Perioperative Transition Experience of Patients Undergoing Shoulder Arthroscopy Day Surgery: An Exploratory Study Using Patient Journey Mapping

Perioperative Transition Experience of Patients Undergoing Shoulder Arthroscopy Day Surgery: An Exploratory Study Using Patient Journey Mapping | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perioperative Transition Experience of Patients Undergoing Shoulder Arthroscopy Day Surgery: An Exploratory Study Using Patient Journey Mapping Li Wang, Ya-Qing Zhang, Rong Song, Chun-yan Wang, Rong Hu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7486333/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jan, 2026 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 11 You are reading this latest preprint version Abstract Background With the advancement of orthopedic enhanced recovery after surgery (ERAS), the frequency of orthopedic procedures performed as day surgeries has increased. Improvements in shoulder arthroscopy techniques and updates in ERAS protocols have enabled arthroscopic rotator cuff repair (ARCR) to be conducted as a day surgery. However, the reduced hospital stay introduces significant challenges for patients. Limited research exists on how day surgery patients manage the transition between home and the surgical setting, although these experiences and coping strategies have a substantial impact on patient health outcomes. This study aimed to identify the perioperative healthcare experiences of patients undergoing ARCR day surgery, reduce perioperative risks, and improve patient satisfaction. Methods A descriptive qualitative study was conducted. Interview guides were developed based on the Transition Theory. Semi-structured interviews were performed with 13 patients undergoing day surgery in the orthopedic ward of a tertiary hospital in Sichuan Province, China, between January and March 2025. Data were analyzed using content analysis, and patient journey maps (PJMs) were constructed. Results PJMs were created along the treatment timeline and perioperative phases. Patient experiences and needs during ARCR day surgery were categorized into 22 themes across 4 dimensions (Tasks, Emotions, Pain Points, Improvement Points) and 3 stages: Preoperative Stage (8 themes): Comprehensive assessment and examinations; Comorbidity management; Understanding the disease and treatment process; Helplessness; Anxiety; Preoperative preparation. Perioperative Stage (7 themes): Symptom management; Worry; Waiting; Information communication; Caregiving burden. Postoperative Stage (7 themes): Follow-up; Rehabilitation exercises; Listening; Discharge readiness; Telemedicine support. Conclusion The healthcare journey for patients undergoing ARCR day surgery is condensed and characterized by complex, evolving needs. PJMs enable healthcare providers to identify critical interaction points, challenges, and opportunities for improvement throughout the perioperative process. Utilizing PJMs supports the optimal allocation of medical resources, enhances clinical services, ensures patient safety, and improves the overall patient experience. Arthroscopic rotator cuff repair Day surgery Journey mapping Patient experience Descriptive qualitative study Figures Figure 1 Background With the continuous aging of the global population, shoulder disorders have emerged as a significant and growing public health concern. Among these, rotator cuff tears stand as the most prevalent tendon pathology in orthopedic practice, clinically characterized by shoulder pain, weakness, sleep disturbances, and restricted range of motion [ 1 ] . Surgical intervention is typically indicated when non-operative management fails after 3–6 months, the tear size is large, or symptoms significantly impair the patient's activities of daily life [ 2 – 3 ] . ARCR is the most established treatment for rotator cuff tears, effectively restoring shoulder function, relieving pain, and improving quality of life [ 4 ] . Driven by advancements in medical technology and improvements in healthcare delivery models, day surgery has undergone rapid expansion. In many European countries, over 50% of elective procedures are now performed as day surgeries [ 5 ] , Day surgery is defined as a surgical pathway where patients undergo admission, the surgical procedure, and discharge within a 24-to-48-hour period [ 6 ] , this surgical pathway is characterized by its efficiency, brief inpatient duration, and cost-effectiveness [ 7 ] . Driven by advancements in minimally invasive shoulder arthroscopy techniques and the implementation of ERAS protocols [ 8 ] , ARCR has transitioned into the realm of day surgery, with its safety profile well established [ 9 ] . Patients undergoing day surgery, like all surgical patients, navigate a complex healthcare journey involving multiple departments and numerous procedural steps. The shortened inpatient duration does not equate to a simplified care pathway; rather, it imposes heightened demands on interdepartmental coordination and necessitates an enhanced patient experience. Our observations reveal persistent challenges in patient experience and care support. China's “Action Plan for Enhancing the Patient Experience (2023–2025)” explicitly prioritizes improving the healthcare experience for the public, mandating comprehensive review and optimization of clinical workflows to address bottlenecks in healthcare access [ 10 ] . Understanding and enhancing the patient experience is increasingly recognized as a critical measure for improving healthcare quality, ensuring patient safety, and promoting treatment effectiveness. Patient experience encompasses individuals' interactions with the care environment, nursing practices, communication exchanges, and their emotional journey throughout the treatment process [ 11 ] . While patient experience has garnered increased attention within healthcare services, the focus has predominantly centered on chronic conditions such as diabetes and cancer. Conversely, the experience of day surgery patients, characterized by short hospital stays, remains underexplored [ 12 – 13 ] . Journey mapping originated in the market research sector as a methodology for understanding consumer needs. It has subsequently been applied to healthcare, giving rise to PJMs – a visualization tool that depicts patient interactions with healthcare services across different stages of disease progression [ 14 – 15 ] , Specifically, the care interaction map utilizes graphic narratives to visualize interactions between patients and the healthcare system. It captures facilitators, barriers, experiences, and provider interactions encountered by patients and caregivers during entry into, engagement with, and exit from the healthcare system. This tool goes beyond a static patient perspective, delineating critical touchpoints, interaction moments, emotional states, pain points, and satisfaction drivers within the patient journey [ 16 ] . This study aims to utilize patient journey mapping to visualize interaction touchpoints, pain points, and emotional responses during patients' healthcare encounters, to identify actionable targets for healthcare support interventions aligned with genuine patient needs, enabling future-oriented resource allocation and tailored delivery of care support. Methods Participants Patients undergoing arthroscopic rotator cuff repair at Mianyang Central Hospital between April and June 2025 were selected using maximum variation purposive sampling for semi-structured interviews. Sample size was determined according to the principle of data saturation [ 17 ] . Data saturation is reached when no new themes emerge during data analysis. Inclusion criteria were: age ≥ 18 years; scheduled for primary ARCR; intact cognitive function with adequate communication and comprehension abilities; voluntary participation with provision of signed informed consent. Exclusion criteria comprised: severe comorbidities and/or complications; refusal to provide contact information*; voluntary withdrawal during the interview process. Consequently, 13 patients were enrolled (6 males, 7 females), with an age range of 36–73 years. Six procedures were performed on the left shoulder and seven on the right. Ethical All participants provided informed consent voluntarily. The study was approved by the Ethics Committee of Mianyang Central Hospital (No. S20250240-01). Clinical trial number: not applicable.’ Study design This study followed established methodology for PJMs. A preliminary framework was developed through literature review and on-site observation. Semi-structured interviews were then conducted to refine the journey's details based on patients' actual experiences and needs. Finally, the map was collaboratively evaluated and finalized with key stakeholders. Synopsis of an interview The interview guide was developed based on the study objectives and Meleis's Transition Theory model [ 18 ] , encompassing four core processes: transition nature, transition conditions, nursing therapeutics, and response patterns. Guided by this theory, hospitals have increasingly refined their nursing workflows in recent years to deliver phase-specific care that supports patients' successful transition throughout treatment. Meanwhile, an initial interview guide was developed based on literature review and team discussions and was subsequently refined after two pilot interviews. The semi-structured interview guide comprised ten open-ended questions: (1) How did you feel about the process from deciding to undergo surgery to completing the preoperative examinations? What was the primary reason for your decision to proceed with surgery? (2) What challenges or facilitators did you encounter during the preoperative preparation phase? How did these factors impact your experience? (e.g.outpatient visits, preoperative tests, waiting for admission, family support, material preparations) (3) What information did you most want to know before surgery? Was this information provided to you, and if so, by whom (e.g., healthcare providers, family)? How did you perceive the clarity and usefulness of this communication? (4) Describe your overall experience on the day of surgery. (e.g., waiting times, pain levels, sleep quality, dietary arrangements, hospital environment) (5) What were your thoughts and feelings from