Abstract
Background
This study aimed to investigate the current status of knowledge, beliefs, and behaviors regarding the prevention of lower-extremity deep venous thrombosis (LDVT) in patients who underwent hip and knee replacement surgery and analyze the influencing factors to improve the behavioral management of LDVT after surgery.
Methods
A cross-sectional survey design was adopted. Convenience sampling was used to select 350 patients who underwent hip and knee replacement surgery and were hospitalized in a tertiary hospital in Anhui Province between November 2024 and April 2025. The survey was conducted using a self-made general information questionnaire and an LDVT knowledge and behavior survey scale. Through univariate and multiple linear regression analyses, the influencing factors of knowledge, attitude, and behavior levels of LDVT were identified.
Results
A total of 350 questionnaires were distributed, of which 312 valid questionnaires were collected, with an effective response rate of 89.14%. The total score of the knowledge, attitude, and behavior survey scale of patients with LDVT was 62.53 ± 10.00 points, and the scores for the knowledge, attitude, and behavior dimensions were 10.38 ± 4.88, 43.93 ± 6.70, and 8.21 ± 1.00 points, respectively. Univariate analysis showed that there were statistically significant differences in knowledge scores among patients with different ages, occupations, educational levels, places of residence, caregivers and surgical modality (F-values: 3.295, 4.994, 2.959, 4.001, 4.690, and 1.759, respectively; P < 0.05). The difference in patient belief scores among the caregivers was statistically significant (F = 5.353; P < 0.05). There were statistically significant differences in behavior scores among patients of various ages, educational levels, and caregivers (F-values: 2.554, 2.563, and 3.431, respectively; P < 0.05). Multiple linear regression analysis showed that age, occupation, place of residence and caregiver were the influencing factors on the level of knowledge, attitude, and behavior of patients with LDVT who underwent hip and knee replacement surgery.
Conclusions
The overall level of LDVT knowledge, beliefs, and actions in patients undergoing hip and knee replacement surgery was moderate, with a total score rate of 65.14%. Their behaviors showed high compliance and a positive attitude, but their knowledge levels were insufficient.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12891-025-09204-8.
Keywords: Hip and knee replacement surgery; Deep vein thrombosis; Knowledge, attitudes, and practices; Analysis of influencing factors; Care
Background
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are play an essential role in the clinical treatment of degenerative diseases such as osteoarthritis, rheumatoid arthritis, and traumatic arthritis [1]. With an increase in the aging population globally, the incidence rates of degenerative joint diseases and osteoporosis continue to rise, which directly increases the demand for joint replacement surgery. According to epidemiological surveys [2], more than one million THAs are performed globally each year, with an annual growth rate of 8–10% for TKA. Furthermore, 80% and 90% of THA and TKA surgeries, respectively, are performed in elderly individuals aged 65 years [3, 4]. Notably, the rate of joint replacement surgery in Europe ranks among the highest worldwide, with annual knee and hip replacement volumes reaching 2500 and 3000 cases/million [5], respectively, which are significantly higher than the average levels in other regions.
Although THA/TKA can effectively improve joint function and enhance patients’ quality of life, postoperative complication management remains a major clinical challenge. Among them, lower-extremity deep venous thrombosis (LDVT) is one of the most dangerous complications that can lead to pulmonary embolism which might be fatal [6]. Clinical studies have shown that the incidence of asymptomatic DVT after joint replacement surgery is as high as 30–80%, whereas the incidence of symptomatic DVT is 0.5–4% [7].
As a classic framework for health behavior research, the Knowledge, Attitudes, and Practices (KAP) concept can provide a theoretical basis for developing precise intervention strategies by systematically evaluating specific populations’ cognitive levels, beliefs, tendencies, and behavioral practices [8]. Although, existing research primarily focuses on orthopedic traumas, there is a significant lack of KAP research on the postoperative behavioral characteristics of patients undergoing joint replacement surgery. Therefore, this study aimed to investigate the current status of DVT prevention knowledge, attitudes, and behaviors among patients who underwent hip and knee replacement surgery and analyze the factors influencing of patients’ health behaviors to provide theoretical support for establishing personalized thrombosis prevention and control plans based on evidence-based medicine.
