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Fleischmann M, Vaughan B, Fitzgerald K. The Use of Exercise Prescription in Australian Osteopathy Practice: Secondary Analysis of a Nationally Representative Sample of the Profession. ScientificWorldJournal 2024; 2024:1977684. [PMID: 38911694 PMCID: PMC11192601 DOI: 10.1155/2024/1977684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/03/2024] [Accepted: 05/15/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Exercise is beneficial for improving general health, wellbeing, and specific medical conditions. In musculoskeletal conditions such as chronic low back and neck pain, prescribed exercise has been found to be moderately effective in decreasing pain and improving function. Osteopaths are primary contact health professionals who manage predominantly musculoskeletal complaints. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and profiles the characteristics of osteopaths who often use exercise prescription in patient care. Methodology. Secondary analysis of a cross-sectional survey of 992 osteopaths was registered with the Osteopathy Research and Innovation Network, an Australian practice-based research network. Demographics, practice, and treatment characteristics of Australian osteopaths who "often" use exercise prescription in patient care were examined. Results Seven-hundred and thirty-three Australian osteopaths (74%) indicated that they use exercise prescription "often" in patient care. Australian osteopaths who often use exercise prescription are more likely to be colocated with another osteopath (ORa 1.54) and send referrals to an exercise physiologist (ORa 1.94) and a specialist medical practitioner (ORa 1.72). Those osteopaths who often used exercise prescription were also more likely to discuss physical activity (ORa 5.61) and nutrition (ORa 1.90). Australian osteopaths who use exercise prescription often were more likely to treat patients with sports injuries (ORa 2.43) and use soft tissue techniques (ORa 1.92), trigger point techniques (ORa 2.72), and sports taping (ORa 1.78). Conclusion Osteopaths who utilise exercise prescription were more likely to discuss physical activity, diet, and nutrition and utilise referral networks with specialist medical practitioners and exercise physiologists. Australian osteopaths who often use exercise prescriptions were also more likely to treat patients with sport injury. The results suggest that most Australian osteopaths use exercise prescription and have referral networks with other health professionals for patient management. Further work is required to explore the type of exercise prescription used and for what conditions.
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Affiliation(s)
- Michael Fleischmann
- School of Health and Biomedical Science, RMIT University, Melbourne, Australia
- Osteopathy College of Sport, Health and Engineering (CoSHE), Victoria University, Melbourne, Australia
| | - Brett Vaughan
- Department of Medical Education, University of Melbourne, Melbourne, Australia
| | - Kylie Fitzgerald
- Department of Medical Education, University of Melbourne, Melbourne, Australia
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Farjami Rad Y, Shahmoradi L, Nakhostin Ansari N, Hasson S, Ebrahimi M, Rahmani Katigari M. Developing a Content Model of a Mobile-Based Application to Manage Patients with Low-Back and Neck Pain. Int J Telemed Appl 2024; 2024:8415777. [PMID: 38223335 PMCID: PMC10787052 DOI: 10.1155/2024/8415777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/09/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction As a complementary tool in health, the design of mobile applications to influence care and increase awareness of patients has grown a lot. The purpose of this study is to design and validate the content model of a mobile-based application for managing patients with low-back and neck pain. Methods This descriptive-analytical study was conducted in two main stages to determine the content model of the application. The first stage consisted of three steps: finding the right exercise, determining the right scale to assess the pain intensity, and determining the appropriate features of the application. In the second stage, data elements collected from the previous stage were prepared in the form of a questionnaire that was given to 12 experts in physical therapy and sports medicine for validation. After collecting the questionnaire, data elements in all parts were analyzed based on the content validity ratio (CVR) and descriptive statistics indicators. Result The content of the application was prepared in the three axes of exercises for low-back and neck pain, assessment of pain intensity, and features of the application. In the axis of sports exercises, 8 exercises for back pain and 3 exercises for neck pain were included according to the reference books. A Functional Rating Index (FRI) scale with 10 elements was selected in the axis of determining pain intensity. Also, 12 features such as the daily exercise section, using the animation, and using an audio file to explain how to do exercises were included in the model. Conclusion According to the gaps identified in the existing applications, determining the content model of the application that is based on evidence and according to the opinion of experts is useful in improving the apps. The content model of this study was presented in 3 axes to increase the patient's willingness to do exercises, the correct way to perform exercises, conservative treatment, and check the progress of the treatment. The software developers can use these findings as a basis for designing new apps to manage low-back pain and neck pain.