leaving the ward until the administration of anesthesia in the operating room? (6) Did you face any unexpected difficulties on the day of surgery? If so, how were they resolved? (7) How would you describe your overall recovery experience and physical/emotional state after the procedure? (8) How effective was the communication with doctors and nurses throughout your hospitalization? (9) As you prepared for discharge, what were your primary concerns or unanswered questions about managing your recovery at home? (10) Reflecting on your entire hospitalization journey, what suggestions would you offer to improve the experience for future patients? During interviews, participants were prompted with follow-up questions regarding key themes they raised, such as decision-making processes regarding treatment options, pain management experiences, treatment-related dilemmas, and coping strategies employed. Data Collection Trained qualitative researchers (n = 2) conducted face-to-face, semi-structured interviews using a descriptive approach. Before each session, researchers obtained informed consent from both the patient and family members. The interview process was introduced through self-presentation, clarification of research objectives, and strict confidentiality assurances regarding all shared information. To establish trust, interviews were conducted in a private conference room with audio recording. All identifiers were replaced with anonymous codes to protect privacy, with explicit confirmation that data would be used solely for this study. During interviews, researchers encouraged open narration of experiences and authentic expression of perspectives while avoiding leading questions. Non-verbal cues (e.g., expressions, emotional shifts) were systematically documented. Follow-up probes, paraphrasing, and clarification techniques were employed to explore significant responses until data saturation was achieved. Each interview lasted 40–60 minutes to balance depth and efficiency of data collection. Data Analysis Content analysis [ 19 ] was employed to extract and analyze the interview data. All audio recordings were transcribed verbatim within 24 hours after each interview. The transcripts were then returned to participants for verification to ensure the accuracy of the textual data. Data coding was performed using NVivo software (version 20.2.0) to analyze the textual transcripts. Meaningful statements were extracted and coded to identify recurrent viewpoints. These codes were categorized according to the pre-established three-phase journey framework for patients undergoing arthroscopic rotator cuff repair (preoperative, intraoperative, and postoperative), focusing on the dimensions of tasks, emotions, and pain points across the care continuum. The process ensured comprehensive coverage of all descriptions and identification of similar perspectives. Any coding discrepancies were resolved through group discussions. Finally, researchers collaboratively reviewed the emergent themes with patient representatives to refine and validate the journey map content, ensuring its completeness and coherence. Results A total of 13 patients undergoing ARCR within a day of surgery were interviewed for this study. All 13 participants completed the initial interview, with two participants additionally completing one follow-up interview each, resulting in 15 completed interviews in total. The demographic characteristics of the participants are presented in Table 1 . Table 1 Participant Demographics(n = 13) Participant Gender Age Marital Status Place of residence Level of education Employment status Surgery side N1 Female 73 Widowed urban Primary school Retired left N2 Female 69 Married urban Primary school Farmer right N3 Male 59 Married rural Secondary school Farmer right N4 Male 65 Married urban Secondary school Retired left N5 Female 60 Married rural Secondary school Farmer left N6 Male 36 Married urban Secondary school Teacher left N7 Male 71 Married rural Primary school Farmer right N8 female 65 Married urban Primary school Retired right N9 female 59 Married urban Secondary school Self-employed right N10 female 62 Married urban Primary school Self-employed left N11 female 64 Widowed urban Primary school Farmer right N12 Male 46 Married urban Secondary school Self-employed left N13 Male 37 Married urban Graduate school Teacher right The standard framework for a PJM consists of a horizontal timeline axis and a vertical task-oriented axis [ 14 ] . Based on Meleis's Transition Theory model [ 20 ] , the horizontal axis (timeline) of the patient journey for ARCR patients was divided into three stages in this study: Preoperative Diagnosis and Evaluation, Intraoperative Procedure, and Postoperative Recovery. A preliminary journey framework was developed based on the standard clinical pathway for this patient population and routine tasks across different phases. The vertical axis incorporated the key dimensions of tasks, emotions, pain points, and satisfied specific to the day surgery journey, aligned with the study objectives. Diagnostic and treatment functions for each phase were further refined through iterative analysis of interview data. Figure 1 . Preoperative Diagnosis and Evaluation Tasks Management of comorbidities to mitigate surgical complication risks. "I was diagnosed with a rotator cuff tear and advised to undergo surgery. However, since I have diabetes and hypertension, my doctors emphasized that these conditions must be well-controlled within normal parameters before proceeding. During this period, I strictly adhered to my medication regimen and monitored my blood glucose and blood pressure daily."(N10) Understanding disease etiology and the treatment process. "I was very keen to understand how the rotator cuff tear occurred and the surgical procedure itself -specifically how the repair would resolve the problem."(N12) Emotions Anxiety and Concerns Fear that comorbidities may compromise surgical outcomes or lead to severe complications. "I have severe osteoporosis. The doctor mentioned that the procedure requires anchor/screw fixation , but I'm worried the implants might loosen or fail due to my bone condition."(N5) "I have a cardiac stent and require long-term anticoagulants. I'm deeply concerned about how surgery might affect my heart function and clotting mechanisms."(N11) Helplessness Perceived unidirectional flow of medical information. "The doctor mentioned that if my test results were normal, I would be promptly notified for hospital admission and surgery. However, several days passed without any update. I had no way to know if the results were abnormal, nor did I have contact information to reach my attending physician."(N6) Pain points Preoperative Preparation "The nurse called to inform me about preparing postoperative supplies, but I had never seen these items before. I was uncertain about the specific specifications of the shoulder abduction pillow and the required quantity or dimensions of the nursing pads. (N9) Satisfied Group Education Session "The day before surgery, the medical team notified us to come to the hospital to complete preoperative preparations. A nurse detailed the NPO (nothing by mouth) requirements, and a rehabilitation specialist demonstrated how to properly wear the shoulder abduction pillow and perform postoperative exercises."(N7) Intraoperative Procedure This phase encompasses the period from hospital admission to the completion of surgery and return to the ward. Tasks Symptom Management This encompassed the management of pain, elimination, and sleep "After returning from surgery, I urgently needed to use the toilet. However, being connected to the electrocardiographic (ECG) monitor made it feel quite inconvenient."(N15) "The pain kept me awake at night. I had to frequently press the button on the patient-controlled analgesia (PCA) pump to increase the analgesic dose."(N3) Establishment of a Care Support System "My wife was my primary caregiver throughout the entire process, accompanying me from the preoperative examinations right through to the postoperative period."(N7) "Since my family members were all working and unavailable to care for me, I arranged for a professional attendant from the hospital in advance."( N9) Emotions Worries and expectations about the surgery “Several people around me have undergone this surgery, and they have all recovered well. I believe my surgery will also be successful.” (N6) “After the surgery, I have been feeling a lot of pain, and there is a lot of blood on the dressing. I wonder if the surgery was not done properly, but I don’t dare to ask.” (N13) “When I signed the surgical consent form, I already knew that surgery involved many uncertainties. After the operation, coughing, blood on the dressing, and numbness all became sources of concern for me. That’s why I keep asking doctors and nurses questions.” (N9) Pain points Limited ability to understand information leading to ineffective communication. “When I entered the operating room, the anesthesiologist asked me if I wanted an analgesia pump. I didn’t really know whether it was good or not, and it was quite expensive, so I declined. After the surgery, when I returned to the ward, I was in severe pain and saw that others had analgesia pumps. At that point, I wanted one, but it was already too late.” (N7) Excessive waiting time for surgery “The doctor told me to come to the ward at 8 a.m. to wait for surgery, but I ended up waiting until noon before entering the operating room. I wish the doctor could give me a more precise time to arrive at the ward.” (N4) Satisfied Reduced caregiving burden on family members “When I was hospitalized, the hospital was implementing a ‘care without companions’ service. During my two days in the hospital, we had professional caregivers. I felt they were very professional, which gave me great reassurance.”