The research team, led by Xiangyun Wang and Shuyin Qian as co-first authors with Junlin Chen as corresponding author, set out to quantify healthcare professionals’ knowledge, attitudes, and practices (KAP) regarding neck and shoulder functional rehabilitation exercises after cervical lymph node dissection. Between September and November 2025, they invited every eligible healthcare professional within a predefined sampling frame at the hospital to complete a self-administered online questionnaire. The instrument captured demographic characteristics alongside the three classic KAP dimensions, a framework long used in health services research to diagnose where the gaps between what clinicians know, what they believe, and what they do actually lie.

The response statistics alone make the study a methodologically solid snapshot. Of 455 eligible professionals invited, 414 returned the questionnaire, a response rate of 91.0 percent. After four invalid questionnaires were excluded, 410 participants entered the final analysis. In clinical survey research, response rates above 90 percent are rare and valuable, because nonresponse bias, the systematic tendency of certain groups to skip surveys, is one of the most common threats to the validity of cross-sectional findings. A near-census of the eligible workforce means the results likely reflect the actual composition of staff at this institution rather than a skewed volunteer sample.

The headline numbers reveal an asymmetry that rehabilitation specialists will find familiar. Participants scored 6.59 plus or minus 2.95 on the knowledge dimension, on a possible range of 0 to 10, indicating suboptimal command of the technical details of post-dissection rehabilitation. Attitude scores, by contrast, averaged 27.56 plus or minus 3.73 on a possible range of 6 to 30, sitting close to the ceiling and signaling strongly positive beliefs about the value of the exercises. Practice scores averaged 42.45 plus or minus 8.88 on a possible range of 10 to 50, which the authors characterize as high levels of self-reported practice. In plain terms: the staff were not walking encyclopedias of rehabilitation science, but they were enthusiastic believers and, by their own accounts, active deliverers of the exercises.

The statistical heart of the paper lies in how these three dimensions relate to one another, and here the findings challenge the intuitive assumption that knowledge is the engine of good clinical behavior. Knowledge showed a statistically significant but negligible negative correlation with practice, with a Pearson coefficient of r equal to minus 0.098 and a P value of 0.048. A negative correlation of this magnitude is so small that it is essentially indistinguishable from zero in practical terms, yet its statistical significance in a sample of 410 is a striking signal: knowing more about the rehabilitation protocol did not translate into doing more, and if anything pointed very weakly in the opposite direction.

Attitude told a completely different story. It demonstrated a moderate positive correlation with practice, r equal to 0.555 with P less than 0.001, meaning that professionals who held more favorable beliefs about the exercises reported substantially more consistent delivery of them. To probe whether this association held up under more sophisticated modeling, the team turned to structural equation modeling, or SEM, a statistical framework that allows researchers to test hypothesized networks of direct and indirect relationships among latent constructs rather than examining pairwise correlations in isolation. The SEM confirmed the pattern: attitude was significantly associated with practice in the model, with a standardized path coefficient of beta equal to 0.385 and P equal to 0.012, while knowledge had no significant direct or indirect associations with practice.

That null result for knowledge, in both the direct and indirect pathways, is the finding with the widest implications. In many health behavior models, knowledge is theorized to work partly through attitude, shaping what people believe and thereby what they do. If knowledge had shown an indirect effect through attitude, the prescription would be straightforward: invest in education and the rest follows. Instead, the data suggest that at this institution, the bottleneck is not information but conviction and system design. The authors conclude that future efforts should prioritize standardized training and multidisciplinary rehabilitation pathways to strengthen knowledge translation and improve postoperative rehabilitation guidance, a formulation that acknowledges both the knowledge deficit and the primacy of attitude in driving behavior.

Several technical caveats frame how these results should be read. The study is a single-center cross-sectional survey, so it captures one hospital at one point in time; it cannot establish causality, and it cannot tell us whether the attitude-practice link would replicate in institutions with different staffing mixes, training cultures, or patient populations. The practice measure is self-reported, which invites social desirability bias, the well-documented tendency of professionals to overstate their adherence to recommended care. Objective observation of exercise delivery, or patient-reported receipt of guidance, would be needed to confirm that high self-reported practice corresponds to real-world behavior. The knowledge scale’s possible range of 0 to 10 also means the observed mean of 6.59, while labeled suboptimal, leaves room for interpretation about where the clinical threshold for adequate knowledge should sit.

The clinical stakes of these questions are substantial. Head and neck cancers, abbreviated HNCs in the paper, are among the most disfiguring and functionally consequential malignancies, and cervical lymph node dissection is a common component of their surgical management. The spinal accessory nerve, which innervates the trapezius muscle, is frequently at risk during neck dissection, and injury to it produces the shoulder droop, weakness, and pain syndrome that functional rehabilitation exercises are designed to mitigate. When postoperative guidance is inconsistent or technically imprecise, patients may develop avoidable disability, reduced quality of life, and higher long-term care burdens. That is why the education of the professionals who deliver this guidance, from surgeons to nurses to rehabilitation therapists, is a legitimate target of research in its own right.

What emerges from the Nantong survey is a data-driven argument for rethinking how rehabilitation capacity is built in post-oncologic surgical care. If attitude is the strongest lever on practice, then interventions that build genuine conviction, such as multidisciplinary pathways that embed rehabilitation into routine postoperative care, may outperform pure knowledge campaigns. At the same time, the suboptimal knowledge scores and the authors’ call for standardized training indicate that factual mastery cannot be neglected, even if it does not directly move behavior in this dataset. The study, published on 16 October 2026 with the DOI 10.1186/s12909-026-10367-8, was approved by the Medical Ethics Committee of The Sixth People’s Hospital of Nantong and conducted in accordance with the Declaration of Helsinki, with written informed consent from all participants. Its most durable contribution may be methodological: a template for measuring, with statistical rigor, whether the workforce entrusted with cancer rehabilitation is equipped to deliver it, and a reminder that in clinical behavior change, what professionals believe may matter more than what they know.

Subject of Research: Medical Education

Article Title: Knowledge, attitudes, and practices of healthcare professionals regarding neck and shoulder functional rehabilitation exercises after cervical lymph node dissection: a single-center cross-sectional survey

Article References: Wang, X., Qian, S., Chen, J., Cao, C., & Ma, X. (2026). Knowledge, attitudes, and practices of healthcare professionals regarding neck and shoulder functional rehabilitation exercises after cervical lymph node dissection: a single-center cross-sectional survey. BMC Medical Education. https://doi.org/10.1186/s12909-026-10367-8

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10367-8

Keywords: neck dissection, rehabilitation, exercise therapy, healthcare professionals, KAP survey, medical education, head and neck cancer, structural equation modeling, Knowledge, attitudes, practices, healthcare