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Affiliation(s)
- Yasaman Farjami Rad
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Shahmoradi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, Georgia, USA
| | - Maryam Ebrahimi
- Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Meysam Rahmani Katigari
- Department of Health Information Technology, Saveh University of Medical Sciences, Saveh, Iran
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Hakam HT, Mühlensiepen F, Salzmann M, Lettner J, Becker R, Kopf S, Prill R. Development of the INpaTiEnt Rehabilitation App Compliance QuesTionnaire [INTERACT]. J Pers Med 2023; 13:1638. [PMID: 38138865 PMCID: PMC10744598 DOI: 10.3390/jpm13121638] [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: 09/21/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The elements of previously designed questionnaires do not take into consideration the burdens encountered in an inpatient hospital setting. The purpose of this study is to validate elements of a non-compliance survey in an in-hospital setting and discuss aspects of compliance with telerehabilitative physiotherapy in the early postoperative period. METHODS A literature search was conducted to identify elements that prevent patients from performing their prescribed physical therapy exercises. These items were then evaluated by the expert review technique as described by Ikart. Afterwards, the synthesized survey was handed out to patients for the assessment of the quality of its items. RESULTS The results of the expert review technique identified some conceptual and grammatical problems. This led to the adjustment of some of the elements. The quality of the resulting questionnaire was deemed to be good, as patients were able to fully understand the concepts and answer accordingly. A statistical analysis was conducted to evaluate the responses. CONCLUSIONS The items of this second questionnaire have proven to be reliable to assess the compliance of patients in an in-hospital setting. These items will be added to the cross-culturally adapted items of a previous questionnaire.
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Affiliation(s)
- Hassan Tarek Hakam
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School, Hochstr. 29, 14770 Brandenburg an der Havel, Germany
- Faculty of Health Science, Brandenburg Medical School, 14770 Brandenburg an der Havel, Germany
- Center of Evidence Based Practice in Brandenburg (EBB), A JBI Affiliated Group, Brandenburg Medical School, 14770 Brandenburg an der Havel, Germany
| | - Felix Mühlensiepen
- Faculty of Health Science, Brandenburg Medical School, 14770 Brandenburg an der Havel, Germany
- Center of Evidence Based Practice in Brandenburg (EBB), A JBI Affiliated Group, Brandenburg Medical School, 14770 Brandenburg an der Havel, Germany
- Center for Health Services Research, Brandenburg Medical School, 15562 Rüdersdorf, Germany
| | - Mikhail Salzmann
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School, Hochstr. 29, 14770 Brandenburg an der Havel, Germany
| | - Jonathan Lettner
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School, Hochstr. 29, 14770 Brandenburg an der Havel, Germany
- Faculty of Health Science, Brandenburg Medical School, 14770 Brandenburg an der Havel, Germany
- Center of Evidence Based Practice in Brandenburg (EBB), A JBI Affiliated Group, Brandenburg Medical School, 14770 Brandenburg an der Havel, Germany
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School, Hochstr. 29, 14770 Brandenburg an der Havel, Germany
- Faculty of Health Science, Brandenburg Medical School, 14770 Brandenburg an der Havel, Germany
| | - Sebastian Kopf
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School, Hochstr. 29, 14770 Brandenburg an der Havel, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School, Hochstr. 29, 14770 Brandenburg an der Havel, Germany
- Faculty of Health Science, Brandenburg Medical School, 14770 Brandenburg an der Havel, Germany
- Center of Evidence Based Practice in Brandenburg (EBB), A JBI Affiliated Group, Brandenburg Medical School, 14770 Brandenburg an der Havel, Germany
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Halfpap J, Allen C, Rhon DI. A novel Home Exercise Assessment Tool (HEAT) to assess recall and performance: A reliability study. Physiother Theory Pract 2023; 39:423-432. [PMID: 35129064 DOI: 10.1080/09593985.2021.2017089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND A reliable and valid tool to measure short-term recall does not exist. OBJECTIVE The purpose of this study was o assess the reliability of a novel tool designed to evaluate the immediate recall and performance of prescribed exercises. This reliability study was secondary from a parent randomized controlled trial. METHODS Patients ages 18 to 65 with low back or unilateral knee pain longer than 6 weeks, reporting to a primary care or physical therapy clinic at one large military hospital. Participants were randomized into one of four groups based on number of exercises and type of instruction. The Home Exercise Assessment Tool (HEAT) is scored along an ordinal scale, (zero = low; three = high performance), with 2+ equal to meeting the intent of the exercise. Reliability of testing was assessed using a pool of four raters. RESULTS The interrater reliability of the HEAT performed on 30 participants (9 females, and 21males, mean age 36.7 (SD = 11.7)) and eight participants during pilot testing demonstrated moderate to good reliability (ICC = 0.66-0.77). Intrarater reliability during pilot testing was excellent (ICC = 0.93-0.96). CONCLUSION The HEAT demonstrated moderate to good interrater and excellent intrarater reliability. This tool is unique in that it assesses both recall and adherence, and merits further testing in other settings.