(N5) Simple and easy-to-understand health education “After surgery, there was a medication that needed to be given by subcutaneous injection. I didn’t know what it was for, but the nurse explained that it was to prevent venous thrombosis. She compared a blood clot to impurities in a water pipe, and said this medicine could reduce the risk of blockage. I immediately understood.” (N6) Postoperative Recovery This phase covers the pre-discharge postoperative period. Participants described their changing emotions and needs during the transition home. Tasks Rehabilitation exercises and mastering proper methods. “The surgery only took a little over an hour, and the doctor said I would be discharged the next day. Rehabilitation exercises afterward are very important, but I am not sure whether going to the hospital’s rehabilitation clinic is more effective or if I can just exercise at home.” (N10) “The doctor only told me to strengthen my exercises, but I don’t know when it will be safe to move my shoulder freely. I am worried that I might tear the tendon again while exercising.” (N12) Outpatient review and follow-up “Although my home is far from the hospital, I will come back for reviews as required by the doctor, which makes me feel more reassured.” (N3) “The nurse said they would follow up by phone after discharge to ask about our pain, rehabilitation exercises, and management of comorbidities. That way, I can also ask questions about things I don’t understand.” (N9) Emotions Insufficient readiness for discharge “I usually live alone, and my daughter is very busy. Now that I have had surgery on my right hand, I cannot even manage basic tasks like cooking or doing laundry at home. My daughter is still busy trying to find a caregiver for me, so my discharge was delayed by one day.” (N1) “The hospital stay was so short, and now I must go home. What if something unexpected happens at home? That is what worries me the most.” (N5) Pain points Feeling Unheard "I felt unsafe about being discharged after surgery. I expressed my desire to stay a few more days to my doctor, but they perceived it as excessive worry."(N3) Disrupted Continuity of Care During the Hospital-to-Home Transition "I live alone. After returning home, I needed assistance—even with basic tasks like combing my hair became impossible after this surgery. Although I hired a caregiver, she wasn't familiar with the specific precautions and needs following my procedure."(N1) Inaccessible Post-Discharge Healthcare Services "I live far from the hospital. The doctor suggested that if my wound started bleeding at home, I could either visit a local hospital for evaluation or return here. However, the nearest hospital is 50 kilometers away. Moreover, I have limited trust in local hospitals' expertise; even if a problem arises, I would still prefer returning here for care." (N7) Satisfied Telemedicine support “When I was discharged, I added the nurse on WeChat. If I have problems with the wound or difficulty moving with my shoulder, I can take a photo and send it to her, which helps me avoid frequent trips to the hospital.” (N13) “The nurse found some videos about rotator cuff injuries for me to watch. I roughly understood the causes of the condition, which also helps me pay more attention in the future to avoid the same problem happening to my right shoulder.” (N12) Discussion This study constructed a PJM depicting the perioperative care experiences of individuals undergoing ARCR in a day surgery setting. The findings delineate key tasks, pain points, emotions, and satisfied drivers across the entire care continuum. This visualization facilitates the identification of potential service improvements and provides an in-depth understanding of patients' lived experiences and perceptions throughout their healthcare journey. The results serve to illuminate the nuanced nursing needs of day surgery recipients across various clinical scenarios, thereby laying the groundwork for an integrated healthcare system. Interdepartmental collaboration is crucial for ensuring the sustainable development of the day surgery model The qualitative findings revealed that patients undergoing this day surgery experienced issues such as preoperative anxiety and inadequate continuity of postoperative care, which is consistent with the quantitative results [ 5 ] . With the progression of population aging, a significant number of surgical patients are often found to have comorbid chronic conditions, including diabetes, hypertension, osteoporosis, among others [ 21 ] . Optimizing a patient's physical condition is essential for day surgery to minimize perioperative risks. The sustainable development of the day surgery model relies on collaborative support from surgeons, nurses, anesthesiologists, and rehabilitation therapists. Sharing critical information—including specific preoperative test results and anesthesia assessments—facilitates timely adjustments to surgical plans, thereby preventing last-minute delays or cancellations due to unmet surgical criteria upon admission [ 22 ] . In the future, the information sharing platform for day surgery patients requires further development to enable real-time access to patient data throughout all perioperative stages. However, this process introduces significant challenges in patient privacy protection and data security, which represent critical issues demanding focused attention in the digital healthcare era. Visualization of the healthcare process enhances patient engagement in medical services Arthroscopic day surgery for the shoulder has matured into a safe, efficient, and cost-effective healthcare model [ 9 ] . However, its condensed timeframe places greater demands on the coordination and seamless integration of all perioperative phases. Furthermore, the successful implementation of day surgery relies heavily on patients' awareness and acceptance of minimally invasive techniques and enhanced recovery protocols. Study findings reveal a predominantly unidirectional flow of information during the patient journey. This passive reception of medical information results in low levels of patient engagement in the care process. This study employed in-depth, face-to-face interviews to extract key themes and construct a patient journey map. This map consolidates fragmented and specialized perioperative information into a clear, intuitive visual narrative, achieving visualization of the clinical pathway. By dismantling information barriers between patients and providers, it fosters a bidirectional exchange of information, which serves as the foundation for transitioning patients from passive recipients to active participants in their care [ 23 ] . Future initiatives should refine the mapped journey by detailing pain points across the preoperative preparation, intraoperative process, postoperative recovery, and rehabilitation phases. This will enable the development of patient-facing visual aids that clarify the patient's role and tasks throughout the entire care continuum. Additionally, given the substantial proportion of older adults with rotator cuff tears, accessibility features such as enlarged fonts, audio assistance, and graphical representations should be incorporated into the visual design to enhance patient engagement and health literacy. Providing tailored discharge preparedness support to meet the needs of a diverse patient population Self-care, functional exercise, and wound management during the transition from hospital to home represent a critical extension of the surgical procedure for day surgery patients. Findings from this study indicate that a majority of patients felt inadequately prepared before discharge, expressing concerns about potential postoperative complications and doubting their own self-care and emergency management capabilities. This apprehension stems from the significant challenge of adapting to daily life when health issues intersect with essential Activities of Daily Living, such as cooking, laundry, toileting, and personal hygiene—impacting their overall post-discharge adjustment capacity [ 24 ] . These findings highlight current gaps in care continuity following arthroscopic day surgery. Given the geographical distance many patients live from the hospital, future efforts should focus on enhancing intelligent remote follow-up management systems. These systems can collect patient-generated health data and provide personalized guidance on postoperative precautions, thereby strengthening professional support. Furthermore, strengthening the connection between hospitals, homes, and community care services can improve transitional care. This enhanced collaboration can facilitate monitoring of comorbidities, assessment of the surgical site, and proper brace management—effectively extending specialized nursing support beyond the hospital walls [ 25 ] . The results indicated that patients' concerns regarding postoperative functional recovery stemmed primarily from economic and geographical constraints, which prevented most from returning to outpatient clinics for rehabilitation. Exercise prescription [ 26 ] presents a viable solution. During hospitalization, rehabilitation specialists develop tailored plans specifying exercise frequency, type, intensity, and duration, based on individual shoulder function, age, and comorbidities. Patients then execute these predefined rehabilitation protocols at home, with adherence and outcomes tracked via an intelligent follow-up system. This approach enables effective telerehabilitation, enhances the feasibility of day surgery programs, optimizes the patient experience, and improves overall healthcare efficiency. Conclusion Our study utilized a PJM to gain an in-depth understanding of the transition experiences and perspectives of patients who are undergoing ARCR with day surgery, as they moved rapidly from home to hospital and back to home-based care. The PJM provides a collective illustration of their touchpoints, pain points, emotions, and satisfied throughout the healthcare process. This visualization helps identify potential areas for improvement, refine the coordinated health management resource system within the day surgery model, and ultimately enhance both the patient experience and satisfaction levels. Furthermore, the journey map serves to showcase the complexities of nursing care and reinforces the concept that patients and their caregivers are essential partners who need to be engaged throughout the entire care process. Limitation Limitations of this study include its conduction within a single center, along with constraints such as a small sample size, regional and cultural specificity, a limited time frame, and the inherent subjectivity of interview-based data. Consequently, the findings may not be directly generalizable to other regions or to patients undergoing different types of day surgeries. Future research should aim to expand both the sample size and geographical scope, incorporate long-term follow-up, and explore multidimensional assessment and optimization strategies. Leveraging modern information technology to enable more precise and AI-driven personalized management throughout the entire day surgery process is also essential, with the ultimate goal of comprehensively enhancing patients' overall experience and quality of life. Declarations E thical A pproval All methods were performed according to the relevant guidelines and regulations or by the Declaration of Helsinki. Biomedical ethics committee of Mianyang Central Hospital approved the study (NO: S20250240-01). All participants gave informed voluntary consent following assurance of the confidentiality of the study questionnaires. