{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:28:09Z","timestamp":1786512489667,"version":"build-2736575974"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Alexithymia, characterized by difficulty identifying and describing emotions and a tendency toward externally oriented thinking, is common among people living with chronic pain and may compromise perioperative communication and rehabilitation engagement. However, previous studies have largely adopted variable-centered approaches, which may overlook clinically meaningful heterogeneity in alexithymia among patients undergoing TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify latent alexithymia profiles using latent profile analysis (LPA) of alexithymia among patients undergoing TKA and to determine demographic, clinical, and psychosocial factors associated with profile membership.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted among 467 patients scheduled for TKA at a tertiary hospital in Ningxia, China, between July 2025 and April 2026. Participants completed a general information questionnaire, the Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20), the Numerical Rating Scale for pain (NRS), the Hospital Anxiety and Depression Scale (HADS), and the Perceived Social Support Scale (PSSS). LPA was conducted using the three TAS-20 subscale scores (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking) as profile indicators. Multinomial logistic regression was used to identify factors associated with profile membership.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean TAS-20 score was 57.02\u202f\u00b1\u202f5.76, indicating moderate alexithymic traits. A three-profile solution was identified: emotionally competent (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f106, 22.70%), emotionally expressive difficulty (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f197, 42.18%), and emotional-cognitive deficit (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f164, 35.12%). Educational level, monthly income, pain duration, pain intensity, anxiety, depression, and perceived social support were associated with profile membership in univariable analyses (all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.05). In multivariable multinomial logistic regression, higher perceived social support was associated with lower odds of membership in both the emotionally expressive difficulty profile (OR\u202f=\u202f0.883, 95% CI: 0.793\u20130.983) and the emotional-cognitive deficit profile (OR\u202f=\u202f0.767, 95% CI: 0.673\u20130.873). The emotional-cognitive deficit profile was additionally associated with higher anxiety scores (OR\u202f=\u202f1.363, 95% CI: 1.124\u20131.652) and was associated with a broader range of adverse socioeconomic and psychological factors. Than the emotionally expressive difficulty profile (e.g., pain intensity: OR\u202f=\u202f8.517 vs. 2.356; monthly income &amp;lt; 2,000 RMB: OR\u202f=\u202f10.549 vs. 3.592).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Alexithymia in patients undergoing TKA comprises three clinically distinguishable profiles. Profile membership is closely related to socioeconomic status, pain burden, psychological distress, and social support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for nursing<\/jats:title>\n                    <jats:p>Routine preoperative TAS-20 screening could facilitate early identification of patients at risk for alexithymia-related communication barriers. Profile-specific interventions should combine tailored communication strategies, pain management, psychological support, and family-inclusive social support, particularly for patients with emotional-cognitive deficits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1919123","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:42:32Z","timestamp":1786509752000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Latent profile analysis of alexithymia and its influencing factors in patients undergoing total knee arthroplasty"],"prefix":"10.3389","volume":"14","author":[{"given":"Fengdi","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Nursing, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoyue","family":"Gao","sequence":"additional","affiliation":[{"name":"School of Nursing, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xun","family":"Li","sequence":"additional","affiliation":[{"name":"School of Nursing, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuling","family":"Ma","sequence":"additional","affiliation":[{"name":"School of Nursing, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajie","family":"Deng","sequence":"additional","affiliation":[{"name":"School of Nursing, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingxue","family":"Mei","sequence":"additional","affiliation":[{"name":"Medical Education Administration Division, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"721","DOI":"10.3969\/i.issn.1671-315x.2021.10.008","article-title":"Relationship between illness perception and home-based rehabilitation adherence in elderly patients after total knee arthroplasty","volume":"21","author":"Liu","year":"2021","journal-title":"J Nurs Adm"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e221462","DOI":"10.1001\/jamanetworkopen.2022.1462","article-title":"Effect of prehabilitation before total knee replacement for knee osteoarthritis on functional outcomes: a randomized clinical trial","volume":"5","author":"Nguyen","year":"2022","journal-title":"JAMA Netw Open"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1016\/j.arth.2022.10.011","article-title":"Are 20% of patients actually dissatisfied following total knee arthroplasty? 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