<![CDATA[Background: Suboptimal health-related quality of life (HRQoL) during recovery from lower-extremity surgery can increase healthcare costs and reduce patients’ overall well-being. However, evidence regarding factors influencing HRQoL trajectories remains limited.Purpose: This study examined predictors of HRQoL and self-efficacy at weeks 1 and 4 after hospital discharge in patients undergoing lower-extremity orthopedic surgery.Methods: This prospective cohort study used consecutive sampling to recruit 90 patients undergoing lower-extremity orthopedic surgery (hip, femur, knee, tibia) at a tertiary hospital in Thailand. Collected data included demographic characteristics, clinical factors, anthropometric measurements (body mass index [BMI] and waist circumference), and surgical variables. Outcomes were assessed at weeks 1 and 4 after discharge using the 12-Item Short Form Health Survey (SF-12) to measure HRQoL and a validated 25-item questionnaire to measure self-efficacy. Multiple regression analysis was used to identify independent predictors of postoperative HRQoL, while paired-samples t-tests were used to examine changes in HRQoL and self-efficacy between weeks 1 and 4.Results: This study found that BMI independently predicted poorer physical-domain HRQoL at week 1 (β = -0.54, p = 0.023) and week 4 (β = -0.62, p = 0.008). Waist circumference emerged as an additional predictor of the physical domain of HRQoL at week 4 (β = -0.58, p = 0.002). The regression models explained 22.8% of the variance at week 1 (R² = 0.228, p < 0.001) and 21.8% at week 4 (R² = 0.218, p < 0.001). Self-efficacy improved substantially from week 1 to week 4 (MD = 14.33, SDD = 9.86, Cohen’s d = 2.03, p < 0.001). In contrast, the SF-12 physical component summary (PCS) scores remained unchanged (week 1: M = 28.21, SD = 1.66; week 4: M = 28.11, SD = 1.30; MD = -0.10, SDD = 1.35, Cohen’s d = 0.07, p = 0.571), revealing a marked dissociation between improved psychological confidence and stable outcomes in the physical domain of HRQoL.Conclusion: Elevated BMI consistently predicts poorer postoperative HRQoL following lower extremity surgery, with improvements in the physical domain of HRQoL often lagging behind improvements in patients’ self-efficacy. Perioperative nurses should emphasize routine BMI assessment and targeted weight-management education to bridge the gap between perceived self-efficacy and physical HRQoL outcomes in perioperative care protocols.]]>
