{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:34:18Z","timestamp":1792758858299,"version":"4.5.0"},"reference-count":38,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T00:00:00Z","timestamp":1736726400000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,25]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Nearly 40\u2009000 Italian patients had their arthroplasty postponed between March and May 2020 (lockdown period) and experienced a period of several months without knowing when surgeries would resume. The hypothesis was that such conditions caused changes in perceived well-being and quality of life. The study aimed to explore the feelings, perceptions and concerns of orthopaedic patients in Italy during COVID-related arthroplasty rescheduling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>The study designed by an interdisciplinary research group, used a qualitative methodology based on thematic analysis of semi-structured interviews.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Interviews were conducted by phone from August to November 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>A purposive sample of orthopaedic patients (from North, Centre and South of Italy), whose elective arthroplasty was delayed due to the COVID-related healthcare measures, was selected. Patients who opted for further voluntary deferment were included. Participants were mainly recruited through orthopaedic surgeons.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We conducted and analysed 26 interviews (12 males and 14 females; age range 50\u201385 years). We identified six themes describing negative feelings, deterioration of quality of life, resources behind coping strategies associated with surgery postponement and lockdowns. A psychosocial phenomenon we called the \u2018lockdown paradox\u2019 was detected. It was induced by the general condition of isolation at home that made orthopaedic patients share restricted mobility with all the people in the country and, therefore, suffer less.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Arthroplasty suspension in the context of anti-COVID measures had implications on emotional well-being and perceived quality of life. Deterioration appeared mitigated by inner resources, favourable living conditions and, in some cases, by the psychosocial phenomenon, not detected in other studies, of the \u2018lockdown paradox\u2019 associated with mobility and autonomy restrictions shared by the whole community. Future studies are needed to investigate predictors of negative feelings and deterioration of quality of life in patients experiencing sudden major surgery delays.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2023-083598","type":"journal-article","created":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T02:55:15Z","timestamp":1736909715000},"page":"e083598","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Understanding patients\u2019 emotional well-being, perceptions and concerns during an unprecedented deferment of arthroplasty: an Italian qualitative study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2394-2394","authenticated-orcid":false,"given":"Iuliia","family":"Urakcheeva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Ciccarelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Tenti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Torre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virgilia","family":"Toccaceli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"key":"2025031814162290000_15.1.e083598.1","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2020.00790","article-title":"COVID-19 Pandemic and Lockdown Measures Impact on Mental Health Among the General Population in Italy","volume":"11","author":"Rossi","year":"2020","journal-title":"Front Psychiatry"},{"key":"2025031814162290000_15.1.e083598.2","unstructured":"World Health Organization . WHO coronavirus (covid-19) dashboard. Available: https:\/\/covid19.who.int\/more-resources [Accessed 16 Aug 2023]."},{"key":"2025031814162290000_15.1.e083598.3","unstructured":"Ciccarelli P , Urakcheeva I , Biondi A , et al . Annual report 2021 \u2013 addendum. 2021. Available: https:\/\/riap.iss.it\/riap\/it\/attivita\/report\/2023\/07\/10\/report-annuale-riap-2021-addendum-al-volume\/"},{"key":"2025031814162290000_15.1.e083598.4","unstructured":"Torre M , Urakcheeva I , Ciminello E , et al . Impatto dell\u2019emergenza covid-19 sui volumi di attivit\u00e0 della chirurgia protesica ortopedica in sette regioni italiane. versione del 17 marzo 2021. In: Rapporto ISS COVID-19 n. 7\/2021 Rev. Roma: Istituto Superiore di Sanit\u00e0, 2021: 3\u201344."