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Mianyang Health Commission[grant numbers 2024057] and Sichuan Medical Association of china [grant numbers 2022TG26] Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Acknowledgments We would like to thank all the patients and caregiver for their participation in the current study. Author’s contributions All authors approved the study. RH, YW conceived the study. ZQ, LW, and RS collected the data. LW wrote the first draft of the manuscript. All authors read and critically revised the first draft and confirmed the final version of the manuscript. Author’s information (optional) Rong Hu, Department of Nursing, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China. 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Cite Share Download PDF Status: Published Journal Publication published 09 Jan, 2026 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Revision requested 27 Nov, 2025 Reviews received at journal 24 Oct, 2025 Reviews received at journal 14 Oct, 2025 Reviewers agreed at journal 07 Oct, 2025 Reviewers agreed at journal 05 Oct, 2025 Reviewers agreed at journal 03 Oct, 2025 Reviewers invited by journal 16 Sep, 2025 Editor invited by journal 01 Sep, 2025 Editor assigned by journal 30 Aug, 2025 Submission checks completed at journal 30 Aug, 2025 First submitted to journal 29 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7486333","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":518487755,"identity":"e7fd2f09-2455-49a9-ae11-1186f4e1eadb","order_by":0,"name":"Li Wang","email":"","orcid":"","institution":"Mianyang Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Wang","suffix":""},{"id":518487756,"identity":"e1481d87-128b-4054-8802-011584a19f4b","order_by":1,"name":"Ya-Qing Zhang","email":"","orcid":"","institution":"Mianyang Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Ya-Qing","middleName":"","lastName":"Zhang","suffix":""},{"id":518487758,"identity":"ad81479d-792b-41b0-a6cf-fe287a10abe2","order_by":2,"name":"Rong Song","email":"","orcid":"","institution":"Mianyang Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Rong","middleName":"","lastName":"Song","suffix":""},{"id":518487759,"identity":"4e51c447-e5a8-4266-86bd-dfeeccfeb52c","order_by":3,"name":"Chun-yan Wang","email":"","orcid":"","institution":"Mianyang Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Chun-yan","middleName":"","lastName":"Wang","suffix":""},{"id":518487760,"identity":"8f593fe3-bac2-4a37-895b-45be00c9d304","order_by":4,"name":"Rong Hu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuElEQVRIiWNgGAWjYHACNgjF3tj48AMx6nngWngONxtLkKZFIr1NgIcYLfbsp9Me8+6xyZOPfNjGIMFgJ6fbQMgWntztxjzP0ooNbye2PShgSDY2O0BIiwTvNmmeA4cTN85ObDeQYDiQuI14LTMPtknwkKRlvgQjsVrO5G6TnHMgLXEDTyIwkA2I8At7+9ltEm8O2CTObz/+8OGHCjs5glrgwACs0oBY5SAg30CK6lEwCkbBKBhRAAA+3UA/AUALrwAAAABJRU5ErkJggg==","orcid":"","institution":"Mianyang Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":true,"prefix":"","firstName":"Rong","middleName":"","lastName":"Hu","suffix":""}],"badges":[],"createdAt":"2025-08-29 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06:38:59","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":91460,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7486333/v1/e4cce27ad1b0023c7a7a3c86.html"},{"id":92144067,"identity":"9469e82e-c2c5-4bf2-b1fb-f2e0398791ce","added_by":"auto","created_at":"2025-09-25 06:38:58","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":640680,"visible":true,"origin":"","legend":"\u003cp\u003ePatient journey map of individuals undergoing ARCR\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7486333/v1/c372836c8ec36187826a45dd.jpeg"},{"id":100070843,"identity":"a8dae486-1bda-4ff1-a4d2-caa8b087b374","added_by":"auto","created_at":"2026-01-12 16:18:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1360012,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7486333/v1/ea748ec0-a77f-43e8-9258-7898b9b9278b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perioperative Transition Experience of Patients Undergoing Shoulder Arthroscopy Day Surgery: An Exploratory Study Using Patient Journey Mapping","fulltext":[{"header":"Background","content":"\u003cp\u003eWith the continuous aging of the global population, shoulder disorders have emerged as a significant and growing public health concern. Among these, rotator cuff tears stand as the most prevalent tendon pathology in orthopedic practice, clinically characterized by shoulder pain, weakness, sleep disturbances, and restricted range of motion \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Surgical intervention is typically indicated when non-operative management fails after 3\u0026ndash;6 months, the tear size is large, or symptoms significantly impair the patient's activities of daily life \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. ARCR is the most established treatment for rotator cuff tears, effectively restoring shoulder function, relieving pain, and improving quality of life \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Driven by advancements in medical technology and improvements in healthcare delivery models, day surgery has undergone rapid expansion. In many European countries, over 50% of elective procedures are now performed as day surgeries \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e, Day surgery is defined as a surgical pathway where patients undergo admission, the surgical procedure, and discharge within a 24-to-48-hour period \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e, this surgical pathway is characterized by its efficiency, brief inpatient duration, and cost-effectiveness \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Driven by advancements in minimally invasive shoulder arthroscopy techniques and the implementation of ERAS protocols \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, ARCR has transitioned into the realm of day surgery, with its safety profile well established \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePatients undergoing day surgery, like all surgical patients, navigate a complex healthcare journey involving multiple departments and numerous procedural steps. The shortened inpatient duration does not equate to a simplified care pathway; rather, it imposes heightened demands on interdepartmental coordination and necessitates an enhanced patient experience. Our observations reveal persistent challenges in patient experience and care support. China's \u0026ldquo;Action Plan for Enhancing the Patient Experience (2023\u0026ndash;2025)\u0026rdquo; explicitly prioritizes improving the healthcare experience for the public, mandating comprehensive review and optimization of clinical workflows to address bottlenecks in healthcare access \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Understanding and enhancing the patient experience is increasingly recognized as a critical measure for improving healthcare quality, ensuring patient safety, and promoting treatment effectiveness. Patient experience encompasses individuals' interactions with the care environment, nursing practices, communication exchanges, and their emotional journey throughout the treatment process \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. While patient experience has garnered increased attention within healthcare services, the focus has predominantly centered on chronic conditions such as diabetes and cancer. Conversely, the experience of day surgery patients, characterized by short hospital stays, remains underexplored \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eJourney mapping originated in the market research sector as a methodology for understanding consumer needs. It has subsequently been applied to healthcare, giving rise to PJMs \u0026ndash; a visualization tool that depicts patient interactions with healthcare services across different stages of disease progression \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e, Specifically, the care interaction map utilizes graphic narratives to visualize interactions between patients and the healthcare system. It captures facilitators, barriers, experiences, and provider interactions encountered by patients and caregivers during entry into, engagement with, and exit from the healthcare system. This tool goes beyond a static patient perspective, delineating critical touchpoints, interaction moments, emotional states, pain points, and satisfaction drivers within the patient journey \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. This study aims to utilize patient journey mapping to visualize interaction touchpoints, pain points, and emotional responses during patients' healthcare encounters, to identify actionable targets for healthcare support interventions aligned with genuine patient needs, enabling future-oriented resource allocation and tailored delivery of care support.