Attitude toward physical activity after total hip or knee replacement: A cross-sectional survey study of Dutch and Norwegian patients

Inge van den Akker-Scheek; Martin Stevens; Astrid J De Vries; Anne Marie Fenstad; Ove Nord Furnes; Håvard Østerås; Bregje E Raap-van Sleuwen; Katja Saris; Geranda E C Slager; Monica Unsgaard-Tøndel; Odd Magne Hals; Ann-Katrin Stensdotter

doi:10.1371/journal.pone.0325746

Attitude toward physical activity after total hip or knee replacement: A cross-sectional survey study of Dutch and Norwegian patients

Inge van den Akker-Scheek
, Martin Stevens
, Astrid J De Vries
, Anne Marie Fenstad
, Ove Nord Furnes
, Håvard Østerås
, Bregje E Raap-van Sleuwen
, Katja Saris
, Geranda E C Slager
, Monica Unsgaard-Tøndel
, Odd Magne Hals
, Ann-Katrin Stensdotter

University of Groningen, University Medical Center Groningen, Department of Orthopaedics
Martini Hospital, Department of Orthopaedic Surgery
Department of Anaesthesia and Intensive Care, Haukeland University Hospital
University of Bergen, Department of Clinical Medicine
Dept. of Neuromedicine and Movement Science Norwegian University of Science and Technology
Department of Orthopaedic Surgery/Research Department
Radboud University Medical Center, Department of Orthopaedics

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective To gain insight into the attitude towards physical activity (PA) of Norwegian and Dutch patients after hip or knee replacement, possible differences in attitude between the countries and which factors explain a more positive or negative attitude. Methods A cross-sectional survey study investigating attitude toward PA 6–12 months after hip or knee replacement was conducted in Norway and the Netherlands. Patients received a questionnaire consisting of three parts: demography, received health service, and the survey about attitude toward PA consisting of 32 statements divided into four domains – quality of life, level of PA, function, and kinesiophobia. Attitude was scored on a 4-graded Likert scale. A high score indicated a positive attitude toward PA. Survey responses from the Norwegian and Dutch cohorts were compared using one-way ANOVA for group comparison. To identify factors explaining the outcome of the attitude survey, stepwise regressions were used. Results Data from 732 Norwegian patients and 575 Dutch patients was included in the analyses. Overall, the characteristics of the two cohorts were quite similar, although a significantly greater number in the Norwegian cohort had participated in “prehab”, while the participation in “rehab” was similar. In all four domains the attitude scores were generally high, indicating positive attitudes, with Norwegian patients scoring significantly higher. Higher participation in sports was the strongest explaining factor for a more positive attitude toward PA. Older age was the strongest independent variable explaining a less positive attitude towards PA. Conclusion Patients seem to have an overall positive attitude towards PA after hip or knee replacement. Norwegian patients had a more positive attitude compared to Dutch patients, which could be the result of more formalized and extensive education of the benefits of PA as part of the “prehab” in Norway.

Translated title of the contribution	Attitude ten opzichte van lichamelijke activiteit na een totale knie- of heupprothese: een cross-sectioneel enquêteonderzoek onder Nederlandse en Noorse patiënten
Original language	English
Article number	0325746
Pages (from-to)	1-14
Number of pages	14
Journal	PLOS ONE
Volume	21
Issue number	1 JANUARY
DOIs	https://doi.org/10.1371/journal.pone.0325746
Publication status	Published - 23 Jan 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 03 Good Health and Well-being

Keywords

Humans
Norway
Cross-Sectional Studies
Arthroplasty, Replacement, Knee/psychology
Netherlands
Female
Male
Arthroplasty, Replacement, Hip/psychology
Aged
Middle Aged
Surveys and Questionnaires
Quality of Life
Exercise
Attitude to Health
Motor Activity

Research Focus Areas Hanze University of Applied Sciences * (mandatory by Hanze)

Healthy Ageing

Research Focus Areas Research Centre or Centre of Expertise * (mandatory by Hanze)

Healthy lifestyle and living environment
Frailty and adequate care

Publinova themes

Recreation, Exercise and Sports

Access to Document

10.1371/journal.pone.0325746Licence: CC BY

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van den Akker-Scheek, I., Stevens, M., De Vries, A. J., Fenstad, A. M., Furnes, O. N., Østerås, H., Raap-van Sleuwen, B. E., Saris, K., Slager, G. E. C., Unsgaard-Tøndel, M., Hals, O. M., & Stensdotter, A.-K. (2026). Attitude toward physical activity after total hip or knee replacement: A cross-sectional survey study of Dutch and Norwegian patients. PLOS ONE, 21(1 JANUARY), 1-14. Article 0325746. https://doi.org/10.1371/journal.pone.0325746

