{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:57:42Z","timestamp":1781269062829,"version":"3.54.1"},"reference-count":32,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"the Nursing Association of Hebei Province, China.","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,28]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Total knee arthroplasty (TKA) is a common and effective procedure for end-stage knee osteoarthritis, yet patients frequently encounter a complex and dynamic symptom experience during the initial period that can significantly impact their rehabilitation and quality of life. This study aimed to explore the symptom experience of patients within 6 weeks after TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A longitudinal qualitative study using semi-structured interviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This study was conducted in an orthopaedics department of a tertiary general hospital in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Interviews were conducted with 16 patients at 3\u20135\u2009days postoperatively, 14 patients at 2 weeks postoperatively and 10 patients at 6 weeks postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were collected between July 2024 and November 2024. A purposive sampling method was used to recruit patients. Data were analysed using directed content analysis, with data collection and analysis performed concurrently.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three themes and nine subthemes were identified: (1) symptom perception, including perceived complexity of symptoms, self-identity conflict due to functional limitations, activation of negative emotions and psychological adaptation and interaction and amplification effects among symptoms; (2) symptom evaluation, characterised by the dynamic cognitive reframing of symptom meaning, self-blame tendency and internalisation of responsibility and interference from social and medical information; (3) symptom coping, involving dynamic evolution of active coping strategies and self-efficacy reinforcement, temporal characteristics of passive coping patterns and rehabilitation barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The symptom experience of patients who had TKA is complex and dynamic. Healthcare providers should implement tailored interventions based on patients\u2019 symptom experiences at different stages to facilitate symptom management, alleviate distress and negative emotions and improve quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110241","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:05:29Z","timestamp":1781265929000},"page":"e110241","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Symptom experience of patients after total knee arthroplasty in China: a longitudinal qualitative study"],"prefix":"10.1136","volume":"16","author":[{"given":"Ke","family":"Wu","sequence":"first","affiliation":[{"name":"The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyu","family":"Zhu","sequence":"additional","affiliation":[{"name":"The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Liu","sequence":"additional","affiliation":[{"name":"The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Li","sequence":"additional","affiliation":[{"name":"The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Congcong","family":"Li","sequence":"additional","affiliation":[{"name":"The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Chen","sequence":"additional","affiliation":[{"name":"The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huixian","family":"Sun","sequence":"additional","affiliation":[{"name":"The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2361-6557","authenticated-orcid":false,"given":"Huiling","family":"Liu","sequence":"additional","affiliation":[{"name":"The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"2026061205051775000_16.6.e110241.1","unstructured":"Expert Group of Chinese Guidelines for Diagnosis and Treatment of Osteoarthritis, The Pain Disease Branch of the Chinese Aging Well Association, Huang D , et al . Chinese guidelines for diagnosis and treatment of osteoarthritis (2024 edition). 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