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eParticipants\u003c/p\u003e\u003cp\u003ePatients undergoing arthroscopic rotator cuff repair at Mianyang Central Hospital between April and June 2025 were selected using maximum variation purposive sampling for semi-structured interviews. Sample size was determined according to the principle of data saturation \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Data saturation is reached when no new themes emerge during data analysis. Inclusion criteria were: age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; scheduled for primary ARCR; intact cognitive function with adequate communication and comprehension abilities; voluntary participation with provision of signed informed consent. Exclusion criteria comprised: severe comorbidities and/or complications; refusal to provide contact information*; voluntary withdrawal during the interview process. Consequently, 13 patients were enrolled (6 males, 7 females), with an age range of 36\u0026ndash;73 years. Six procedures were performed on the left shoulder and seven on the right.\u003c/p\u003e\u003cp\u003eEthical\u003c/p\u003e\u003cp\u003e All participants provided informed consent voluntarily. The study was approved by the Ethics Committee of Mianyang Central Hospital (No. S20250240-01). Clinical trial number: not applicable.\u0026rsquo;\u003c/p\u003e\u003cp\u003eStudy design\u003c/p\u003e\u003cp\u003eThis study followed established methodology for PJMs. A preliminary framework was developed through literature review and on-site observation. Semi-structured interviews were then conducted to refine the journey's details based on patients' actual experiences and needs. Finally, the map was collaboratively evaluated and finalized with key stakeholders.\u003c/p\u003e\u003cp\u003eSynopsis of an interview\u003c/p\u003e\u003cp\u003eThe interview guide was developed based on the study objectives and Meleis's Transition Theory model\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, encompassing four core processes: transition nature, transition conditions, nursing therapeutics, and response patterns. Guided by this theory, hospitals have increasingly refined their nursing workflows in recent years to deliver phase-specific care that supports patients' successful transition throughout treatment. Meanwhile, an initial interview guide was developed based on literature review and team discussions and was subsequently refined after two pilot interviews. The semi-structured interview guide comprised ten open-ended questions: (1) How did you feel about the process from deciding to undergo surgery to completing the preoperative examinations? What was the primary reason for your decision to proceed with surgery? (2) What challenges or facilitators did you encounter during the preoperative preparation phase? How did these factors impact your experience? (e.g.outpatient visits, preoperative tests, waiting for admission, family support, material preparations) (3) What information did you most want to know before surgery? Was this information provided to you, and if so, by whom (e.g., healthcare providers, family)? How did you perceive the clarity and usefulness of this communication? (4) Describe your overall experience on the day of surgery. (e.g., waiting times, pain levels, sleep quality, dietary arrangements, hospital environment) (5) What were your thoughts and feelings from leaving the ward until the administration of anesthesia in the operating room? (6) Did you face any unexpected difficulties on the day of surgery? If so, how were they resolved? (7) How would you describe your overall recovery experience and physical/emotional state after the procedure? (8) How effective was the communication with doctors and nurses throughout your hospitalization? (9) As you prepared for discharge, what were your primary concerns or unanswered questions about managing your recovery at home? (10) Reflecting on your entire hospitalization journey, what suggestions would you offer to improve the experience for future patients?\u003c/p\u003e\u003cp\u003e During interviews, participants were prompted with follow-up questions regarding key themes they raised, such as decision-making processes regarding treatment options, pain management experiences, treatment-related dilemmas, and coping strategies employed.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Collection\u003c/h2\u003e\u003cp\u003eTrained qualitative researchers (n\u0026thinsp;=\u0026thinsp;2) conducted face-to-face, semi-structured interviews using a descriptive approach. Before each session, researchers obtained informed consent from both the patient and family members. The interview process was introduced through self-presentation, clarification of research objectives, and strict confidentiality assurances regarding all shared information. To establish trust, interviews were conducted in a private conference room with audio recording. All identifiers were replaced with anonymous codes to protect privacy, with explicit confirmation that data would be used solely for this study. During interviews, researchers encouraged open narration of experiences and authentic expression of perspectives while avoiding leading questions. Non-verbal cues (e.g., expressions, emotional shifts) were systematically documented. Follow-up probes, paraphrasing, and clarification techniques were employed to explore significant responses until data saturation was achieved. Each interview lasted 40\u0026ndash;60 minutes to balance depth and efficiency of data collection.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eContent analysis \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e was employed to extract and analyze the interview data. All audio recordings were transcribed verbatim within 24 hours after each interview. The transcripts were then returned to participants for verification to ensure the accuracy of the textual data. Data coding was performed using NVivo software (version 20.2.0) to analyze the textual transcripts. Meaningful statements were extracted and coded to identify recurrent viewpoints. These codes were categorized according to the pre-established three-phase journey framework for patients undergoing arthroscopic rotator cuff repair (preoperative, intraoperative, and postoperative), focusing on the dimensions of tasks, emotions, and pain points across the care continuum. The process ensured comprehensive coverage of all descriptions and identification of similar perspectives. Any coding discrepancies were resolved through group discussions. Finally, researchers collaboratively reviewed the emergent themes with patient representatives to refine and validate the journey map content, ensuring its completeness and coherence.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 13 patients undergoing ARCR within a day of surgery were interviewed for this study. All 13 participants completed the initial interview, with two participants additionally completing one follow-up interview each, resulting in 15 completed interviews in total. The demographic characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant Demographics(n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePlace of residence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLevel of education\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eEmployment status\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSurgery side\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eleft\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eright\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003erural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003cp\u003eschool\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eright\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003cp\u003eschool\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eleft\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003erural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003cp\u003eschool\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eleft\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003cp\u003eschool\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTeacher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eleft\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003erural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eright\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eright\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003cp\u003eschool\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eright\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eleft\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eright\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003cp\u003eschool\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eleft\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGraduate school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTeacher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eright\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe standard framework for a PJM consists of a horizontal timeline axis and a vertical task-oriented axis \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Based on Meleis's Transition Theory model \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, the horizontal axis (timeline) of the patient journey for ARCR patients was divided into three stages in this study: Preoperative Diagnosis and Evaluation, Intraoperative Procedure, and Postoperative Recovery. A preliminary journey framework was developed based on the standard clinical pathway for this patient population and routine tasks across different phases. The vertical axis incorporated the key dimensions of tasks, emotions, pain points, and satisfied specific to the day surgery journey, aligned with the study objectives. Diagnostic and treatment functions for each phase were further refined through iterative analysis of interview data. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ePreoperative Diagnosis and Evaluation\u003c/p\u003e\u003cp\u003eTasks\u003c/p\u003e\u003cp\u003eManagement of comorbidities to mitigate surgical complication risks.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I was diagnosed with a rotator cuff tear and advised to undergo surgery. However, since I have\u003c/em\u003e diabetes and hypertension, my doctors emphasized that these conditions must be well-controlled within normal parameters before proceeding. During this period, I strictly adhered to my medication regimen and monitored my blood glucose and blood pressure daily.\"(N10)\u003c/p\u003e\u003cp\u003eUnderstanding disease etiology and the treatment process.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I was very keen to understand how the rotator cuff tear occurred and the surgical procedure itself\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003cp\u003e-specifically how the repair would resolve the problem.