{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:28:21Z","timestamp":1787239701874,"version":"build-2736575974"},"reference-count":49,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Shanghai Municipal Health Commission Clinical Research project","award":["202240143"],"award-info":[{"award-number":["202240143"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,2]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Although total knee arthroplasty (TKA) is effective in relieving pain and restoring function in patients with advanced knee osteoarthritis, postoperative recovery remains suboptimal for many patients due to insufficient engagement in care and rehabilitation. Patient participation in decision-making is a key determinant of treatment adherence and outcomes; however, heterogeneity in decision-making engagement among patients undergoing TKA has not been well characterised. This study aimed to identify latent profiles of decision-making engagement among Chinese patients undergoing TKA and to examine factors associated with different engagement profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted between May and September 2024 at a tertiary hospital in Shanghai, China. Patients undergoing TKA completed questionnaires assessing sociodemographic characteristics, disease-related information and decision-making engagement. Latent profile analysis was used to identify distinct decision-making engagement profiles. Univariate analyses and multinomial logistic regression were performed to explore factors associated with different engagement profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>This study was conducted in a tertiary hospital in Shanghai, China, and included adult patients undergoing TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome<\/jats:title>\n                    <jats:p>Decision-making engagement profiles among patients undergoing TKA and factors associated with different engagement profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 316 patients were included in the analysis. Three distinct decision-making engagement profiles were identified: low engagement (71\/316, 22.5%), moderate engagement (144\/316, 45.6%) and high engagement (101\/316, 32.0%), with mean total engagement scores of 97.82, 111.75 and 136.42, respectively. Household income, education level, area of residence and preoperative use of walking aids differed significantly across engagement profiles. Multinomial logistic regression showed that lower patient-perceived shared decision-making scores (OR=0.940, 95%\u2009CI 0.919 to 0.963; p&lt;0.001) and lower informed awareness of medical decision-making (OR=0.846, 95%\u2009CI 0.782 to 0.915; p&lt;0.001) were associated with lower engagement profiles. In addition, active decision-making role preferences were less frequently observed among patients in the Moderate-Level Engagement\u2013Weak Communication Ability profile than in the High-Level Engagement\u2013Stable profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Distinct decision-making engagement profiles exist among Chinese patients undergoing TKA. Lower patient-perceived shared decision-making scores, lower awareness of medical decision-making and passive decision-making role preferences were associated with membership in less engaged decision-making profiles. Targeted interventions focusing on decision literacy and communication support may help enhance patient engagement in TKA care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-118285","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:45:29Z","timestamp":1787237129000},"page":"e118285","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Heterogeneity in decision-making engagement among total knee arthroplasty patients in China: a cross-sectional study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5604-3410","authenticated-orcid":false,"given":"Huijuan","family":"Qian","sequence":"first","affiliation":[{"name":"School of Nursing, Fudan University, Shanghai, China"},{"name":"Nursing Department, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3901-4800","authenticated-orcid":false,"given":"Yi","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Nursing, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihui","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongyu","family":"Yang","sequence":"additional","affiliation":[{"name":"Rehabilitation Department, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengyan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qunfeng","family":"Lu","sequence":"additional","affiliation":[{"name":"Nursing Department, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3473-8412","authenticated-orcid":false,"given":"Tingting","family":"Cai","sequence":"additional","affiliation":[{"name":"School of Nursing, Fudan University, Shanghai, China"},{"name":"School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8480-2569","authenticated-orcid":false,"given":"Changrong","family":"Yuan","sequence":"additional","affiliation":[{"name":"School of Nursing, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"2026082007452364000_16.8.e118285.