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Ley C, Putz P. Efficacy of interventions and techniques on adherence to physiotherapy in adults: an overview of systematic reviews and panoramic meta-analysis. Syst Rev 2024; 13:137. [PMID: 38773659 PMCID: PMC11106864 DOI: 10.1186/s13643-024-02538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/17/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Adherence to physiotherapeutic treatment and recommendations is crucial to achieving planned goals and desired health outcomes. This overview of systematic reviews synthesises the wide range of additional interventions and behaviour change techniques used in physiotherapy, exercise therapy and physical therapy to promote adherence and summarises the evidence of their efficacy. METHODS Seven databases (PEDro, PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO and CINAHL) were systematically searched with terms related to physiotherapy, motivation, behaviour change, adherence and efficacy (last searched on January 31, 2023). Only systematic reviews of randomised control trials with adults were included. The screening process and quality assessment with AMSTAR-2 were conducted independently by the two authors. The extracted data was synthesised narratively. In addition, four meta-analyses were pooled in a panoramic meta-analysis. RESULTS Of 187 reviews identified in the search, 19 were included, comprising 205 unique trials. Four meta-analyses on the effects of booster sessions, behaviour change techniques, goal setting and motivational interventions showed a significantly small overall effect (SMD 0.24, 95% CI 0.13, 0.34) and no statistical heterogeneity (I2 = 0%) in the panoramic meta-analysis. Narrative synthesis revealed substantial clinical and methodological diversity. In total, the certainty of evidence is low regarding the efficacy of the investigated interventions and techniques on adherence, due to various methodological flaws. Most of the RCTs that were included in the reviews analysed cognitive and behavioural interventions in patients with musculoskeletal diseases, indicating moderate evidence for the efficacy of some techniques, particularly, booster sessions, supervision and graded exercise. The reviews provided less evidence for the efficacy of educational and psychosocial interventions and partly inconsistent findings. Most of the available evidence refers to short to medium-term efficacy. The combination of a higher number of behaviour change techniques was more efficacious. CONCLUSIONS The overview of reviews synthesised various potentially efficacious techniques that may be combined for a holistic and patient-centred approach and may support tailoring complex interventions to the patient's needs and dispositions. It also identifies various research gaps and calls for a more holistic approach to define and measure adherence in physiotherapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021267355.
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Affiliation(s)
- Clemens Ley
- Department Health Sciences, Physiotherapy, FH Campus Wien University of Applied Sciences, Favoritenstrasse 226, 1100, Vienna, Austria.
| | - Peter Putz
- Department Health Sciences, Competence Center INDICATION, FH Campus Wien, University of Applied Sciences, Favoritenstrasse 226, 1100, Vienna, Austria
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Truong LK, Mosewich AD, Miciak M, Losciale JM, Li LC, Whittaker JL. Social support and therapeutic relationships intertwine to influence exercise behavior in people with sport-related knee injuries. Physiother Theory Pract 2024:1-14. [PMID: 38374585 DOI: 10.1080/09593985.2024.2315520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Explore how social support influences exercise therapy participation and adherence before and after enrolling in an education and exercise therapy intervention (Stop OsteoARthritis, SOAR). METHODS Study design: Interpretative description. We sampled participants with sport-related knee injuries from the SOAR randomized controlled trial. SOAR is a virtual, physiotherapist-guided, education and exercise therapy-based knee health program that targets individuals at risk of early osteoarthritis. One-on-one semi-structured interviews were completed, and an inductive approach was guided by Braun & Clarke's reflexive thematic analysis. RESULTS Fifteen participants (67% female, median age 26 [19-35] years) were interviewed. Three themes were generated that encapsulated participants' social support experiences that fostered exercise participation: 1) Treat me as a whole person represented the value of social support that went beyond participants' physical needs, 2) Work with me highlighted the working partnership between the clinician and the participant, and 3) Journey with me indicated a need for on-going support is necessary for the long-term management of participants' knee health. A theme of the therapeutic relationship was evident across the findings. CONCLUSIONS Insight was gained into how and why perceived support may be linked to exercise behavior, with the therapeutic relationship being potentially linked to perceived support. Social support strategies embedded within an education and exercise therapy program may boost exercise adherence after sport-related knee injuries.
