Is military employment associated with the risk of cognitive impairment in older adult? Evidence from China.

The number of individuals undergoing total knee arthroplasty (TKA) has grown substantially over recent decades, driven by aging populations, rising incidence of osteoarthritis, and improving surgical techniques and implant designs. TKA is widely regarded as an effective intervention for relieving pain and restoring function in patients with end-stage knee osteoarthritis; nonetheless, a notable proportion of patients continue to experience persistent pain, functional limitations, or reduced satisfaction with outcomes (). Such observations highlight that successful rehabilitation after TKA involves more than implant mechanics or surgical factors alone: psychological, behavioral, and self-management dimensions play critical roles. Among these, the patient's coping strategies cognitive, emotional, and behavioral responses to pain and rehabilitation demands are emerging as key determinants of rehabilitation success and post-surgical pain experience (, ). Post-operative rehabilitation after TKA aims at restoring range of motion (ROM), improving quadriceps strength, regaining functional mobility (walking, stair climbing, chair rises), and enabling safe return to daily activities. Protocols frequently emphasize early mobilization, goal-oriented physiotherapy, strength training, gait re-education, and home exercise programs. Even with optimal surgical technique and post-operative care, a subset of patients fails to achieve expected functional levels or continue to experience bothersome knee pain beyond the acute phase. A recent systematic review reported persistent knee pain more than three months after TKA in approximately 5%–10% of patients, that is strongly associated with reduced satisfaction and suboptimal functional outcomes. Several factors influence the trajectory of recovery: surgical and implant variables (alignment, component positioning, soft tissue balancing), patient factors (age, comorbidities, preoperative function, BMI), and rehabilitation delivery (timing, intensity, adherence). However, psychological and behavioral dimensions, particularly coping responses, expectations and adherence, are increasingly recognized as significant modulators of outcome (). The increasing interest in remote or tele-rehabilitation (home exercise with remote monitoring, teleconsultation, digital feedback) has been prompted by pressures to shorten hospital stays, reduce costs, and support patient self-management (). Home-based or hybrid rehabilitation models have shown promise but also highlight the importance of engagement and tailored support. The addition of psychoeducational elements—pain education, coping skills training, and motivational interviewing—may help enhance patient engagement, manage expectations, and address fear of movement (kinesiophobia), thus improving both adherence and clinical outcomes (, ).