},{"key":"2025031814162290000_15.1.e083598.5","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.20.00602","article-title":"SARS-CoV-2 Impact on Elective Orthopaedic Surgery: Implications for Post-Pandemic Recovery","volume":"102","author":"Jain","year":"2020","journal-title":"J Bone Joint Surg Am"},{"key":"2025031814162290000_15.1.e083598.6","first-page":"1440","article-title":"Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans","volume":"107","author":"Collaborative","year":"2020","journal-title":"Br J Surg"},{"key":"2025031814162290000_15.1.e083598.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-053194","article-title":"Experience of the COVID-19 pandemic as lived by patients with hip and knee osteoarthritis: an Italian qualitative study","volume":"11","author":"Battista","year":"2021","journal-title":"BMJ Open"},{"key":"2025031814162290000_15.1.e083598.8","doi-asserted-by":"crossref","unstructured":"Longhurst R . Interviews: In-Depth, Semi-Structured. Int Encycl Hum Geogr 2009;580\u20134. doi:10.1016\/b978-008044910-4.00458-2","DOI":"10.1016\/B978-008044910-4.00458-2"},{"key":"2025031814162290000_15.1.e083598.9","doi-asserted-by":"crossref","first-page":"87","DOI":"10.4103\/0976-0105.141942","article-title":"Qualitative research method-interviewing and observation","volume":"5","author":"Jamshed","year":"2014","journal-title":"J Basic Clin Pharm"},{"key":"2025031814162290000_15.1.e083598.10","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2025031814162290000_15.1.e083598.11","unstructured":"Boyatzis RE . Transforming Qualitative Information: Thematic Analysis and Code Development. Case Western Reserve University, USA: Sage Publications Inc, 1998:1\u2013184."},{"key":"2025031814162290000_15.1.e083598.12","doi-asserted-by":"crossref","unstructured":"Braun V , Clarke V . Thematic analysis. In: APA handbook of research methods in psychology, Vol. 2: Research designs: Quantitative, qualitative, neuropsychological, and biological. Washington, DC: American Psychological Association 2012:57-71,","DOI":"10.1037\/13620-004"},{"key":"2025031814162290000_15.1.e083598.13","doi-asserted-by":"publisher","DOI":"10.1111\/jan.13031"},{"key":"2025031814162290000_15.1.e083598.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12955-018-0935-6","article-title":"Cross-cultural adaptation and validation of the Italian version of the Hip disability and Osteoarthritis Outcome Score (HOOS)","volume":"16","author":"Torre","year":"2018","journal-title":"Health Qual Life Outcomes"},{"key":"2025031814162290000_15.1.e083598.15","doi-asserted-by":"publisher","DOI":"10.1177\/1525822X05279903"},{"key":"2025031814162290000_15.1.e083598.16","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-018-0594-7","article-title":"Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period","volume":"18","author":"Vasileiou","year":"2018","journal-title":"BMC Med Res Methodol"},{"key":"2025031814162290000_15.1.e083598.17","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281053"},{"key":"2025031814162290000_15.1.e083598.18","unstructured":"Lumivero . NVivo transcription. Available: https:\/\/help-nv.qsrinternational.com\/12\/win\/v12.1.112-d3ea61\/Content\/files\/nvivo-transcription.htm [Accessed 31 Jul 2023]."},{"key":"2025031814162290000_15.1.e083598.19","doi-asserted-by":"crossref","unstructured":"Nowell LS , Norris JM , White DE , et al . Thematic Analysis: Striving to Meet the Trustworthiness Criteria. Int J Qual Methods 2017;16. doi:10.1177\/1609406917733847","DOI":"10.1177\/1609406917733847"},{"key":"2025031814162290000_15.1.e083598.20","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2025031814162290000_15.1.e083598.21","doi-asserted-by":"crossref","first-page":"2435","DOI":"10.1007\/s00167-020-06104-3","article-title":"The negative impact of the COVID-19 lockdown on pain and physical function in patients with end-stage hip or knee osteoarthritis","volume":"28","author":"Endstrasser","year":"2020","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"2025031814162290000_15.1.e083598.22","doi-asserted-by":"crossref","first-page":"152","DOI":"10.5312\/wjo.v12.i3.152","article-title":"Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic","volume":"12","author":"Pietrzak","year":"2021","journal-title":"World J Orthop"},{"key":"2025031814162290000_15.1.e083598.23","doi-asserted-by":"crossref","first-page":"2379","DOI":"10.1007\/s00167-021-06529-4","article-title":"COVID-19-related cancellation of elective orthopaedic surgery caused increased pain and psychosocial distress