\"(N12)\u003c/p\u003e\n\u003cp\u003eEmotions\u003c/p\u003e\u003cp\u003eAnxiety and Concerns Fear that comorbidities may compromise surgical outcomes or lead to\u003c/p\u003e\u003cp\u003esevere complications.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I have severe osteoporosis. The doctor mentioned that the procedure requires anchor/screw fixation\u003c/em\u003e,\u003c/p\u003e\n\u003cp\u003ebut I'm worried the implants might loosen or fail due to my bone condition.\"(N5)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"I have a cardiac stent and require long-term anticoagulants. I'm deeply concerned about how\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003cp\u003esurgery might affect my heart function and clotting mechanisms.\"(N11)\u003c/p\u003e\u003cp\u003eHelplessness Perceived unidirectional flow of medical information.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"The doctor mentioned that if my test results were normal, I would be promptly notified for hospital admission and surgery. However, several days passed without any update. I had no way to know if the results were abnormal, nor did I have contact information to reach my attending physician.\"(N6)\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePain points Preoperative Preparation\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"The nurse called to inform me about preparing postoperative supplies, but I had never seen these items before. I was uncertain about the specific specifications of the shoulder abduction pillow and the required quantity or dimensions of the nursing pads. (N9)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eSatisfied Group Education Session\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"The day before surgery, the medical team notified us to come to the hospital to complete preoperative preparations. A nurse detailed the NPO (nothing by mouth) requirements, and a rehabilitation specialist demonstrated how to properly wear the shoulder abduction pillow and perform postoperative exercises.\"(N7)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIntraoperative Procedure This phase encompasses the period from hospital admission to the completion of surgery and return to the ward.\u003c/p\u003e\u003cp\u003eTasks\u003c/p\u003e\u003cp\u003eSymptom Management This encompassed the management of pain, elimination, and sleep\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"After returning from surgery, I urgently needed to use the toilet. However, being connected to the electrocardiographic (ECG) monitor made it feel quite inconvenient.\"(N15)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"The pain kept me awake at night. I had to frequently press the button on the patient-controlled analgesia (PCA) pump to increase the analgesic dose.\"(N3)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eEstablishment of a Care Support System\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"My wife was my primary caregiver throughout the entire process, accompanying me from the preoperative examinations right through to the postoperative period.\"(N7)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Since my family members were all working and unavailable to care for me, I arranged for a professional attendant from the hospital in advance.\"( N9)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eEmotions\u003c/p\u003e\u003cp\u003eWorries and expectations about the surgery\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Several people around me have undergone this surgery, and they have all recovered well. I believe my surgery will also be successful.\u0026rdquo; (N6)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;After the surgery, I have been feeling a lot of pain, and there is a lot of blood on the dressing. I wonder if the surgery was not done properly, but I don\u0026rsquo;t dare to ask.\u0026rdquo; (N13)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e \u0026ldquo;When I signed the surgical consent form, I already knew that surgery involved many uncertainties. After the operation, coughing, blood on the dressing, and numbness all became sources of concern for me. That\u0026rsquo;s why I keep asking doctors and nurses questions.\u0026rdquo; (N9)\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePain points\u003c/p\u003e\u003cp\u003eLimited ability to understand information leading to ineffective communication.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I entered the operating room, the anesthesiologist asked me if I wanted an analgesia pump. I didn\u0026rsquo;t really know whether it was good or not, and it was quite expensive, so I declined. After the surgery, when I returned to the ward, I was in severe pain and saw that others had analgesia pumps. At that point, I wanted one, but it was already too late.\u0026rdquo; (N7)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eExcessive waiting time for surgery\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The doctor told me to come to the ward at 8 a.m. to wait for surgery, but I ended up waiting until noon before entering the operating room. I wish the doctor could give me a more precise time to arrive at the ward.\u0026rdquo; (N4)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eSatisfied\u003c/p\u003e\u003cp\u003eReduced caregiving burden on family members\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I was hospitalized, the hospital was implementing a \u0026lsquo;care without companions\u0026rsquo; service. During my two days in the hospital, we had professional caregivers. I felt they were very professional, which gave me great reassurance.\u0026rdquo;(N5)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eSimple and easy-to-understand health education\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;After surgery, there was a medication that needed to be given by subcutaneous injection. I didn\u0026rsquo;t know what it was for, but the nurse explained that it was to prevent venous thrombosis. She compared a blood clot to impurities in a water pipe, and said this medicine could reduce the risk of blockage. I immediately understood.\u0026rdquo; (N6)\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePostoperative Recovery\u003c/p\u003e\u003cp\u003eThis phase covers the pre-discharge postoperative period. Participants described their changing emotions and needs during the transition home.\u003c/p\u003e\u003cp\u003eTasks\u003c/p\u003e\u003cp\u003eRehabilitation exercises and mastering proper methods.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The surgery only took a little over an hour, and the doctor said I would be discharged the next day. Rehabilitation exercises afterward are very important, but I am not sure whether going to the hospital\u0026rsquo;s rehabilitation clinic is more effective or if I can just exercise at home.\u0026rdquo; (N10)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The doctor only told me to strengthen my exercises, but I don\u0026rsquo;t know when it will be safe to move my shoulder freely. I am worried that I might tear the tendon again while exercising.\u0026rdquo; (N12)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eOutpatient review and follow-up\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Although my home is far from the hospital, I will come back for reviews as required by the doctor, which makes me feel more reassured.\u0026rdquo; (N3)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The nurse said they would follow up by phone after discharge to ask about our pain, rehabilitation exercises, and management of comorbidities. That way, I can also ask questions about things I don\u0026rsquo;t understand.\u0026rdquo; (N9)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eEmotions\u003c/p\u003e\u003cp\u003eInsufficient readiness for discharge\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I usually live alone, and my daughter is very busy. Now that I have had surgery on my right hand, I cannot even manage basic tasks like cooking or doing laundry at home. My daughter is still busy trying to find a caregiver for me, so my discharge was delayed by one day.\u0026rdquo; (N1)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The hospital stay was so short, and now I must go home. What if something unexpected happens at home? That is what worries me the most.\u0026rdquo; (N5)\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePain points\u003c/p\u003e\u003cp\u003eFeeling Unheard\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I felt unsafe about being discharged after surgery. I expressed my desire to stay a few more days to my doctor, but they perceived it as excessive worry.\"(N3)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eDisrupted Continuity of Care During the Hospital-to-Home Transition\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I live alone. After returning home, I needed assistance\u0026mdash;even with basic tasks like combing my hair became impossible after this surgery. Although I hired a caregiver, she wasn't familiar with the specific precautions and needs following my procedure.\"(N1)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eInaccessible Post-Discharge Healthcare Services\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I live far from the hospital. The doctor suggested that if my wound started bleeding at home, I could either visit a local hospital for evaluation or return here. However, the nearest hospital is 50 kilometers away. Moreover, I have limited trust in local hospitals' expertise; even if a problem arises, I would still prefer returning here for care.\" (N7)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eSatisfied\u003c/p\u003e\u003cp\u003eTelemedicine support\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I was discharged, I added the nurse on WeChat. If I have problems with the wound or difficulty moving with my shoulder, I can take a photo and send it to her, which helps me avoid frequent trips to the hospital.