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60752-6"},{"key":"2026082007452364000_16.8.e118285.2","doi-asserted-by":"publisher","DOI":"10.1590\/S0042-96862003000900007"},{"key":"2026082007452364000_16.8.e118285.3","first-page":"205","article-title":"Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I","volume":"2","author":"Heidari","year":"2011","journal-title":"Caspian J Intern Med"},{"key":"2026082007452364000_16.8.e118285.4","doi-asserted-by":"crossref","unstructured":"Feng B , Zhu W , Bian Y-Y , et al . n.d. China artificial joint annual data report. Chin Med J 134:752\u20133. doi:10.1097\/CM9.0000000000001196","DOI":"10.1097\/CM9.0000000000001196"},{"key":"2026082007452364000_16.8.e118285.5","doi-asserted-by":"crossref","DOI":"10.1186\/s42836-023-00175-6","article-title":"Epidemiology of primary and revision total knee arthroplasty: analysis of demographics, comorbidities and outcomes from the national inpatient sample","volume":"5","author":"Nham","year":"2023","journal-title":"Arthroplasty"},{"key":"2026082007452364000_16.8.e118285.6","first-page":"12","article-title":"Early follow-up results of total knee arthroplasty based on intelligent follow-up system","volume":"61","author":"Zhao","year":"2023","journal-title":"Chin J Surg"},{"key":"2026082007452364000_16.8.e118285.7","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.00679"},{"key":"2026082007452364000_16.8.e118285.8","doi-asserted-by":"crossref","unstructured":"Bryan S , Goldsmith LJ , Davis JC , et al . Revisiting patient satisfaction following total knee arthroplasty: a longitudinal observational study. BMC Musculoskelet Disord 2018;19. doi:10.1186\/s12891-018-2340-z","DOI":"10.1186\/s12891-018-2340-z"},{"key":"2026082007452364000_16.8.e118285.9","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.jcot.2018.08.008","article-title":"Patient expectations and satisfaction in orthopaedic surgery: A review of the literature","volume":"10","author":"Swarup","year":"2019","journal-title":"J Clin Orthop Trauma"},{"key":"2026082007452364000_16.8.e118285.10","first-page":"721","article-title":"Study on the relationship between illness perception and home-based rehabilitation adherence in elderly patients with knee arthroplasty","volume":"21","author":"Liu","year":"2021","journal-title":"J Nurs Admin (Chinese)"},{"key":"2026082007452364000_16.8.e118285.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-021-04847-9","article-title":"Comparing ERAS-outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both","volume":"22","author":"Hardy","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"key":"2026082007452364000_16.8.e118285.12","unstructured":"World Health Organization . WHO global strategy on people - centred and integrated health services: interim report. World Health Organization; 2015. Available: https:\/\/iris.who.int\/handle\/10665\/155002 [Accessed 16 Mar 2024]."},{"key":"2026082007452364000_16.8.e118285.13","article-title":"The many faces of patient engagement","volume":"4","author":"Gallivan","year":"2012","journal-title":"J Particip Med"},{"key":"2026082007452364000_16.8.e118285.14","doi-asserted-by":"publisher","DOI":"10.1111\/hex.12380"},{"key":"2026082007452364000_16.8.e118285.15","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-029693","article-title":"Patient engagement in the development of best practices for transitions from hospital to home: a scoping review","volume":"9","author":"Zhao","year":"2019","journal-title":"BMJ Open"},{"key":"2026082007452364000_16.8.e118285.16","unstructured":"Epstein R , Street R . Patient-centered care for the 21st century: Physicians\u2019 roles, health systems and patients\u2019 preferences. Philadelphia: ABIM Foundation, 2008."},{"key":"2026082007452364000_16.8.e118285.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39246.581169.80"},{"key":"2026082007452364000_16.8.e118285.18","first-page":"80","article-title":"Building the business case for patient-centered care","volume":"62","author":"Charmel","year":"2008","journal-title":"Healthc Financ Manage"},{"key":"2026082007452364000_16.8.e118285.19","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s40271-023-00649-4","article-title":"Role Preferences in Medical Decision Making: Relevance and Implications for Health Preference Research","volume":"17","author":"van Til","year":"2024","journal-title":"Patient"},{"key":"2026082007452364000_16.8.e118285.20","doi-asserted-by":"publisher","DOI":"10.1097\/JAC.0b013e318249e0fd"},{"key":"2026082007452364000_16.8.e118285.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2004.00269.x"},{"key":"2026082007452364000_16.8.e118285.22","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1007\/s12178-020-09638-8","article-title":"Using Patient Engagement Platforms in the Postoperative Management of Patients","volume":"13","author":"Campbell","year":"2020","journal-title":"Curr Rev Musculoskelet Med"},{"key":"2026082007452364000_16.8.e118285.23","doi-asserted-by":"publisher","DOI":"10.1080\/10810730490504233"},{"key":"2026082007452364000_16.8.e118285.24","doi-asserted-by":"crossref","unstructured":"Collins LM , Lanza ST . Latent class and latent transition analysis: With applications in the social, behavioral, and health sciences. New York: John Wiley & Sons, 2009.","DOI":"10.1002\/9780470567333"},{"key":"2026082007452364000_16.8.e118285.25","first-page":"783","article-title":"The potential value of person-centred statistical methods in ageing research","volume":"48","author":"Mangoni","year":"2019","journal-title":"Age Ageing"},{"key":"2026082007452364000_16.8.e118285.26","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.3724\/SP.J.1042.2020.01056","article-title":"Potential profile analysis in the field of organizational behavior","volume":"28","author":"Yin","year":"2020","journal-title":"Adv Psychol Sci"},{"key":"2026082007452364000_16.8.e118285.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-024-07744-z","article-title":"Heterogeneity of social participation in patients three months after total knee arthroplasty: a latent profile analysis","volume":"25","author":"Qu","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"key":"2026082007452364000_16.8.e118285.28","unstructured":"Liu Q . Research on the composition and status quo of patients\u2019 participation ability in chinese context [Master\u2019s thesis]. Changsha, Hunan Central South University, 2012"},{"key":"2026082007452364000_16.8.e118285.29","unstructured":"Xiao L , Peng MF , Liu YW , et al . Effect of participation competence on perceived shared decision making among cancer patients. J Nurs 2022;42\u20135."