Attitudes towards physical activity after total knee or hip arthroplasty: an exploratory cross-sectional study of physical therapists in Germany, Norway, and the Netherlands

Johanne  Nordlund-Bjørnset; Gesine  Seeber; Håvard Østerås; Monica Unsgaard-Tøndel; Odd Magne Hals; Ann-Katrin Stensdotter; Geranda Slager; Inge van den Akker-Scheek; Martin stevens

doi:10.1080/21679169.2026.2659757

Attitudes towards physical activity after total knee or hip arthroplasty: an exploratory cross-sectional study of physical therapists in Germany, Norway, and the Netherlands

Johanne Nordlund-Bjørnset (First author), Gesine Seeber, Håvard Østerås, Monica Unsgaard-Tøndel, Odd Magne Hals, Ann-Katrin Stensdotter, Geranda Slager, Inge van den Akker-Scheek, Martin stevens

University of Groningen, University Medical Center Groningen, Department of Orthopaedics
School of Medicine and Health Sciences, Division of Orthopaedics at Campus Pius-Hospital, Carl von Ossietzky Universität Oldenburg, Oldenburg,
Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway;

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

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Abstract

Background: Total knee and hip arthroplasty (TKA/THA) remain standard treatments for end-stage osteoarthritis. Physical activity (PA) is critical for optimal functional outcomes during and after rehabilitation. Objective was to assess attitudes and practices of physical therapists (PTs) regarding PA in TKA/THA patients across Germany, Norway, and the Netherlands, and explore how background factors, including education and national healthcare settings, influence practices and recommendations. Methods: A cross-sectional survey was administered to PTs in Germany (n = 113), Norway (n = 83), and the Netherlands (n = 156). Background characteristics and responses were analysed using descriptive and chi-square statistics. Results: PTs from all three countries showed positive attitudes towards PA post-TKA/THA, with notable variations in approach. Norwegian PTs, the highest-educated, emphasised PA intensity and muscle strengthening. Dutch PTs reported the highest availability of PA program services in their clinics. German PTs were less familiar with WHO guidelines but provided personalised advice. Conclusion: PTs’ attitudes were positive but varied, possibly due to differences in education and national healthcare structure. Findings highlight the need for tailored education and cross-national knowledge-sharing to support effective PA integration into TKA/THA rehabilitation.

Translated title of the contribution	Attitudes ten opzichte van lichamelijke activiteit na een totale knie- of heuparthroplastiek: een verkennende cross-sectionele studie onder fysiotherapeuten in Duitsland, Noorwegen en Nederland
Original language	English
Pages (from-to)	1-10
Number of pages	10
Journal	European Journal of Physiotherapy
DOIs	https://doi.org/10.1080/21679169.2026.2659757
Publication status	E-pub ahead of print - 16 Apr 2026

UN SDGs

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

SDG 03 Good Health and Well-being

Keywords

exercise
fitness
health
hip
knee
physiotherapy
prosthesis

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)

Frailty and adequate care
Healthy lifestyle and living environment

Publinova themes

Health
Recreation, Exercise and Sports

Access to Document

10.1080/21679169.2026.2659757Licence: CC BY

Attitudes towards physical activity after total knee or hip arthroplasty an exploratory cross-sectional study of physical therapists in Germany, Norway, and the NetherlandsFinal published version, 1.55 MBLicence: CC BY

Attitude toward physical activity after total hip or knee replacement: A cross-sectional survey study of Dutch and Norwegian patients
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., 23 Jan 2026, In: PLOS ONE. 21, 1 JANUARY, p. 1-14 14 p., 0325746.
Research output: Contribution to journal › Article › Academic › peer-review

Open Access
Effectiveness of rehabilitation for working-age patients after a total hip arthroplasty: a comparison of usual care in the Netherlands versus Germany
Wijnen, A., Heber, G., Dietz, G., Dijkstra, B., Dekker, J. S., Vermeulen, K. M., Slager, G., Hessel, A., Lazovic, D., Bulstra, S. K. & Stevens, M., 27 Jun 2023, In: BMC Musculoskeletal Disorders. 24, 1, 525 (2023).
Research output: Contribution to journal › Article › Academic › peer-review

Open Access
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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
Wijnen, A., Hoogland, J., Munsterman, T., Gerritsma, C. L. E., Dijkstra, B., Zijlstra, W. P., Dekker, H. J. S., Annegarn, J., Ibarra, F., Slager, G., Zijlstra, W. & Stevens, M., 27 Apr 2020, In: JMIR Rehabilitation and Assistive Technologies. 7, 1, 11 p., PMID: 32338621.
Research output: Contribution to journal › Article › Academic › peer-review

Open Access

Cite this

Nordlund-Bjørnset, J., Seeber, G., Østerås, H., Unsgaard-Tøndel, M., Magne Hals, O., Stensdotter, A.-K., Slager, G., van den Akker-Scheek, I., & stevens, M. (2026). Attitudes towards physical activity after total knee or hip arthroplasty: an exploratory cross-sectional study of physical therapists in Germany, Norway, and the Netherlands. European Journal of Physiotherapy, 1-10. Advance online publication. https://doi.org/10.1080/21679169.2026.2659757