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title = "Attitude toward physical activity after total hip or knee replacement: A cross-sectional survey study of Dutch and Norwegian patients",

abstract = "Objective To gain insight into the attitude towards physical activity (PA) of Norwegian and Dutch patients after hip or knee replacement, possible differences in attitude between the countries and which factors explain a more positive or negative attitude. Methods A cross-sectional survey study investigating attitude toward PA 6–12 months after hip or knee replacement was conducted in Norway and the Netherlands. Patients received a questionnaire consisting of three parts: demography, received health service, and the survey about attitude toward PA consisting of 32 statements divided into four domains – quality of life, level of PA, function, and kinesiophobia. Attitude was scored on a 4-graded Likert scale. A high score indicated a positive attitude toward PA. Survey responses from the Norwegian and Dutch cohorts were compared using one-way ANOVA for group comparison. To identify factors explaining the outcome of the attitude survey, stepwise regressions were used. Results Data from 732 Norwegian patients and 575 Dutch patients was included in the analyses. Overall, the characteristics of the two cohorts were quite similar, although a significantly greater number in the Norwegian cohort had participated in “prehab”, while the participation in “rehab” was similar. In all four domains the attitude scores were generally high, indicating positive attitudes, with Norwegian patients scoring significantly higher. Higher participation in sports was the strongest explaining factor for a more positive attitude toward PA. Older age was the strongest independent variable explaining a less positive attitude towards PA. Conclusion Patients seem to have an overall positive attitude towards PA after hip or knee replacement. Norwegian patients had a more positive attitude compared to Dutch patients, which could be the result of more formalized and extensive education of the benefits of PA as part of the “prehab” in Norway.",

keywords = "Humans, Norway, Cross-Sectional Studies, Arthroplasty, Replacement, Knee/psychology, Netherlands, Female, Male, Arthroplasty, Replacement, Hip/psychology, Aged, Middle Aged, Surveys and Questionnaires, Quality of Life, Exercise, Attitude to Health, Motor Activity, mensen, noorwegen, cross-sectionele studies, artroplastiek, knievervanging/psychologie, nederland, vrouwelijk, mannelijk, artroplastiek, Heupvervanging/psychologie, ouder, middelbare leeftijd, vragenlijsten en enqu{\^e}tes, kwaliteit van leven, sporten, houding ten opzichte van gezondheid, motorische activiteit",

author = "\{van den Akker-Scheek\}, Inge and Martin Stevens and \{De Vries\}, \{Astrid J\} and Fenstad, \{Anne Marie\} and Furnes, \{Ove Nord\} and H{\aa}vard {\O}ster{\aa}s and \{Raap-van Sleuwen\}, \{Bregje E\} and Katja Saris and Slager, \{Geranda E C\} and Monica Unsgaard-T{\o}ndel and Hals, \{Odd Magne\} and Ann-Katrin Stensdotter",

note = "Copyright: {\textcopyright} 2026 van den Akker-Scheek et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2026",

month = jan,

day = "23",

doi = "10.1371/journal.pone.0325746",

language = "English",

volume = "21",

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journal = "PLOS ONE",

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number = "1 JANUARY",

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van den Akker-Scheek, I, Stevens, M, De Vries, AJ, Fenstad, AM, Furnes, ON, Østerås, H, Raap-van Sleuwen, BE, Saris, K, Slager, GEC, Unsgaard-Tøndel, M, Hals, OM & Stensdotter, A-K 2026, 'Attitude toward physical activity after total hip or knee replacement: A cross-sectional survey study of Dutch and Norwegian patients', PLOS ONE, vol. 21, no. 1 JANUARY, 0325746, pp. 1-14. https://doi.org/10.1371/journal.pone.0325746

TY - JOUR

T1 - Attitude toward physical activity after total hip or knee replacement

T2 - A cross-sectional survey study of Dutch and Norwegian patients

AU - van den Akker-Scheek, Inge

AU - Stevens, Martin

AU - De Vries, Astrid J

AU - Fenstad, Anne Marie

AU - Furnes, Ove Nord

AU - Østerås, Håvard

AU - Raap-van Sleuwen, Bregje E

AU - Saris, Katja

AU - Slager, Geranda E C

AU - Unsgaard-Tøndel, Monica

AU - Hals, Odd Magne

AU - Stensdotter, Ann-Katrin

N1 - Copyright: © 2026 van den Akker-Scheek et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2026/1/23