},{"key":"2026082007452364000_16.8.e118285.30","first-page":"21","article-title":"The Control Preferences Scale","volume":"29","author":"Degner","year":"1997","journal-title":"Can J Nurs Res"},{"key":"2026082007452364000_16.8.e118285.31","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90110-9"},{"key":"2026082007452364000_16.8.e118285.32","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.lungcan.2016.02.009","article-title":"Patients\u2019 preferred and perceived roles in making decisions about adjuvant chemotherapy for non-small-cell lung cancer","volume":"95","author":"Moth","year":"2016","journal-title":"Lung Cancer"},{"key":"2026082007452364000_16.8.e118285.33","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540420081039"},{"key":"2026082007452364000_16.8.e118285.34","unstructured":"Xiaolin X . The patients satisfaction with participation in medical decision-making scale: Development, reliability, and validity. Central South University, 2010."},{"key":"2026082007452364000_16.8.e118285.35","first-page":"688","article-title":"Preferred roles in treatment decision making among patients with cancer: a pooled analysis of studies using the Control Preferences Scale","volume":"16","author":"Singh","year":"2010","journal-title":"Am J Manag Care"},{"key":"2026082007452364000_16.8.e118285.36","first-page":"823","article-title":"Reliability and validity for Chinese version of the 9 item Shared Decision-Making Questionnaire Making","volume":"44","author":"Bihual","year":"2019","journal-title":"J Cent South Univ (Med Sci)"},{"key":"2026082007452364000_16.8.e118285.37","doi-asserted-by":"crossref","unstructured":"Wang J , Wang X . Structural equation modeling: Applications using mplus. 2nd edn. New York: John Wiley, 2020.","DOI":"10.1002\/9781119422730"},{"key":"2026082007452364000_16.8.e118285.38","doi-asserted-by":"publisher","DOI":"10.1080\/10705510709336735"},{"key":"2026082007452364000_16.8.e118285.39","doi-asserted-by":"crossref","DOI":"10.1177\/23743735211036525","article-title":"Patient Engagement Approaches in Total Joint Arthroplasty: A Review of Two Decades","volume":"8","author":"Alokozai","year":"2021","journal-title":"J Patient Exp"},{"key":"2026082007452364000_16.8.e118285.40","article-title":"Can digital engagement improve outcomes for total joint replacements?","volume":"8","author":"Milliren","year":"2022","journal-title":"Digit Health"},{"key":"2026082007452364000_16.8.e118285.41","doi-asserted-by":"crossref","first-page":"3108","DOI":"10.1016\/j.arth.2021.04.022","article-title":"Quantifying Patient Engagement in Total Joint Arthroplasty Using Digital Application-Based Technology","volume":"36","author":"Knapp","year":"2021","journal-title":"J Arthroplasty"},{"key":"2026082007452364000_16.8.e118285.42","unstructured":"Silow-Carroll S , Alteras T , Stepnick L . Patient-centered care for underserved populations: Ddefinition and best practices. Washington, DC: Economic and Social Research Institute, 2006."},{"key":"2026082007452364000_16.8.e118285.43","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/2052-1847-5-25","article-title":"Obesity, knee osteoarthritis and knee arthroplasty: a review","volume":"5","author":"Salih","year":"2013","journal-title":"BMC Sports Sci Med Rehabil"},{"key":"2026082007452364000_16.8.e118285.44","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1903768"},{"key":"2026082007452364000_16.8.e118285.45","doi-asserted-by":"crossref","first-page":"102869","DOI":"10.1016\/j.ejon.2025.102869","article-title":"Predictors of shared decision-making in patients with recurrent and metastatic nasopharyngeal carcinoma: An observational structural equation modeling approach","volume":"76","author":"Wu","year":"2025","journal-title":"Eur J Oncol Nurs"},{"key":"2026082007452364000_16.8.e118285.46","first-page":"5353","article-title":"Who decides? Shared decision-making among colorectal cancer surgery patients in China","volume":"28","author":"Zhai","year":"2020","journal-title":"Support Care Cancer"},{"key":"2026082007452364000_16.8.e118285.47","doi-asserted-by":"crossref","DOI":"10.1111\/ijcp.14286","article-title":"How common are Chinese patients with multimorbidity involved in decision-making and having a treatment plan? A cross-sectional study","volume":"75","author":"Lee","year":"2021","journal-title":"Int J Clin Pract"},{"key":"2026082007452364000_16.8.e118285.48","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-023-03968-1","article-title":"Is shared decision-making a determinant of polypharmacy in older patients with chronic disease? A cross-sectional study in Hubei Province, China","volume":"23","author":"Zong","year":"2023","journal-title":"BMC Geriatr"},{"key":"2026082007452364000_16.8.e118285.49","doi-asserted-by":"crossref","unstructured":"Zhou P , Rosenberg MW . \u201cOld friend and powerful cadre\u201d: Doctor-patient relationships and multi-dimensional therapeutic landscapes in China\u2019s primary hospitals. Health Place 2021;72. doi:10.1016\/j.healthplace.2021.102708","DOI":"10.1016\/j.healthplace.2021.102708"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-118285","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:45:51Z","timestamp":1787237151000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-118285"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":49,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,20]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bmjopen-2026-118285"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-118285","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}