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Affiliation(s)
- Joshua Halfpap
- Bowling Green State University, College of Health and Human Services Doctor of Physical Therapy Program, Ohio Bowling Green U.S.A
| | - Christopher Allen
- Doctor of Physical Therapy Program University of Cincinnati, College of Allied Health Sciences, Cincinnati Ohio U.S.A
| | - Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio Texas U.S.A
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Bourke J, Skouteris H, Hatzikiriakidis K, Fahey D, Malliaras P. Use of Behavior Change Techniques Alongside Exercise in the Management of Rotator Cuff-Related Shoulder Pain: A Scoping Review. Phys Ther 2022; 102:6482025. [PMID: 34972867 DOI: 10.1093/ptj/pzab290] [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: 01/20/2021] [Revised: 08/20/2021] [Accepted: 11/19/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The aims of this scoping review were to: (1) determine the frequency and types of behavior change techniques (BCTs) and education utilized in trials investigating exercise interventions for rotator cuff related shoulder pain (RCRSP); (2) subcategorize the BCTs and education found in the trials to summarize all behavior change approaches reported by trials; and (3) compare the frequency, types, and subcategories of BCTs and education utilized in the clinical guidelines for managing RCRSP between the trials. METHODS Data sources included Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE, CINAHL Plus, Google Scholar and PubMed, which were searched from inception to June 2020. Trials assessing exercise interventions for RCRSP were included. Three authors independently determined eligibility and extracted data. The frequency and types of BCTs and education in the trials and clinical practice guidelines were reported and compared descriptively. Two authors assessed the content of the BCTs to develop subcategories. RESULTS Most trials reported including at least 1 type of BCT (89.2%), which was most commonly feedback and monitoring (78.5%). There were many different approaches to the BCTs and education; for example, feedback and monitoring was subcategorized into supervised exercise, exercise monitoring, and feedback through external aids, such as mirrors. Clinical guidelines recommend supervision, goal setting, activity modification, pain management recommendations, information about the condition, and exercise education. CONCLUSION Although over two-thirds of trials reported including a BCT alongside exercise interventions for RCRSP, the breadth of these interventions is limited (supervision is the only common one). Future trialists should consider using any type of BCT that may improve exercise adherence and outcomes. IMPACT The findings of this review have: (1) identified gaps in the literature; and (2) contributed to the design of future exercise interventions for RCRSP.
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Affiliation(s)
- Jaryd Bourke
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kostas Hatzikiriakidis
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Fahey
- Enhance Sports Performance and Rehabilitation, Maribyrnong, Victoria, Australia
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
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Mitchell UH, Lee H, Dennis HE, Seeley MK. Quality of knee strengthening exercises performed at home deteriorates after one week. BMC Musculoskelet Disord 2022; 23:164. [PMID: 35183152 PMCID: PMC8857831 DOI: 10.1186/s12891-022-05120-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/15/2022] [Indexed: 01/28/2023] Open
Abstract
Background To compare the performance (as determined by lower extremity kinematics) of knee exercises in healthy middle-aged and older individuals immediately after instruction and one week later. Methods This is a cross-sectional study in a laboratory setting. Nineteen healthy volunteers (age [y] 63.1 ± 8.6, mass [kg] 76.3 ± 14.7, height [m] 1.7 ± 0.1) participated in this study. High speed video and reflective markers were used to track motion during four exercises. The exercises were knee flexion, straight leg raise, and “V “in supine position, and hip abduction in side lying position. All participants received verbal and tactile cues during the training phase and the therapist observed and, if necessary, corrected the exercises. Upon return a week later the participants performed the same exercises without any further instructions. Knee and hip sagittal and rotational angles were extracted from the motion capture. A repeated measures t-test was used to compare the motions between two visits. Results Participants demonstrated more knee flexion during straight leg raise and “V in” exercises at the 2nd visit compared to the 1st visit (both p < 0.05). During the “V out” exercise, they performed more external rotation (p < 0.05) while they showed more internal rotation during the “V in” exercise at the 2nd visit compared to the 1st visit. Conclusions Exercise performance declined significantly in healthy middle-aged and older individuals one week after instruction. This decline occurred despite an instructional exercise sheet being given to every participant. Other approaches designed to help individuals retain the ability to perform rehabilitative exercises correctly need to be explored.