Methods
Survey participants
Convenience sampling was used to select patients who underwent hip and knee replacement surgery and were hospitalized in a tertiary hospital in Anhui Province between November 2024 and April 2025. The inclusion criteria of this study were as follows: ① Patients who underwent unilateral THA/TKA surgery for the first time; ② those with a postoperative hospitalization observation time of ≥ 24 h; ③ those with clear consciousness and Glasgow Coma Scale score of ≥ 14 and possessing basic communication skills; and ④ those who provided a signed informed consent and agreed to voluntarily participate in this study. The exclusion criteria of this study were as follows: ① Individuals with previously diagnosed venous thromboembolism or contraindications to anticoagulant therapy; ② those with severe mental disorders (ICD-10 diagnostic codes: F20–F39) or cognitive impairment (Mini-Mental State Examination score, ≤ 23); ③ those with a history of significant trauma (Injury Severity Score, ≥ 16) or who underwent major abdominal/pelvic surgery within the past 3 months; ④ those with severe organ dysfunction (Child–Pugh grade C, stage IV–V chronic kidney disease, and New York Heart Association grade III–IV); and ⑤ those with active malignant tumors or immune system diseases (such as human immunovirus infection or systemic lupus erythematosus). According to the sample size formula [9], N=
, where z is considered at a 95% confidence level of 1.96. A previous study [10] found that the knowledge, belief, and practice score for preventing DVT in the lower limbs of patients who underwent orthopedic surgery was 78.49% (P = 78.49% and d = 0.05). Based on this, the sample size was calculated to be 260. Considering that 20% of the questionnaires were invalid, the final sample size was 312 participants. This study was approved by the Hospital Ethics Review Committee (2025-044-01); all participants provided informed consent. This study was performed in accordance with the guidelines of the Declaration of Helsinki (2024).
Investigation tools
General information survey form
Through a literature review and expert consultation, the research team independently compiled a list and created a survey form that included sex, diagnosis, surgical name, educational level, occupation, marital status, and primary caregiver status.
Knowledge, attitude, and practice survey scale for LDVT
The KAP scale was designed by You Weifang [11] and consists of 23 items. It is divided into three subscales: the LDVT Knowledge (9 items), Belief (12 items), and Behavior Scales (2 items). All subscales are scored using a Likert 5-point scoring method and are divided into fully agree, partially agree, uncertain, disagree, and completely disagree, with scores ranging from 1 to 5. The reverse items are scored in reverse, with maximum scores of 26, 60, and 10 points for each subscale, respectively. The total score of the questionnaire is 14–96 points, with higher scores indicating a higher confidence level in taking preventive measures against DVT during orthopedic surgery. The score is calculated as the average score divided by the total score and multiplied by 100%. A scoring rate of less than 60% is considered low level, 60%–79% is considered moderate, and greater than 80% is considered high level [12]. The total Cronbach’s alpha coefficient of the scale was 0.88, the Guttman fold-off coefficient was 0.78, and the construct validity ranged from 0.8 to 0.9. According to reliability and validity testing, the total Cronbach’s alpha coefficient of the scale in this study was 0.906 and the structural validity ranged from 0.824 to 0.902.
Data collection and quality control methods
Before the survey, two researchers received standardized training on the main concepts of the survey tools and the use of instructional language. Data were collected through an electronic questionnaire platform. Informed consent was obtained from patients or their families before the start of the study, and detailed explanations of the research purpose, significance, and precautions were explained. The survey participants completed and submitted the questionnaire anonymously, with each IP address allowed to be filled out only once to avoid duplicate submissions. For patients who could not complete the questionnaire after surgery, their family members or the researcher completed the survey on behalf of the patient. After completing the survey, two researchers evaluated the responses. Questionnaires with the same options or answering times of less than 200 s were excluded. A total of 350 questionnaires were distributed, of which 312 valid questionnaires were collected, with an effective response rate of 89.14%.