Y1 - 2026/1/23

N2 - Objective To gain insight into the attitude towards physical activity (PA) of Norwegian and Dutch patients after hip or knee replacement, possible differences in attitude between the countries and which factors explain a more positive or negative attitude. Methods A cross-sectional survey study investigating attitude toward PA 6–12 months after hip or knee replacement was conducted in Norway and the Netherlands. Patients received a questionnaire consisting of three parts: demography, received health service, and the survey about attitude toward PA consisting of 32 statements divided into four domains – quality of life, level of PA, function, and kinesiophobia. Attitude was scored on a 4-graded Likert scale. A high score indicated a positive attitude toward PA. Survey responses from the Norwegian and Dutch cohorts were compared using one-way ANOVA for group comparison. To identify factors explaining the outcome of the attitude survey, stepwise regressions were used. Results Data from 732 Norwegian patients and 575 Dutch patients was included in the analyses. Overall, the characteristics of the two cohorts were quite similar, although a significantly greater number in the Norwegian cohort had participated in “prehab”, while the participation in “rehab” was similar. In all four domains the attitude scores were generally high, indicating positive attitudes, with Norwegian patients scoring significantly higher. Higher participation in sports was the strongest explaining factor for a more positive attitude toward PA. Older age was the strongest independent variable explaining a less positive attitude towards PA. Conclusion Patients seem to have an overall positive attitude towards PA after hip or knee replacement. Norwegian patients had a more positive attitude compared to Dutch patients, which could be the result of more formalized and extensive education of the benefits of PA as part of the “prehab” in Norway.

AB - Objective To gain insight into the attitude towards physical activity (PA) of Norwegian and Dutch patients after hip or knee replacement, possible differences in attitude between the countries and which factors explain a more positive or negative attitude. Methods A cross-sectional survey study investigating attitude toward PA 6–12 months after hip or knee replacement was conducted in Norway and the Netherlands. Patients received a questionnaire consisting of three parts: demography, received health service, and the survey about attitude toward PA consisting of 32 statements divided into four domains – quality of life, level of PA, function, and kinesiophobia. Attitude was scored on a 4-graded Likert scale. A high score indicated a positive attitude toward PA. Survey responses from the Norwegian and Dutch cohorts were compared using one-way ANOVA for group comparison. To identify factors explaining the outcome of the attitude survey, stepwise regressions were used. Results Data from 732 Norwegian patients and 575 Dutch patients was included in the analyses. Overall, the characteristics of the two cohorts were quite similar, although a significantly greater number in the Norwegian cohort had participated in “prehab”, while the participation in “rehab” was similar. In all four domains the attitude scores were generally high, indicating positive attitudes, with Norwegian patients scoring significantly higher. Higher participation in sports was the strongest explaining factor for a more positive attitude toward PA. Older age was the strongest independent variable explaining a less positive attitude towards PA. Conclusion Patients seem to have an overall positive attitude towards PA after hip or knee replacement. Norwegian patients had a more positive attitude compared to Dutch patients, which could be the result of more formalized and extensive education of the benefits of PA as part of the “prehab” in Norway.

KW - Humans

KW - Norway

KW - Cross-Sectional Studies

KW - Arthroplasty, Replacement, Knee/psychology

KW - Netherlands

KW - Female

KW - Male

KW - Arthroplasty, Replacement, Hip/psychology

KW - Aged

KW - Middle Aged

KW - Surveys and Questionnaires

KW - Quality of Life

KW - Exercise

KW - Attitude to Health

KW - Motor Activity

KW - mensen

KW - noorwegen

KW - cross-sectionele studies

KW - artroplastiek, knievervanging/psychologie

KW - nederland

KW - vrouwelijk

KW - mannelijk

KW - artroplastiek, Heupvervanging/psychologie

KW - ouder

KW - middelbare leeftijd

KW - vragenlijsten en enquêtes

KW - kwaliteit van leven

KW - sporten

KW - houding ten opzichte van gezondheid

KW - motorische activiteit

U2 - 10.1371/journal.pone.0325746

DO - 10.1371/journal.pone.0325746

M3 - Article

C2 - 41575945

SN - 1932-6203

VL - 21

SP - 1

EP - 14

JO - PLOS ONE

JF - PLOS ONE

IS - 1 JANUARY

M1 - 0325746

ER -

Attitude toward physical activity after total hip or knee replacement: A cross-sectional survey study of Dutch and Norwegian patients

Abstract

UN SDGs

Keywords

Research Focus Areas Hanze University of Applied Sciences * (mandatory by Hanze)

Research Focus Areas Research Centre or Centre of Expertise * (mandatory by Hanze)

Publinova themes

Access to Document

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Effectiveness of rehabilitation for working-age patients after a total hip arthroplasty: a comparison of usual care in the Netherlands versus Germany

Effectiveness of a home-based rehabilitation program after total hip arthroplasty driven by a tablet app and remote coaching: nonrandomized controlled trial combining a single-arm intervention cohort with historical controls

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