Factors Influencing Decision-Making and Rehabilitation Among Older Women Who Underwent Total Knee Replacement: A Qualitative Study in Taiwan.

Purpose: To explore the factors influencing decision-making and the rehabilitation experiences of older women who underwent total knee replacement (TKR). Methods: A qualitative descriptive design with purposive sampling was employed. Women aged over 60 who had undergone TKR at a medical center in northern Taiwan were recruited during COVID-19 pandemic. Data were collected through two rounds of face-to-face interviews (3-5 days and 6-8 weeks post-surgery) and a follow-up telephone interview conducted 6 months after surgery. Thematic analysis was performed using a constant comparative approach. Results: Twenty women participated. A central theme-reclaiming independent life through surgical transformation-emerged, encompassing two interrelated themes: (1) Decision-making factors were driven by pain, external concerns (becoming a burden on the family, body image change), dissatisfaction with conservative treatments, and the influence of significant others (physicians, families and friends, peers); (2) Surgical recovery involved striving to achieve the "rehabilitation golden phase" by enduring pain, establishing personal goals, and working toward functional recovery, while managing "challenges in home-based rehabilitation" through coping strategies and social support, and engaging in "post-surgical reflections" to assess pain relief and identify levels of functional recovery. Conclusion: Older women perceived TKR to regain mobility, autonomy, and reduce dependence on family members. Their decisions reflected the interplay between physical suffering and cultural expectations. Despite rehabilitation challenges, participants demonstrated resilience and strong motivation for recovery. These findings emphasize the importance of gender-sensitive, patient-centered decision-support strategies and family-inclusive, culturally responsive rehabilitation care.