Statistical analysis
The collected data were imported into an Excel spreadsheet, and SPSS 26.0 (IBM; Armonk, New York)statistical software was used for data analysis. Count data are expressed as frequencies and percentages, and measurement data that conformed to a normal distribution are expressed as means and standard deviations, whereas those that did not conform to a normal distribution are expressed as medians and quartiles. An independent sample t-test was used to compare two data groups that satisfied the requirements of homogeneity of variance and normal distribution in single-factor analysis, whereas the analysis of variance was used for multiple group comparisons. The Mann–Whitney U test was used to compare two datasets with skewed distributions, whereas the Kruskal–Wallis test (H test) was used for multiple group comparisons. Multiple linear regression was used to analyze the factors influencing patients’ knowledge, attitude, and behavior toward LDVT following hip and knee replacement surgery. The test level was set to α = 0.05, and statistical significance was set to a P value of < 0.05.
Results
Demographic characteristics of the participants
We distributed 350 questionnaires, of which we excluded 38 with the same options or a response time of less than 200 s. A total of 312 valid questionnaires were collected, with a response rate of 89.14%. Among the surveyed participants, there were 116 males and 196 females aged between 24 and 93 years, with an average age of 64.98 ± 11.47 years. The predominant age group was patients aged between 66 and 75 years (n = 108, 34.6%). The educational level of the majority of participants was up to primary school or below (n = 200, 64.1%). The most common occupation was farming (n = 183, 58.7%), and most patients were primarily cared for by their children (n = 168, 53.8%). The surveyed participants were primarily from rural areas (n = 246, 78.8%). The most commonly used surgical method was TKA (n = 169, 54.2%) (Table 1).
Table 1.
General information of the patient
| Project | Number of people | Percentage (%) | |
|---|---|---|---|
| Sex | Male | 116 | 37.2 |
| Female | 196 | 62.8 | |
| Age, years | ≤ 45 | 13 | 4.20 |
| 46–55 | 41 | 13.1 | |
| 56–65 | 100 | 32.1 | |
| 66–75 | 108 | 34.6 | |
| 76–85 | 39 | 12.5 | |
| ≥ 86 | 11 | 3.50 | |
| Degree of education | Elementary school and below | 200 | 64.1 |
| Junior high school | 75 | 24.0 | |
| High school or vocational school | 24 | 7.70 | |
| Junior college | 4 | 1.30 | |
| Bachelor’s degree or above | 9 | 2.90 | |
| Career | Farmer | 183 | 58.7 |
| Worker | 17 | 5.40 | |
| Civil servant | 3 | 1.00 | |
| Merchant | 2 | 0.60 | |
| Medical worker | 3 | 1.00 | |
| Retired | 48 | 15.4 | |
| Other | 56 | 17.9 | |
| Marital status | Married | 307 | 98.4 |
| Unmarried | 3 | 1.00 | |
| Other | 2 | 0.60 | |
| Place of residence | City | 66 | 21.2 |
| Rural area | 246 | 78.8 | |
| Primary Caregiver | Children | 168 | 53.8 |
| Spouse | 104 | 33.3 | |
| Father and mother | 5 | 1.60 | |
| Take turns taking care of the patient | 14 | 4.50 | |
| Caregiver | 21 | 6.70 | |
| Surgical modality | THA | 143 | 45.8 |
| TKA | 169 | 54.2 |
Current status of the knowledge, attitude, and practice of LDVT after hip and knee replacement surgery
The survey results showed that 312 patients who underwent hip and knee replacement surgery had a total score of 32–94 points on the questionnaire on knowledge, attitude, and behavior toward LDVT, with an average score of 62.53 ± 10.00 points and a scoring rate of 65.14%. The average scores for knowledge, belief, and behavior were 10.38 ± 4.88, 43.93 ± 6.70, and 8.21 ± 1.00 points, respectively, and the corresponding scoring rates were 39.92%, 73.23%, and 82.14%, respectively. The overall level of LDVT knowledge, belief, and behavior among patients who underwent hip and knee replacement surgery was moderate, with a low level of expertise that was significantly below the low threshold of 60%, a moderate level of belief, and a high level of behavior, respectively (Table 2).
