Knowledge, Practice and Barriers to Exercise Rehabilitation Among Chinese Patients with Acute Musculoskeletal Injury: A Mixed-Methods Study

Purpose: This study aimed to identify the current status and barriers to exercise rehabilitation among Chinese patients with acute musculoskeletal injury. Patients and Methods: This single-center, sequential explanatory mixed-methods evaluation included a quantitative survey and qualitative semi-structured interviews. The quantitative survey was distributed online to patients who had acute musculoskeletal injury within five years. For the qualitative component, patients and their families, as well as physiotherapists, orthopedic surgeons, coaches, and personal trainers were recruited. Interview guides were inductively developed and revised based on data analysis. Thematic analysis was conducted using the Capability, Opportunity, and Motivation Behavior model. Results: Among 284 participants, only 65.1% visited the hospital, 22.9% sought rehabilitation services, and 6.0% completed training after injury. The most common reasons for not going to the hospital (92.9%) or rehabilitation department (70.1%) was underestimation of the injury severity. However, one year after injury, 65.7% still experienced abnormalities at the injury sites, and 46.9% had changed their sport habits. In total, 23 participants were interviewed. Barriers of exercise rehabilitation included patient’s lack of knowledge about the requirement of exercise rehabilitation guidance and instruction from orthopedic surgeons, difficulty with mobility and enough time, insufficient number of qualified physiotherapists or clinics, underestimation of injury severity, low expectation of rehabilitation, and cost reasons. Conclusion: This study provides novel evidence on systemic and behavioral barriers to exercise rehabilitation in China, supporting efforts in education for both orthopedic providers and patients, expanding the workforce of qualified specialists, and integrated referral and remote-supervision models. Plain Language Summary: Guidelines recommend exercise rehabilitation guidance in the early stage following acute musculoskeletal injury. However, physiotherapists are insufficient to meet the healthcare needs of the population in China. This was the first mixed methods study focusing on exercise rehabilitation among patients with Chinese acute musculoskeletal injury. The quantitative and qualitative data from participants in different roles demonstrated consistency at multiple points. Keywords: patient education, orthopedist education, referral system, online remote supervision A Letter to the Editor has been published for this article .