{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T06:55:21Z","timestamp":1770533721075,"version":"3.49.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011698","name":"Chartered Society of Physiotherapy Charitable Trust","doi-asserted-by":"publisher","award":["PRF\/21\/PRE09"],"award-info":[{"award-number":["PRF\/21\/PRE09"]}],"id":[{"id":"10.13039\/100011698","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Aims<\/jats:title>\n To evaluate the feasibility of a substantive cohort study to determine whether modifiable lifestyle factors, including smoking, physical inactivity, alcohol consumption and being overweight, affect patient-reported clinical outcomes after total knee replacement surgery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Adults awaiting total knee replacement surgery were recruited pre-operatively and completed self-reported questionnaires at baseline and 3- and 6-months post-surgery. Feasibility outcomes, including recruitment, retention and response rate of the primary outcome questionnaire were analysed descriptively.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 40 participants were recruited from 183 eligible patients (22%). 87.5% (35\/40) participants returned questionnaires at 6-months. 85% (34\/40) of participants were overweight (BMI\u2009>\u200924.9), 25% (10\/40) drank alcohol (AUDIT-C\u2009>\u20094), 5% (2\/40) smoked tobacco and 67.5% (27\/40) were physically inactive (GPPAQ classification of \u2018moderately inactive\u2019, or \u2018inactive\u2019).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Modifiable lifestyle factors including smoking, alcohol use, physical inactivity and being overweight are highly prevalent in patients waiting for total knee replacement. Based on this study, a future substantive cohort study investigating the effect of lifestyle factors on clinical outcomes post total knee replacement in the UK NHS is feasible.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0332953","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T17:26:29Z","timestamp":1761067589000},"page":"e0332953","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Do lifestyle factors affect patient reported clinical outcomes after total knee replacement surgery? A feasibility cohort study (PRO-Knee)"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9373-0026","authenticated-orcid":true,"given":"Gareth","family":"Stephens","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0460-1404","authenticated-orcid":true,"given":"Triantafyllos","family":"Liloglou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8385-7418","authenticated-orcid":true,"given":"Maria","family":"Moffatt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7703-727X","authenticated-orcid":true,"given":"Chris","family":"Littlewood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"pone.0332953.ref001","unstructured":"National Joint Registry. 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Accessed 2025 May 7. https:\/\/www.jla.nihr.ac.uk\/top-10-priorities\/hip-and-knee-replacement-for-osteoarthritis\/"},{"key":"pone.0332953.ref005","volume-title":"Joint replacement (primary): hip, knee and shoulder. 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Body mass index \u2013 BMI. Accessed 2025 May 7. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight"},{"issue":"3","key":"pone.0332953.ref015","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1057\/s41285-017-0055-0","article-title":"In BMI We Trust: Reframing the Body Mass Index as a Measure of Health","volume":"16","author":"I Gutin","year":"2018","journal-title":"Soc Theory Health"},{"issue":"8","key":"pone.0332953.ref016","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1080\/07448481.2018.1453514","article-title":"Validity of the AUDIT-C screen for at-risk drinking among students utilizing university primary care","volume":"66","author":"CE Campbell","year":"2018","journal-title":"J Am Coll Health"},{"issue":"3","key":"pone.0332953.ref017","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1111\/j.1360-0443.1993.tb00822.x","article-title":"Alcohol consumption and related problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption--I","volume":"88","author":"JB Saunders","year":"1993","journal-title":"Addiction"},{"key":"pone.0332953.ref018","unstructured":"Department of Health. The General Practice Physical Activity Questionnaire: A Screening Tool to Assess Adult Physical Activity Levels, Within Primary Care. 2009. Accessed 2025 May 7. https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/192453\/GPPAQ_-_guidance.pdf"},{"key":"pone.0332953.ref019","volume-title":"Physical activity: brief advice for adults in primary care","author":"National Institute for Health and Care Excellence","year":"2013"},{"key":"pone.0332953.ref020","article-title":"Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study","volume":"370","author":"M Zhao","year":"2020","journal-title":"BMJ"},{"issue":"6","key":"pone.0332953.ref021","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.jclinepi.2004.10.018","article-title":"The development of a comorbidity index with physical function as the outcome","volume":"58","author":"DL Groll","year":"2005","journal-title":"J Clin Epidemiol"},{"issue":"2","key":"pone.0332953.ref022","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1302\/0301-620X.99B2.BJJ-2016-0606.R1","article-title":"Validation of the English language Forgotten Joint Score-12 as an outcome measure for total hip and knee arthroplasty in a British population","author":"DF Hamilton","year":"2017","journal-title":"Bone Joint J"},{"issue":"4","key":"pone.0332953.ref023","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1016\/j.arth.2019.10.058","article-title":"Determining the Validity, Reliability, and Utility of the Forgotten Joint Score: A Systematic Review","volume":"35","author":"M Adriani","year":"2020","journal-title":"J Arthroplasty"},{"issue":"1","key":"pone.0332953.ref024","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1186\/s12891-020-03415-x","article-title":"Minimal important differences for the WOMAC osteoarthritis index and the Forgotten Joint Score-12 in total knee arthroplasty patients","volume":"21","author":"N Holtz","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"pone.0332953.ref025","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1302\/0301-620X.80B1.0800063","article-title":"Questionnaire on the perceptions of patients about total knee replacement","volume":"80","author":"J Dawson","year":"1998","journal-title":"J Bone Joint Surg Br"},{"key":"pone.0332953.ref026","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jclinepi.2021.12.016","article-title":"Minimal important changes and differences were estimated for Oxford hip and knee scores following primary and revision arthroplasty","volume":"143","author":"SA Sabah","year":"2022","journal-title":"J Clin Epidemiol"},{"issue":"10","key":"pone.0332953.ref027","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"M Herdman","year":"2011","journal-title":"Qual Life Res"},{"key":"pone.0332953.ref028","volume-title":"Position statement on use of the EQ-5D-5L value set for England (updated October 2019)","author":"National Institute for Health and Care Excellence","year":"2019"},{"issue":"2","key":"pone.0332953.ref029","doi-asserted-by":"crossref","first-page":"71","DOI":"10.5152\/eurjrheum.2020.19043","article-title":"Validity and reliability of EQ-5D-5L among patients with axial spondyloarthritis in Singapore","volume":"7","author":"JJB Seng","year":"2020","journal-title":"Eur J Rheumatol"},{"key":"pone.0332953.ref030","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1186\/s12955-017-0759-9","article-title":"Is the Hospital Anxiety and Depression Scale (HADS) a valid measure in a general population 65\u201380 years old? 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