Table 2.
Current status of LDVT knowledge, attitude, and practice in patients undergoing hip and knee replacement surgery
| Dimension | minimum value | Maximum value | Average score (
|
Scoring rate (%) |
|---|---|---|---|---|
| Knowledge score | 1 | 25 | 10.38 ± 4.88 | 39.92 |
| Belief score | 21 | 60 | 43.93 ± 6.70 | 73.23 |
| Behavioral score | 2 | 10 | 8.21 ± 1.00 | 82.14 |
| Total score | 32 | 94 | 62.53 ± 10.00 | 65.14 |
Score rate average score/total score × 100%, with a scoring rate of < 60% indicating a low level, scoring rate from 60%–79% indicating a medium level, and a scoring rate > 80% indicating a high level
LDVT Lower-extremity deep venous thrombosis
Analysis of the factors influencing LDVT knowledge, attitude, and behavior after hip and knee replacement surgery
Single factor analysis
In this study, we considered the general information of patients as an independent variable and the knowledge, beliefs, and behavior scores as dependent variables. The knowledge score showed a statistically significant difference (P < 0.05) in the scores of LDVT prevention based on age, education level, occupation, place of residence, primary caregiver status and surgical modality. The belief score showed a statistically significant difference according to the primary caregiver status (P < 0.05). The behavior score showed statistically significant differences according to age, education level, and primary caregiver status (P < 0.05; Table 3).
Table 3.
General information of patients who underwent hip and knee replacement surgery, and univariate analysis results
| Project | Knowledge Scale | Belief Scale | Behavior Scale | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Score | T/F value | P value | Score | T/F value | P value | score | T/F value | P value | |
| Sex | |||||||||
| Male | 10.42 ± 4.68 | 1.167 | 0.281 | 44.60 ± 6.45 | 0.300 | 0.584 | 8.35 ± 0.88 | 2.192 | 0.140 |
| Female | 10.35 ± 5.01 | 43.54 ± 6.82 | 8.13 ± 1.05 | ||||||
| Age, years | |||||||||
| ≤ 45 | 11.15 ± 7.48 | 3.295 | 0.006 | 41.84 ± 9.29 | 1.765 | 0.120 | 7.69 ± 1.37 | 2.554 | 0.028 |
| 46–55 | 10.09 ± 4.55 | 44.82 ± 6.82 | 8.19 ± 1.07 | ||||||
| 56–65 | 9.39 ± 3.79 | 42.96 ± 7.22 | 8.02 ± 1.01 | ||||||
| 66–75 | 10.64 ± 5.02 | 43.97 ± 6.27 | 8.35 ± 0.94 | ||||||
| 76–85 | 10.87 ± 5.36 | 45.05 ± 5.39 | 8.48 ± 0.85 | ||||||
| ≥ 86 | 15.18 ± 5.81 | 47.72 ± 4.36 | 8.36 ± 0.80 | ||||||
| Degree of education | |||||||||
| Elementary school and below | 9.96 ± 4.73 | 2.959 | 0.020* | 44.10 ± 6.63 | 0.767 | 0.548* | 8.31 ± 0.87 | 2.563 | 0.038* |
| Junior high school | 10.32 ± 4.60 | 43.20 ± 6.56 | 7.92 ± 1.17 | ||||||
