A longitudinal qualitative study on decision-making and rehabilitation behavior in patients following arthroscopic rotator cuff repair

The decision-making and rehabilitation journey for patients undergoing arthroscopic rotator cuff repair (ARCR) is complex and shaped by multifaceted physical and psychological factors, yet a longitudinal understanding of this dynamic process remains limited. To explore the evolving experiences, decision-making processes, and rehabilitation behaviors of patients undergoing ARCR across the pre-operative to post-operative continuum. A longitudinal qualitative study was conducted using purposive sampling. Between January and June 2025, 15 patients scheduled for ARCR were recruited from two tertiary hospitals in Nantong, China. Semi-structured interviews were conducted at three time points: preoperatively, before discharge, and 30 days postoperatively. Data were analyzed using Smith’s Interpretative Phenomenological Analysis (IPA), with synchronous analysis after each interview and longitudinal analysis across all time points upon study completion. Three primary themes were identified: (1) Navigating the preoperative decision-making dilemma, driven by pain and functional loss, caught between surgical fears and family concerns, and grappling with prognostic uncertainty; (2) Unmanaged symptoms and information gaps undermining recovery foundations, where postoperative pain triggered safety concerns, loss of autonomy caused psychological distress, and ambiguous instructions created confusion; (3) Forging divergent rehabilitation pathways, with some patients building confidence through positive engagement while others developed catastrophic thinking, pain hypersensitivity, or passive coping due to fear and low self-efficacy. The ARCR recovery journey is a dynamic process of psychological and behavioral adaptation, with the immediate postoperative period serving as a critical juncture influencing long-term outcomes. Implementing structured preoperative education, proactive postoperative symptom management, and continuous individualized support is therefore essential to steer patients toward positive rehabilitation behaviors and improve functional recovery.