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Affiliation(s)
- Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Amber D Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Maxi Miciak
- College of Health Sciences, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
- College of Health Sciences, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Chester R, Daniell H, Belderson P, Wong C, Kinsella P, McLean S, Hill J, Banerjee A, Naughton F. Behaviour Change Techniques to promote self-management and home exercise adherence for people attending physiotherapy with musculoskeletal conditions: A scoping review and mapping exercise. Musculoskelet Sci Pract 2023; 66:102776. [PMID: 37301059 DOI: 10.1016/j.msksp.2023.102776] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Many patients with musculoskeletal problems do not adhere to home exercises or self-management advice provided by physiotherapists. This is due to numerus factors, many of which can be targeted by Behaviour Change Techniques. OBJECTIVES 1) Undertake a scoping review to identify the modifiable determinants (barriers and facilitators) of home exercise adherence and self-management for the physiotherapy management of people with musculoskeletal problems and map them to the Theoretical Domains Framework and Behaviour Change Techniques. 2) For determinants with supporting evidence from ≥2 studies, provide examples of Behaviour Change Techniques for clinical practice. DESIGN This review follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. METHOD Four electronic databases were searched from inception to December 2022. Two independent reviewers carried out manuscript selection, data extraction, quality assessment, and mapping, the latter using the Theory and Techniques Tool. RESULTS Thirteen modifiable determinants were identified in 28 studies. The most frequently identified were self-efficacy, social support, and task appreciation. Determinants were mapped to 7 of 14 Theoretical Domains Framework categories, which in turn mapped onto 42 of 93 Behaviour Change Techniques, the most common being problem solving and instruction on how to perform behaviour. CONCLUSIONS By identifying determinants to home exercise adherence and self-management and mapping these to Behaviour Change Techniques, this review has improved understanding of their selection, targeting, and potential application to musculoskeletal physiotherapy practice. This provides support for physiotherapists targeting the determinants of importance for the patient in front of them.
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Affiliation(s)
- Rachel Chester
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, United Kingdom.
| | - Helena Daniell
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, United Kingdom; Physiotherapy Department, Norfolk and Norwich University Hospital, NHS Trust, Norwich, United Kingdom.
| | - Pippa Belderson
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, United Kingdom.
| | - Carl Wong
- Department of Therapies, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, United Kingdom.
| | - Paula Kinsella
- Flint House Police Rehabilitation, Reading Road, Goring, Reading, RG8 0LL, United Kingdom; Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Campus, Collegiate Cres, Broomhall, Sheffield, S10 2BP, United Kingdom.
| | - Sionnadh McLean
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Campus, Collegiate Cres, Broomhall, Sheffield, S10 2BP, United Kingdom.
| | - Jonathan Hill
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - Anirban Banerjee
- Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - Felix Naughton
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, United Kingdom.