| High school or vocational school | 12.62 ± 5.39 | 45.25 ± 5.24 | 8.41 ± 0.82 | ||||||
| Junior college | 11.00 ± 2.16 | 40.50 ± 11.35 | 8.00 ± 1.63 | ||||||
| Bachelor’s degree or above | 14.00 ± 7.54 | 44.55 ± 10.36 | 8.00 ± 1.73 | ||||||
| Career | |||||||||
| Farmer | 10.01 ± 4.54 | 4.994 | <0.001* | 44.31 ± 6.17 | 1.971 | 0.069* | 8.30 ± 0.86 | 1.903 | 0.080* |
| Worker | 8.82 ± 3.53 | 42.94 ± 7.42 | 8.23 ± 0.66 | ||||||
| Civil servant | 8.66 ± 1.15 | 45.33 ± 4.61 | 8.00 ± 0.01 | ||||||
| Merchant | 14.50 ± 7.77 | 47.50 ± 0.70 | 9.00 ± 1.41 | ||||||
| Medical worker | 23.33 ± 2.08 | 53.33 ± 4.72 | 9.33 ± 1.15 | ||||||
| Retired | 11.43 ± 4.69 | 44.12 ± 5.69 | 8.06 ± 0.88 | ||||||
| Other | 10.39 ± 5.55 | 42.14 ± 8.53 | 7.96 ± 1.45 | ||||||
| Marital status | |||||||||
| Married | 10.35 ± 4.89 | 0.719 | 0.488* | 44.00 ± 6.64 | 2.418 | 0.091* | 8.21 ± 0.97 | 1.784 | 0.170* |
| Unmarried | 10.66 ± 6.02 | 35.66 ± 10.21 | 7.33 ± 3.05 | ||||||
| Other | 14.50 ± 2.12 | 46.00 ± 2.28 | 9.00 ± 1.41 | ||||||
| Place of residence | |||||||||
| City | 12.46 ± 5.52 | 4.001 | 0.049 | 43.50 ± 7.81 | −0.599 | 0.133 | 8.07 ± 1.36 | −1.270 | 0.333 |
| Rural area | 9.82 ± 4.55 | 44.05 ± 6.38 | 8.25 ± 0.88 | ||||||
| Primary Caregiver | |||||||||
| Children | 10.69 ± 4.98 | 4.690 | 0.001* | 44.23 ± 5.90 | 5.353 | <0.001* | 8.32 ± 0.88 | 3.431 | 0.009* |
| Spouse | 9.25 ± 3.98 | 42.36 ± 7.19 | 8.00 ± 1.02 | ||||||
| Father and mother | 6.80 ± 3.56 | 39.20 ± 10.73 | 7.20 ± 1.78 | ||||||
| Take turns taking care of the patient | 13.57 ± 4.78 | 48.71 ± 3.22 | 8.35 ± 0.74 | ||||||
| Caregiver | 12.23 ± 6.64 | 47.28 ± 7.94 | 8.47 ± 1.40 | ||||||
| Surgical modality | |||||||||
| THA | 10.90 ± 5.56 | 1.759 | 0.010 | 44.72 ± 6.68 | 1.902 | 0.965 | 8.26 ± 0.92 | 0.826 | 0.621 |
| TKA | 9.93 ± 4.19 | 43.27 ± 6.65 | 8.17 ± 1.06 | ||||||
THA Total hip arthroplasty, TKA Total knee arthroplasty
“*” uses Fisher’s exact probability method. Surgical modality
Multiple linear regression analysis
A multiple linear regression analysis was conducted using age, education level, occupation, place of residence, primary caregiver and surgical modality as independent variables, which showed statistical significance in the univariate analysis, and the knowledge, belief, and behavior scores as dependent variables. The assignment of independent variables is listed in Table 4. Regression analysis showed that age, occupation and place of residence influenced the knowledge scores, which could explain 14.4% of the total variation. The primary caregiver was the influencing factor of the behavior score, which explained 13.9% of the total variation. (Tables 4 and 5).
