method. Three themes and nine subthemes were identified: (1) Challenges in Physical Rehabilitation: Pain, Functional Limitations, and Exercise Adaptations, including The Helplessness and Grassroots Wisdom in Pain Management, Adaptations and Misunderstandings of Prescribed Exercises, and Loss of Daily Function and Role Changes; (2) Limited Family and Community Support, including Emotional Debt in Familial Care, Limited Rehabilitation Capacity in Village Clinics, and Reluctance to Seek Neighbor Support; and (3) Negotiating Traditional Beliefs and Modern Rehabilitation, including Barriers to Formal Rehabilitation and Reliance on Traditional Remedies, Views on Aging and Prioritizing Family Needs, and Folk Beliefs and Medical Advice. These findings showed that participants’ rehabilitation experiences were shaped by physical limitations, discontinuity of family and community support, and the interaction between traditional beliefs and modern rehabilitation practices. Home-based rehabilitation after hip or knee replacement among rural older adults is shaped by physical, family, cultural, and service-related factors. Potential approaches include accessible rehabilitation materials, structured follow-up, caregiver support, and stronger coordination between tertiary hospitals and rural primary care services; however, their feasibility and effectiveness require further evaluation.