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abstract = "Background: Total knee and hip arthroplasty (TKA/THA) remain standard treatments for end-stage osteoarthritis. Physical activity (PA) is critical for optimal functional outcomes during and after rehabilitation. Objective was to assess attitudes and practices of physical therapists (PTs) regarding PA in TKA/THA patients across Germany, Norway, and the Netherlands, and explore how background factors, including education and national healthcare settings, influence practices and recommendations. Methods: A cross-sectional survey was administered to PTs in Germany (n = 113), Norway (n = 83), and the Netherlands (n = 156). Background characteristics and responses were analysed using descriptive and chi-square statistics. Results: PTs from all three countries showed positive attitudes towards PA post-TKA/THA, with notable variations in approach. Norwegian PTs, the highest-educated, emphasised PA intensity and muscle strengthening. Dutch PTs reported the highest availability of PA program services in their clinics. German PTs were less familiar with WHO guidelines but provided personalised advice. Conclusion: PTs{\textquoteright} attitudes were positive but varied, possibly due to differences in education and national healthcare structure. Findings highlight the need for tailored education and cross-national knowledge-sharing to support effective PA integration into TKA/THA rehabilitation.",

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Nordlund-Bjørnset, J, Seeber, G, Østerås, H, Unsgaard-Tøndel, M, Magne Hals, O, Stensdotter, A-K, Slager, G, van den Akker-Scheek, I & stevens, M 2026, 'Attitudes towards physical activity after total knee or hip arthroplasty: an exploratory cross-sectional study of physical therapists in Germany, Norway, and the Netherlands', European Journal of Physiotherapy, pp. 1-10. https://doi.org/10.1080/21679169.2026.2659757

Attitudes towards physical activity after total knee or hip arthroplasty: an exploratory cross-sectional study of physical therapists in Germany, Norway, and the Netherlands. / Nordlund-Bjørnset, Johanne (First author); Seeber, Gesine ; Østerås, Håvard et al.
In: European Journal of Physiotherapy, 16.04.2026, p. 1-10.

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

TY - JOUR

T1 - Attitudes towards physical activity after total knee or hip arthroplasty

T2 - an exploratory cross-sectional study of physical therapists in Germany, Norway, and the Netherlands

AU - Nordlund-Bjørnset, Johanne

AU - Seeber, Gesine

AU - Østerås, Håvard

AU - Unsgaard-Tøndel, Monica

AU - Magne Hals, Odd

AU - Stensdotter, Ann-Katrin

AU - Slager, Geranda

AU - van den Akker-Scheek, Inge

AU - stevens, Martin

PY - 2026/4/16

Y1 - 2026/4/16

N2 - Background: Total knee and hip arthroplasty (TKA/THA) remain standard treatments for end-stage osteoarthritis. Physical activity (PA) is critical for optimal functional outcomes during and after rehabilitation. Objective was to assess attitudes and practices of physical therapists (PTs) regarding PA in TKA/THA patients across Germany, Norway, and the Netherlands, and explore how background factors, including education and national healthcare settings, influence practices and recommendations. Methods: A cross-sectional survey was administered to PTs in Germany (n = 113), Norway (n = 83), and the Netherlands (n = 156). Background characteristics and responses were analysed using descriptive and chi-square statistics. Results: PTs from all three countries showed positive attitudes towards PA post-TKA/THA, with notable variations in approach. Norwegian PTs, the highest-educated, emphasised PA intensity and muscle strengthening. Dutch PTs reported the highest availability of PA program services in their clinics. German PTs were less familiar with WHO guidelines but provided personalised advice. Conclusion: PTs’ attitudes were positive but varied, possibly due to differences in education and national healthcare structure. Findings highlight the need for tailored education and cross-national knowledge-sharing to support effective PA integration into TKA/THA rehabilitation.

AB - Background: Total knee and hip arthroplasty (TKA/THA) remain standard treatments for end-stage osteoarthritis. Physical activity (PA) is critical for optimal functional outcomes during and after rehabilitation. Objective was to assess attitudes and practices of physical therapists (PTs) regarding PA in TKA/THA patients across Germany, Norway, and the Netherlands, and explore how background factors, including education and national healthcare settings, influence practices and recommendations. Methods: A cross-sectional survey was administered to PTs in Germany (n = 113), Norway (n = 83), and the Netherlands (n = 156). Background characteristics and responses were analysed using descriptive and chi-square statistics. Results: PTs from all three countries showed positive attitudes towards PA post-TKA/THA, with notable variations in approach. Norwegian PTs, the highest-educated, emphasised PA intensity and muscle strengthening. Dutch PTs reported the highest availability of PA program services in their clinics. German PTs were less familiar with WHO guidelines but provided personalised advice. Conclusion: PTs’ attitudes were positive but varied, possibly due to differences in education and national healthcare structure. Findings highlight the need for tailored education and cross-national knowledge-sharing to support effective PA integration into TKA/THA rehabilitation.

KW - exercise

KW - fitness

KW - health

KW - hip

KW - knee

KW - physiotherapy

KW - prosthesis

KW - fysiotherapie

KW - gezondheid

KW - heup

KW - knie

KW - lichamelijke fitheid

KW - oefening

KW - prothese

U2 - 10.1080/21679169.2026.2659757

DO - 10.1080/21679169.2026.2659757

M3 - Article

SN - 2167-9169

SP - 1

EP - 10

JO - European Journal of Physiotherapy

JF - European Journal of Physiotherapy

ER -

Nordlund-Bjørnset J, Seeber G, Østerås H, Unsgaard-Tøndel M, Magne Hals O, Stensdotter AK et al. Attitudes towards physical activity after total knee or hip arthroplasty: an exploratory cross-sectional study of physical therapists in Germany, Norway, and the Netherlands. European Journal of Physiotherapy. 2026 Apr 16;1-10. Epub 2026 Apr 16. doi: 10.1080/21679169.2026.2659757

Attitudes towards physical activity after total knee or hip arthroplasty: an exploratory cross-sectional study of physical therapists in Germany, Norway, and the Netherlands

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

Fingerprint

Research output

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

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

Cite this