Table 4.
Assignment of independent variables in the multiple linear regression analysis
| Independent variable | Assignment criteria |
|---|---|
| Age | Inout original Value |
| Career | Set dummy variables (with “other” as a control) |
| Degree of education | Set dummy variables (using “junior high school” as a control) |
| Place of residence | Set dummy variables (using “city” as a reference) |
| Primary caregiver | Set dummy variables (using “caregiver” as a control) |
| Surgical modality | Set dummy variable (using “THA” as a control) |
THA Total hip arthroplasty
Table 5.
Multiple linear regression analysis of patients who developed LDVT after hip and knee replacement surgery
| Variable | Partial regression coefficient | Standard error | Standardized regression coefficient | t-value | P value |
|---|---|---|---|---|---|
| knowledge | |||||
| Constant term | 7.454 | 1.922 | - | 3.878 | <0.001 |
| Age | 0.073 | 0.030 | 0.171 | 2.458 | 0.015 |
| Career | |||||
| Medical worker | 13.277 | 3.576 | 0.265 | 3.713 | <0.001 |
| Place of residence | |||||
| Rural area | −2.581 | 0.907 | −0.216 | −2.848 | 0.005 |
| Behavior | |||||
| Constant term | 8.300 | 0.469 | - | 17.699 | <0.001 |
| Primary caregiver | |||||
| Spouse | −0.479 | 0.240 | −0.226 | −1.977 | 0.047 |
LDVTLower-extremity deep vein thrombosis
For the knowledge score, we adjusted R2=0.144, F = 4.278, and P < 0.01; and, for the behavior score, we adjusted R2=0.139, F = 2.398, and P = 0.012. Only the results of the variable analysis with statistical significance are displayed in the table
Correlation analysis of the knowledge, beliefs, and practices of LDVT after hip and knee replacement surgery
Pearson’s correlation analysis was conducted on patients’ LDVT knowledge, belief, and behavior scores. The results showed that knowledge and belief, belief and behavior, and knowledge and behavior were significantly and positively correlated (r = 0.309, 0.513, and 0.318, respectively), and the correlation was high (p < 0.01; Table 6
Table 6.
Correlation analysis of LDVT knowledge, beliefs, and behaviors after hip and knee replacement surgery
| Project | LDVT knowledge | LDVT belief | LDVT behavior |
|---|---|---|---|
| LDVT knowledge | 1 | 0.309** | 0.318** |
| LDVT belief | 0.309** | 1 | 0.513** |
| LDVT behavior | 0.318** | 0.513** | 1 |
Note: * * indicates P < 0.01. LDVT, lower-extremity deep vein thrombosis
Discussion
Current status of KAP in preventing LDVT in patients undergoing hip and knee replacement surgery
This study showed that the total score of knowledge, belief, and attitudes for hip and knee replacement in preventing LDVT was 62.53 ± 10.00 points (65.14%), which considered moderate. An analysis of various dimensions showed that the behavioral dimension had the best compliance (82.14%), the attitude dimension showed a positive performance (73.23%), and the knowledge dimension had significantly insufficient mastery (39.92%). This indicates that, although patients tend end to follow preventive practices and show positive attitudes significant deficiencies remain in their understanding of LDVT pathologiology, risk factors, and warning symptoms (Fig. 1)
Fig. 1.