levels","volume":"29","author":"Knebel","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"2025031814162290000_15.1.e083598.24","doi-asserted-by":"publisher","DOI":"10.1136\/jisakos-2020-000514"},{"key":"2025031814162290000_15.1.e083598.25","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000203477.19421.ed"},{"key":"2025031814162290000_15.1.e083598.26","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30460-8"},{"key":"2025031814162290000_15.1.e083598.27","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11420-020-09799-9","article-title":"Patient Perceptions of COVID-19-Related Surgical Delay: An Analysis of Patients Awaiting Total Hip and Knee Arthroplasty","volume":"16","author":"Wilson","year":"2020","journal-title":"HSS J"},{"key":"2025031814162290000_15.1.e083598.28","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1016\/j.arth.2020.04.052","article-title":"The Effect of the COVID-19 Pandemic on Electively Scheduled Hip and Knee Arthroplasty Patients in the United States","volume":"35","author":"Brown","year":"2020","journal-title":"J Arthroplasty"},{"key":"2025031814162290000_15.1.e083598.29","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1108\/JHOM-12-2019-0347","article-title":"Case management service quality and patient-centered care","volume":"ahead-of-print","author":"Perera","year":"2020","journal-title":"J Health Organ Manag"},{"key":"2025031814162290000_15.1.e083598.30","unstructured":"Fassari M . La sanit\u00e0 italiana sempre pi\u00f9 in affanno.prosegue l\u2019esodo delle cure da sud a nord. tempi di attesa peggiorati in met\u00e0 delle regioni e anche il numero delle prestazioni \u00e8 ancora distante dal pre-covid. Available: https:\/\/www.quotidianosanita.it\/studi-e-analisi\/articolo.php?articolo_id=108449 [Accessed 23 May 2018]."},{"key":"2025031814162290000_15.1.e083598.31","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/MLR.0000000000001503","article-title":"Elective Surgical Delays Due to COVID-19: The Patient Lived Experience","volume":"59","author":"Byrnes","year":"2021","journal-title":"Med Care"},{"key":"2025031814162290000_15.1.e083598.32","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.artd.2021.05.013","article-title":"Pain and Anxiety due to the COVID-19 Pandemic: A Survey of Patients With Delayed Elective Hip and Knee Arthroplasty","volume":"10","author":"Johnson","year":"2021","journal-title":"Arthroplast Today"},{"key":"2025031814162290000_15.1.e083598.33","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1302\/2633-1462.28.BJO-2021-0056.R1","article-title":"What can we learn from the experiences and expectations of patients on growing waiting lists for planned care in the COVID-19 pandemic?","volume":"2","author":"Kulkarni","year":"2021","journal-title":"Bone Jt Open"},{"key":"2025031814162290000_15.1.e083598.34","doi-asserted-by":"crossref","first-page":"e1329","DOI":"10.1016\/j.asmr.2021.06.002","article-title":"Female and Younger Orthopaedic Sport Medicine Patients Are More Negatively Affected by COVID-19-Related Health Care Closures","volume":"3","author":"Kopka","year":"2021","journal-title":"Arthrosc Sports Med Rehabil"},{"key":"2025031814162290000_15.1.e083598.35","doi-asserted-by":"crossref","DOI":"10.1186\/s13037-020-00235-9","article-title":"How to risk-stratify elective surgery during the COVID-19 pandemic?","volume":"14","author":"Stahel","year":"2020","journal-title":"Patient Saf Surg"},{"key":"2025031814162290000_15.1.e083598.36","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1136\/bmj.n339","article-title":"Growing backlog of planned surgery due to covid-19","volume":"372","author":"Carr","year":"2021","journal-title":"BMJ"},{"key":"2025031814162290000_15.1.e083598.37","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6939-6-5","article-title":"Top 10 health care ethics challenges facing the public: views of Toronto bioethicists","volume":"6","author":"Breslin","year":"2005","journal-title":"BMC Med Ethics"},{"key":"2025031814162290000_15.1.e083598.38","unstructured":"Ministero della Salute . Piano nazionale di ripresa e resilienza. cos\u2019\u00e8 la missione salute. Available: https:\/\/www.pnrr.salute.gov.it\/portale\/pnrrsalute\/dettaglioContenutiPNRRSalute.jsp?lingua=italiano&id=5833&area=PNRR-Salute&menu=missionesalute [Accessed 31 Jul 2023]."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-083598","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T21:21:56Z","timestamp":1742332916000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-083598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,14]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjopen-2023-083598"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-083598","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}