\u0026rdquo; (N13)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The nurse found some videos about rotator cuff injuries for me to watch. I roughly understood the causes of the condition, which also helps me pay more attention in the future to avoid the same problem happening to my right shoulder.\u0026rdquo; (N12)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study constructed a PJM depicting the perioperative care experiences of individuals undergoing ARCR in a day surgery setting. The findings delineate key tasks, pain points, emotions, and satisfied drivers across the entire care continuum. This visualization facilitates the identification of potential service improvements and provides an in-depth understanding of patients' lived experiences and perceptions throughout their healthcare journey. The results serve to illuminate the nuanced nursing needs of day surgery recipients across various clinical scenarios, thereby laying the groundwork for an integrated healthcare system.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eInterdepartmental collaboration is crucial for ensuring the sustainable development of the day surgery model\u003c/h2\u003e\u003cp\u003eThe qualitative findings revealed that patients undergoing this day surgery experienced issues such as preoperative anxiety and inadequate continuity of postoperative care, which is consistent with the quantitative results \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. With the progression of population aging, a significant number of surgical patients are often found to have comorbid chronic conditions, including diabetes, hypertension, osteoporosis, among others \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Optimizing a patient's physical condition is essential for day surgery to minimize perioperative risks. The sustainable development of the day surgery model relies on collaborative support from surgeons, nurses, anesthesiologists, and rehabilitation therapists. Sharing critical information\u0026mdash;including specific preoperative test results and anesthesia assessments\u0026mdash;facilitates timely adjustments to surgical plans, thereby preventing last-minute delays or cancellations due to unmet surgical criteria upon admission \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. In the future, the information sharing platform for day surgery patients requires further development to enable real-time access to patient data throughout all perioperative stages. However, this process introduces significant challenges in patient privacy protection and data security, which represent critical issues demanding focused attention in the digital healthcare era.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eVisualization of the healthcare process enhances patient engagement in medical services\u003c/h2\u003e\u003cp\u003eArthroscopic day surgery for the shoulder has matured into a safe, efficient, and cost-effective healthcare model \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. However, its condensed timeframe places greater demands on the coordination and seamless integration of all perioperative phases. Furthermore, the successful implementation of day surgery relies heavily on patients' awareness and acceptance of minimally invasive techniques and enhanced recovery protocols. Study findings reveal a predominantly unidirectional flow of information during the patient journey. This passive reception of medical information results in low levels of patient engagement in the care process. This study employed in-depth, face-to-face interviews to extract key themes and construct a patient journey map. This map consolidates fragmented and specialized perioperative information into a clear, intuitive visual narrative, achieving visualization of the clinical pathway. By dismantling information barriers between patients and providers, it fosters a bidirectional exchange of information, which serves as the foundation for transitioning patients from passive recipients to active participants in their care\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Future initiatives should refine the mapped journey by detailing pain points across the preoperative preparation, intraoperative process, postoperative recovery, and rehabilitation phases. This will enable the development of patient-facing visual aids that clarify the patient's role and tasks throughout the entire care continuum. Additionally, given the substantial proportion of older adults with rotator cuff tears, accessibility features such as enlarged fonts, audio assistance, and graphical representations should be incorporated into the visual design to enhance patient engagement and health literacy.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eProviding tailored discharge preparedness support to meet the needs of a diverse patient population\u003c/h2\u003e\u003cp\u003eSelf-care, functional exercise, and wound management during the transition from hospital to home represent a critical extension of the surgical procedure for day surgery patients. Findings from this study indicate that a majority of patients felt inadequately prepared before discharge, expressing concerns about potential postoperative complications and doubting their own self-care and emergency management capabilities. This apprehension stems from the significant challenge of adapting to daily life when health issues intersect with essential Activities of Daily Living, such as cooking, laundry, toileting, and personal hygiene\u0026mdash;impacting their overall post-discharge adjustment capacity\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. These findings highlight current gaps in care continuity following arthroscopic day surgery. Given the geographical distance many patients live from the hospital, future efforts should focus on enhancing intelligent remote follow-up management systems. These systems can collect patient-generated health data and provide personalized guidance on postoperative precautions, thereby strengthening professional support. Furthermore, strengthening the connection between hospitals, homes, and community care services can improve transitional care. This enhanced collaboration can facilitate monitoring of comorbidities, assessment of the surgical site, and proper brace management\u0026mdash;effectively extending specialized nursing support beyond the hospital walls\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. The results indicated that patients' concerns regarding postoperative functional recovery stemmed primarily from economic and geographical constraints, which prevented most from returning to outpatient clinics for rehabilitation. Exercise prescription\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e presents a viable solution. During hospitalization, rehabilitation specialists develop tailored plans specifying exercise frequency, type, intensity, and duration, based on individual shoulder function, age, and comorbidities. Patients then execute these predefined rehabilitation protocols at home, with adherence and outcomes tracked via an intelligent follow-up system. This approach enables effective telerehabilitation, enhances the feasibility of day surgery programs, optimizes the patient experience, and improves overall healthcare efficiency.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e Our study utilized a PJM to gain an in-depth understanding of the transition experiences and perspectives of patients who are undergoing ARCR with day surgery, as they moved rapidly from home to hospital and back to home-based care. The PJM provides a collective illustration of their touchpoints, pain points, emotions, and satisfied throughout the healthcare process. This visualization helps identify potential areas for improvement, refine the coordinated health management resource system within the day surgery model, and ultimately enhance both the patient experience and satisfaction levels. Furthermore, the journey map serves to showcase the complexities of nursing care and reinforces the concept that patients and their caregivers are essential partners who need to be engaged throughout the entire care process.\u003c/p\u003e\u003cp\u003eLimitation\u003c/p\u003e\u003cp\u003eLimitations of this study include its conduction within a single center, along with constraints such as a small sample size, regional and cultural specificity, a limited time frame, and the inherent subjectivity of interview-based data. Consequently, the findings may not be directly generalizable to other regions or to patients undergoing different types of day surgeries. Future research should aim to expand both the sample size and geographical scope, incorporate long-term follow-up, and explore multidimensional assessment and optimization strategies. Leveraging modern information technology to enable more precise and AI-driven personalized management throughout the entire day surgery process is also essential, with the ultimate goal of comprehensively enhancing patients' overall experience and quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eE\u003c/strong\u003e\u003cstrong\u003ethical\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;A\u003c/strong\u003e\u003cstrong\u003epproval\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll methods were performed\u0026nbsp;according to\u0026nbsp;the relevant guidelines and regulations or\u0026nbsp;by\u0026nbsp;the Declaration of Helsinki. Biomedical ethics committee of Mianyang Central Hospital approved the study (NO: S20250240-01). All participants gave informed voluntary consent following assurance of the confidentiality of the study questionnaires.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Mianyang Health Commission[grant numbers 2024057] and Sichuan Medical Association of china [grant numbers 2022TG26]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the patients and caregiver for their participation\u0026nbsp;in the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors approved the study. RH, YW conceived the study. ZQ, LW, and RS collected the data. LW wrote the first draft of the manuscript. All authors read and critically revised the first draft and confirmed the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s information (optional)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRong Hu, Department of Nursing, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eORCID：https://orcid.org/0000-0002-9491-5038\u003c/p\u003e\n\u003cp\u003ehttps://orcid.org/0000-0002-9491-5038\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCole BJ, ElAttrache NS, Anbari A. Arthroscopic rotator cuff repairs: an anatomic and biomechanical rationale for different suture-anchor repair configurations. Arthroscopy. 