Scoring rate
Knowledge level of LDVT in patients undergoing hip and knee replacement needs to be improved
We found that the LDVT prevention knowledge mastery rate was only 39.92%, significantly lower than the median threshold (60%). This feature is highly consistent with the findings of Duan Xiuwei et al. [13]. About half of the participants were aware of symptoms such as leg pain and swelling, and one-third were aware of skin changes and visible veins. Nursing staff emphasis favored postoperative functional exercise and procedural prevention measures, neglecting foundational education on LDVT concept, manifestations, and risk factors [14]. At the same time, some nurses in the department have insufficient mastery of LDVT core knowledge (such as the Virchow triad), resulting in fragmented health education, hindering patients’ development of a systematic cognitive framework. The survey found that 64.1% of patients had a primary school education or below (Table 1), comprehension of professional terminology was challenging, educational content must be tailored to patient literacy levels, with focused efforts to convey core disease knowledge effectively to rural and low-educated populations. Low recognition of key LDVT attributes (such as high incidence of asymptomatic thrombosis) and potential long-term sequelae (such as pulmonary embolism risk), weakening motivation for active learning. Therefore, nursing training should be enhanced to strengthen nurses’ LDVT knowledge and educational skills, utilizing case studies and updated evidence-based guidelines.
Patients undergoing hip and knee replacement had a relatively positive attitude toward LDVT
The results showed that the belief dimension score rate was 73.23%, which is at a moderate level. Consistent with the results of Xu et al. [15]. Patients who undergo lower limb surgery may be more value postoperative functional recovery, thus paying more attention to preventing complications such as DVT to ensure rehabilitation quality. Research has shown that a positive attitude toward coping is significantly correlated with advanced age and perceptions of DVT severity and importiance of early prevention [16, 17]. Therefore, it is recommended to strengthen doctor–patient communication and personalized psychological support, use motivational interviews to consolidate positive beliefs of patients(especially for spouse caregivers), improveing patients’ behavioral compliance and reducing the risk of postoperative LDVT.
High compliance in LDVT behavior among patients undergoing hip and knee replacement surgery
We found that the behavioral dimension score rate was 82.14%, significantly higher than the knowledge dimension (39.92%), indicating a relatively high level. This is consistent with the findings of Li Ling et al. [18]. Patients’ compliance with preventive measures mainly stems from their trust in medical professional authority rather than their understanding of disease pathophysiology. During hospitalization improve patients’ short-term behavioral compliance through external reinforcement. Long-term behavior maintenance requires knowledge internalization and self-efficacy. But may mask deficiencies in their autonomous health management abilities and suggest a potential risk of behavioral decline after discharge [19]. Therefore, the following measures are recommended to establish a continuous intervention system through multidisciplinary team collaboration: home follow-ups, remote monitoring, and digital education. Motivational interviews and the teach-back method should be adopted to enhance patients’ cognitive behavioral integration toward LDVT prevention.
Factors influencing the knowledge, attitude, and practice of preventing LDVT in patients undergoing hip and knee replacement surgery
The analysis showed that age, occupation, and place of residence affected LDVT prevention knowledge. Patients aged ≥ 65 years had higher knowledge scores, which is consistent with the research findings of a previous study [10]. This may be attributed to the elderly being more proactive in acquiring health knowledge. Attention should be paid to patients ≤ 45 years of age (lowest mean score: 7.69 ± 1.37), who are susceptible to cognitive deprivation. It is recommended that for patients ≤ 45 years of age, Virtual reality technology should be applied to simulate sudden symptoms of pulmonary embolism, improve perceptual susceptibility, and break through optimism bias [20]. In this study, the knowledge score of rural patients was significantly lower than that of urban patients, possibly due to low education level, lack of medical resources and inadequate health education in rural areas. The knowledge score of medical workers was the highest (23.33 ± 2.08), which comfirm professional training and clinical experience promoting knowledge integration. According to the score of the primary caregiver’s influence on behavior, patients cared for by their spouses had lower levels of behavior, which may be attributed to a general lack of professional training, as well as excessive protection that restricts patients’ activities. Therefore, health education programs for caregivers(especially spouses) should be developed to enhance their ability to support LDVT prevention. The behavior score of the caregiver care group was the highest, as they had received standardized training and reduced the interference from emotional factors.
