Latent Profiles of Early Personal Mastery and Their Association with Out-of-Hospital Rehabilitation Exercise Adherence One Month After Hip Arthroplasty: A Single-Centre Prospective Observational Study.

Abstract

Purpose: In this single-centre prospective observational study, we aimed to identify latent profiles of early personal mastery in patients after hip arthroplasty, examine factors associated with profile membership, and explore differences in out-of-hospital rehabilitation exercise adherence across profiles.

Patients and methods: A total of 350 patients who underwent primary hip arthroplasty at a tertiary hospital in Urumqi, Xinjiang, from August to December 2024, were recruited by convenience sampling; 17 were lost to follow-up, and 333 completed the 1-month assessment and were included in the analysis. Personal mastery was assessed on postoperative day 1-2 with the Personal Mastery Scale, together with a general information questionnaire; adherence to out-of-hospital rehabilitation exercise was assessed at 1 month postoperatively with the Functional Exercise Adherence Scale for Orthopedic Patients. Latent profile analysis (LPA) was used to identify profiles of personal mastery, and multinomial logistic regression to examine factors associated with profile membership. Differences in adherence across profiles were analysed using the Bolck-Croon-Hagenaars (BCH) approach to account for classification uncertainty, and were additionally examined in linear models adjusted for demographic and clinical covariates.

Results: Of the 350 patients recruited, 17 were lost to follow-up, giving a 1-month follow-up retention rate of 95.14%. LPA identified three profiles of early personal mastery: low (31.53%), intermediate (32.13%) and high (36.34%) personal mastery. In the multinomial logistic regression, age, gender, education level, employment status and chronic comorbidities were independently associated with profile membership (p < 0.05), whereas place of residence was not. Adherence at 1 month differed significantly across profiles (χ ² = 81.398, p < 0.001), and profile membership remained independently associated with adherence after adjustment for demographic and clinical covariates (total adherence score F(2, 307) = 23.23, p < 0.001). The intermediate and high personal mastery profiles did not differ significantly from each other on the learning dimension, the physical dimension or the total adherence score.

Conclusion: Early personal mastery in hip arthroplasty patients is heterogeneous and is associated with out-of-hospital rehabilitation exercise adherence at 1 month. These findings suggest that interventions tailored to patients' mastery profiles warrant investigation, although causal relationships remain to be established.