2007 Jun;23(6):662-9.\u003c/li\u003e\n\u003cli\u003eZhu P, Wang Z, Li H, et al. Platelet-Rich Plasma Injection in Non-Operative Treatment of Partial-Thickness Rotator Cuff Tears: A Systematic Review and Meta-Analysis. J Rehabil Med. 2022 Sep 16;54:jrm00312.\u003c/li\u003e\n\u003cli\u003ePAPALIA R, FRANCESCHI F, ZAMPOGNA B, et al. Augmentation techniques for rotator cuff repair[J/OL]. British Medical Bulletin, 2013, 105: 107-138. \u003c/li\u003e\n\u003cli\u003eWEBER S, CHAHAL J. Management of rotator cuff injuries. Journal of the American Academy of Orthopaedic Surgeons, 2020, 28(5): e193-e201. \u003c/li\u003e\n\u003cli\u003eLARSSON F, STR\u0026Ouml;MB\u0026Auml;CK U, RYSST GUSTAFSSON S, et al. Postoperative recovery: experiences of patients who have undergone orthopedic day surgery. Journal of Perianesthesia Nursing, 2022, 37(4): 515-520. \u003c/li\u003e\n\u003cli\u003eBAILEY C R, AHUJA M, BARTHOLOMEW K, et al. Guidelines for day-case surgery 2019: guidelines from the association of anaesthetists and the british association of day surgery. Anaesthesia, 2019, 74(6): 778-792. \u003c/li\u003e\n\u003cli\u003eLi YR, Zhu LL, Li Q, et al. Day surgery of arthroscopic rotator cuff repair based on enhanced recovery after surgery[J]. Chinese Health Quality Management, 2025, 32(7): 14-19. \u003c/li\u003e\n\u003cli\u003eKHANDHAR S J, SCHATZ C L, COLLINS D T, et al. Thoracic enhanced recovery with ambulation after surgery: a 6-year experience. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery, 2018, 53(6): 1192-1198. \u003c/li\u003e\n\u003cli\u003eQin C, Curtis DM, Reider B, Shi LL, Lee MJ, Athiviraham A. Orthopaedic Shoulder Surgery in the Ambulatory Surgical Center: Safety and Outcomes. Arthroscopy. 2019 Sep;35(9):2545-2550.e1.\u003c/li\u003e\n\u003cli\u003eNotice on Launching a Themed Activity to Enhance the Patient Experience. Gazette of the National Health Commission of the People\u0026apos;s Republic of China, 2023(5): 3-7[2025-08-15]. \u003c/li\u003e\n\u003cli\u003eNEWELL S, JORDAN Z. The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 2015, 13(1): 76-87.\u003c/li\u003e\n\u003cli\u003eCIRIA-SUAREZ L, JIM\u0026Eacute;NEZ-FONSECA P, PALAC\u0026Iacute;N-LOIS M, et al. Breast cancer patient experiences through a journey map: a qualitative study. PLOS One, 2021, 16(9): e0257680. \u003c/li\u003e\n\u003cli\u003eBENSON M, ALBANESE A, BHATIA K P, et al. Development of a patient journey map for people living with cervical dystonia. Orphanet Journal of Rare Diseases, 2022, 17(1): 130. \u003c/li\u003e\n\u003cli\u003eDAVIES E L, BULTO L N, WALSH A, et al. Reporting and conducting patient journey mapping research in healthcare: a scoping review. Journal of Advanced Nursing, 2023, 79(1): 83-100. \u003c/li\u003e\n\u003cli\u003eLY S, RUNACRES F, POON P. Journey mapping as a novel approach to healthcare: a qualitative mixed methods study in palliative care. BMC Health Services Research, 2021, 21(1): 915. \u003c/li\u003e\n\u003cli\u003eSARAGOSA M, NIZZER S, MCKAY S, et al. The hospital-to-home care transition experience of home care clients: an exploratory study using patient journey mapping. BMC Health Services Research, 2023, 23(1): 934. \u003c/li\u003e\n\u003cli\u003eLi Z，Liu Y. Nursing research methods[M]. 2nd ed. Beijing: People\u0026apos;s Medical Publishing House，2018.\u003c/li\u003e\n\u003cli\u003eGAMA L M de P, RIBEIRO K R C, OLIVEIRA J L C de, et al. Transition from hospital to home care: a mixed methods study in light of meleis\u0026rsquo;s theory. Revista Brasileira de Enfermagem, 2025, 78(1): e20230357. \u003c/li\u003e\n\u003cli\u003eHSIEH H F, SHANNON S E. Three approaches to qualitative content analysis. Qualitative Health Research, 2005, 15(9): 1277-1288. \u003c/li\u003e\n\u003cli\u003eDAVIES S. Meleis\u0026rsquo;s theory of nursing transitions and relatives\u0026rsquo; experiences of nursing home entry[J/OL]. Journal of Advanced Nursing, 2005, 52(6): 658-671. \u003c/li\u003e\n\u003cli\u003eRIJKEN M, HUJALA A, VAN GINNEKEN E, et al. Managing multimorbidity: profiles of integrated care approaches targeting people with multiple chronic conditions in Europe. Health Policy (amsterdam, Netherlands), 2018, 122(1): 44-52. \u003c/li\u003e\n\u003cli\u003eWu M, Xia L, Zhang L, et al. Interactive patient journey map of perioperative healthcare experience in patients undergoing day surgery for pulmonary nodules under the enhanced recovery after surgery model. West China Medical Journal, 2025, 40(2): 276-281.\u003c/li\u003e\n\u003cli\u003eZheng J, Fei W Y, Zhu C R, et al. Evaluation of the application effect of a total process-optimized day surgery protocol for arthroscopic rotator cuff repair. Journal of Clinical Medicine in Practice, 2023, 27(12): 63-68. \u003c/li\u003e\n\u003cli\u003eHESTEVIK C H, MOLIN M, DEBESAY J, et al. Older persons\u0026rsquo; experiences of adapting to daily life at home after hospital discharge: a qualitative metasummary. BMC Health Services Research, 2019, 19(1): 224.\u003c/li\u003e\n\u003cli\u003eKIRST M, ELMI A, RAY-DANIELS M, et al. Client engagement in home and community care services: the client and care coordinator perspective. Healthcare Management Forum, 2016, 29(4): 146-148. \u003c/li\u003e\n\u003cli\u003eMANGIONE K K, PALOMBARO K M. Exercise prescription for a patient 3 months after hip fracture[J]. Physical Therapy, 2005, 85(7): 676-687.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Arthroscopic rotator cuff repair, Day surgery, Journey mapping, Patient experience, Descriptive qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-7486333/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7486333/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e With the advancement of orthopedic enhanced recovery after surgery (ERAS), the frequency of orthopedic procedures performed as day surgeries has increased. Improvements in shoulder arthroscopy techniques and updates in ERAS protocols have enabled arthroscopic rotator cuff repair (ARCR) to be conducted as a day surgery. However, the reduced hospital stay introduces significant challenges for patients. Limited research exists on how day surgery patients manage the transition between home and the surgical setting, although these experiences and coping strategies have a substantial impact on patient health outcomes. This study aimed to identify the perioperative healthcare experiences of patients undergoing ARCR day surgery, reduce perioperative risks, and improve patient satisfaction.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e A descriptive qualitative study was conducted. Interview guides were developed based on the Transition Theory. Semi-structured interviews were performed with 13 patients undergoing day surgery in the orthopedic ward of a tertiary hospital in Sichuan Province, China, between January and March 2025. Data were analyzed using content analysis, and patient journey maps (PJMs) were constructed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e PJMs were created along the treatment timeline and perioperative phases. Patient experiences and needs during ARCR day surgery were categorized into 22 themes across 4 dimensions (Tasks, Emotions, Pain Points, Improvement Points) and 3 stages: Preoperative Stage (8 themes): Comprehensive assessment and examinations; Comorbidity management; Understanding the disease and treatment process; Helplessness; Anxiety; Preoperative preparation. Perioperative Stage (7 themes): Symptom management; Worry; Waiting; Information communication; Caregiving burden. Postoperative Stage (7 themes): Follow-up; Rehabilitation exercises; Listening; Discharge readiness; Telemedicine support.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e The healthcare journey for patients undergoing ARCR day surgery is condensed and characterized by complex, evolving needs. PJMs enable healthcare providers to identify critical interaction points, challenges, and opportunities for improvement throughout the perioperative process. Utilizing PJMs supports the optimal allocation of medical resources, enhances clinical services, ensures patient safety, and improves the overall patient experience.\u003c/p\u003e","manuscriptTitle":"Perioperative Transition Experience of Patients Undergoing Shoulder Arthroscopy Day Surgery: An Exploratory Study Using Patient Journey Mapping","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-25 06:38:39","doi":"10.21203/rs.3.rs-7486333/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-27T15:20:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-24T20:40:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T10:00:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205092439747887407995780985022629554167","date":"2025-10-07T04:57:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"289687395247520901404835273871716286557","date":"2025-10-05T10:12:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78544441776420300674008995720244952558","date":"2025-10-03T18:18:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-16T14:04:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-01T08:55:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-30T05:12:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-30T05:12:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-08-29T07:55:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2e9768a2-3fa4-4c3e-8ff1-420ff3cee19b","owner":[],"postedDate":"September 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:16:43+00:00","versionOfRecord":{"articleIdentity":"rs-7486333","link":"https://doi.org/10.1186/s12891-025-09419-9","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2026-01-09 15:59:22","publishedOnDateReadable":"January 9th, 2026"},"versionCreatedAt":"2025-09-25 06:38:39","video":"","vorDoi":"10.1186/s12891-025-09419-9","vorDoiUrl":"https://doi.org/10.1186/s12891-025-09419-9","workflowStages":[]},"version":"v1","identity":"rs-7486333","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7486333","identity":"rs-7486333","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}