Correlation analysis of prevention knowledge, beliefs, and behaviors among patients undergoing hip and knee replacement surgery
Pearson correlation analysis showed that a statistically highly significant positive association between LDVT knowledge, beliefs and preventive behaviors in post arthroplasty patients(P < 0.01). Among them: knowledge and beliefs, and knowledge and behavior showed a moderately weak correlation(r = 0.309, r = 0.318); beliefs and behavior showed a moderately strong correlation(r = 0.513), suggesting that beliefs may be a key target for driving preventive behaviors. This is consistent with the findings of Zhang Hewan [21]. The reasons for this phenomenon are although the lack of knowledge limited the comprehensive understanding, the special nature of the surgical site and the gudiance provided by the medical staff made the patients realize the importance of prevention, therefore, their belief levels were moderate; Simultaneously, with the support of medical staff, families, and hospital environments, patients can overcome the limitations of insufficient knowledge and demonstrate high behavioral compliance. Patients’ trust in medical staff after surgery further enhances their behavioral compliance. The primary prevention, physical or drug intervention, and effective nursing interventions can reduce the risk of LDVT, In addition, patient education is critical to improving health outcomes [22–24]. Finally, this study suggests that future interventions should be layered and enhance knowledge education regarding LDVT for rural, elderly, and other high-risk groups.
Study limitations
In this study, we used convenience sampling method to include only patients from a tertiary hospital in Anhui Province, with narrow geographical coverage. Moreover, this study only evaluated the level of knowledge, belief and action at a certain point in time, and could not track the dynamic changes and long-term compliance of patients’ knowledge, beliefs and behaviors. While the statistical significance of the medical staff subgroup isnotable, its clinical relevance remains debatable due to the small sample size (n = 3) may have influenced the outcomes. In the future, multicenter stratified sampling will be used to expand the sample coverage of geographical and cultural groups, and include patients in the postoperative home rehabilitation stage to evaluate the impact of environmental support on behavior maintenance.
Conclusion
This study revealed that the knowledge, belief, and practice level of LDVT prevention in patients after hip and knee arthroplasty were generally moderate, and the behavioral compliance was high but the knowledge reserve was significantly insufficient, and age, occupation and residence were the main influencing factors. The results of this study provide an important reference for clinical nursing: it is necessary to strengthen the knowledge education for low-educated, rural and young patients, and develop family-centered continuous intervention strategies. Hierarchical education and multimodal health communication can improve patients’ self-management ability in the future, thereby reducing the risk of postoperative LDVT and improving long-term prognosis.
Supplementary Information
Acknowledgements
We thank all the people who offer help for this study. Co-first authors: Xinyan Yu, Chengchen Wang, Yuyan Wu ang Yijia Wang contributed equally to this paper.
Abbreviations
- LDVT
Lower-extremity deep venous thrombosis
- THA
Total hip arthroplasty
- TKA
Total knee arthroplasty
- KAP
Knowledge, Attitudes, and Practices
Authors’ contributions
Xinyan Yu conceived the study idea, revised the manuscript, and provided financial support. XY, CW, YW and YW collected the data and wrote the initial draft. YW, WC, HX and BH contributed to the data collection and analysis. All authors approved the final draft of the manuscript. All authors are accountable for all aspects of the work in ensuring related questions’ accuracy or integrity. Any parts of the work are appropriately investigated and resolved. XY is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding
This study was supported by 2024 Anhui Institute of Translational Medicine Nursing Joint Special Project (Key Project), Project No.: 2024zhyx-HL-A05.
Data availability
Data is provided within the supplementary information files.
Declarations
Ethics approval and consent to participate
In this study, all methods were performed in accordance with the relevant guidelines and regulations. Our study had been verified and approved by the ethics committee of The Affiliated Hospital of Anhui Medical University(NO.2025-44-01), and all the included patiens had signed the written informed consents. This study complies with the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Xinyan Yu, Chengchen Wang, Yuyan Wu and Yijia Wang are co-first authors of this article.
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Data Availability Statement
Data is provided within the supplementary information files.