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Rodríguez Sánchez-Laulhé P, Biscarri-Carbonero Á, Suero-Pineda A, Luque-Romero LG, Barrero García FJ, Blanquero J, Heredia-Rizo AM. The effects of a mobile app-delivered intervention in people with symptomatic hand osteoarthritis: a pragmatic randomized controlled trial. Eur J Phys Rehabil Med 2023; 59:54-64. [PMID: 36633498 PMCID: PMC10035439 DOI: 10.23736/s1973-9087.22.07744-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Exercise therapy, self-management and education are recommended interventions for hand osteoarthritis (OA), but new delivery systems are needed to solve lack of adherence. AIM To determine the effects on hand function and pain related measures of a mobile app-delivered intervention, compared with usual care, in patients with symptomatic hand OA. DESIGN A pragmatic, multicenter, two-group parallel randomized controlled trial. SETTING Community health centers in rural southern Spain. POPULATION Eighty-three participants with unilateral or bilateral symptomatic hand OA were proposed to participate, and finally 74 were included and randomized. METHODS Participants received a home multimodal treatment (exercise, education, and self-management recommendations) with the CareHand mobile app or usual care (written exercises) over 12 weeks. Monthly telephone calls were performed to monitor adherence. The primary outcome was hand physical function (Australian/Canadian Hand Osteoarthritis Index, AUSCAN) at 3- and 6-months. Secondary measures included hand pain intensity and morning stiffness, upper limb function, hand dexterity, and grip and pinch strength. RESULTS The CareHand group showed significant within-group changes in hand function at 6-months (-3.0, 95% CI -5.1 to -0.9 vs. usual care: -0.9, 95% CI -3.3 to 1.5). Neither group showed improvements in hand function at 3-months (CareHand: -1.5, 95% CI -3.1 to 0.1; usual care: -0.5, 95% CI -2.7 to 1.7). For the secondary outcomes, the CareHand group showed better results on upper limb function both at 3- and 6-months, and on pain both at 1- and 3-months compared to usual care group. Linear regression models indicated that baseline scores of pain intensity, hand status, and upper limb function were associated with a greater improvement in hand pain and physical function. CONCLUSIONS A mobile app-delivered intervention is effective for improving hand function, and better than usual care for upper limb function and pain. Further research is warranted to understand the impact of mobile health (mHealth) in people with hand OA. CLINICAL REHABILITATION IMPACT mHealth interventions are a feasible and secure multimodal delivery approach in older adults with hand OA in rural primary care setting. Baseline pain and upper limb function might predict functional hand outcomes.
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Affiliation(s)
- Pablo Rodríguez Sánchez-Laulhé
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain -
- Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, University of Seville, Seville, Spain -
| | | | - Alejandro Suero-Pineda
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain
| | - Luis G Luque-Romero
- Research Unit, Aljarafe-Sevilla North Health District, Andalusian Health Service, Seville, Spain
- Department of Normal and Pathological Cytology and Histology, University of Seville, Seville, Spain
| | | | - Jesús Blanquero
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain
| | - Alberto M Heredia-Rizo
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Seville, Seville, Spain
- Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, University of Seville, Seville, Spain
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Motl RW, Lein DH, Morris DM, Lowman JD, Perez P, Bullard C. Behavior Change Interventions for Health Promotion in Physical Therapist Research and Practice: An Integrative Approach. Phys Ther 2022; 102:6448010. [PMID: 34935964 DOI: 10.1093/ptj/pzab266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/26/2021] [Accepted: 09/15/2021] [Indexed: 11/12/2022]
Abstract
There is an increasing focus on health promotion in physical therapist research and practice. A clinical model (Health-Focused Physical Therapy Model) was developed for identifying major steps in the delivery of health promotion focusing on adoption of healthy lifestyle behaviors. One of the primary steps within this model is the design and delivery of behavior change interventions. Such interventions involve coordinated sets of activities that target change in a specific pattern of unhealthy behavior (eg, physical inactivity, smoking). This Perspective contends that the science and practice of behavior change interventions can be significantly advanced in the field of physical therapy (implementation science) through the integration of behavior change frameworks and techniques within the context of an experimental medicine approach for health behavior change. This perspective presents the integration of the Theoretical Domains Framework, the Behavior Change Wheel, including the Capability Opportunity Motivation-Behavior core system, and the Behavior Change Technique Taxonomy as a comprehensive approach for designing and delivering behavior change interventions in physical therapy. An experimental medicine approach is described, outlining a 4-step process in the design, delivery, and evaluation of behavior change interventions that can be applied to health promotion in physical therapist research and practice. The proposed integrative approach can advance public health and health promotion through healthy lifestyle behavior change in the field of physical therapy.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, Illinois, USA
| | - Donald H Lein
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David M Morris
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John D Lowman
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patricia Perez
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cara Bullard
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
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