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Komaris DS, Tarfali G, O'Flynn B, Tedesco S. Unsupervised IMU-based evaluation of at-home exercise programmes: a feasibility study. BMC Sports Sci Med Rehabil 2022; 14:28. [PMID: 35183244 PMCID: PMC8857882 DOI: 10.1186/s13102-022-00417-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 02/04/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The benefits to be obtained from home-based physical therapy programmes are dependent on the proper execution of physiotherapy exercises during unsupervised treatment. Wearable sensors and appropriate movement-related metrics may be used to determine at-home exercise performance and compliance to a physical therapy program. METHODS A total of thirty healthy volunteers (mean age of 31 years) had their movements captured using wearable inertial measurement units (IMUs), after video recordings of five different exercises with varying levels of complexity were demonstrated to them. Participants were then given wearable sensors to enable a second unsupervised data capture at home. Movement performance between the participants' recordings was assessed with metrics of movement smoothness, intensity, consistency and control. RESULTS In general, subjects executed all exercises similarly when recording at home and as compared with their performance in the lab. However, participants executed all movements faster compared to the physiotherapist's demonstrations, indicating the need of a wearable system with user feedback that will set the pace of movement. CONCLUSION In light of the Covid-19 pandemic and the imperative transition towards remote consultation and tele-rehabilitation, this work aims to promote new tools and methods for the assessment of adherence to home-based physical therapy programmes. The studied IMU-derived features have shown adequate sensitivity to evaluate home-based programmes in an unsupervised manner. Cost-effective wearables, such as the one presented in this study, can support therapeutic exercises that ought to be performed with appropriate speed, intensity, smoothness and range of motion.
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Affiliation(s)
- Dimitrios-Sokratis Komaris
- Tyndall National Institute, University College Cork, Lee Maltings Complex Dyke Parade, Cork, T12 R5CP, Ireland.
| | - Georgia Tarfali
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | - Brendan O'Flynn
- Tyndall National Institute, University College Cork, Lee Maltings Complex Dyke Parade, Cork, T12 R5CP, Ireland
| | - Salvatore Tedesco
- Tyndall National Institute, University College Cork, Lee Maltings Complex Dyke Parade, Cork, T12 R5CP, Ireland
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Gangatharam S. The effect of early controlled mobilization combined with target focused exercise regime in management of closed reduction K-wire fixation of proximal phalanx fracture. HAND SURGERY & REHABILITATION 2021; 40:631-636. [PMID: 33901702 DOI: 10.1016/j.hansur.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/11/2021] [Accepted: 04/17/2021] [Indexed: 11/30/2022]
Abstract
The phalangeal and metacarpal fractures are common fractures of the upper extremity. The most common complications of proximal phalanx fracture are the extensor lag and stiffness at the proximal interphalangeal joint, which leads to poor outcomes. Poor treatment compliance has also been identified among our patients. The target focused exercise regime with early controlled active mobilization should improve outcomes and treatment compliance among our patients. In this observational study with recruited 13 subjects, subjects age group range from 25 to 55 yrs. Baseline assessment was administrated for all the subjects. At 12 weeks the patient was re-assessed for Total Active Motion (TAM), Total Passive Motion (TPM), pain, grip strength, and Michigan Hand outcome measure. The TAM increase was statistically significant at P ≥ 0.01 within 4th, 6th, 8th, 10th, and 12th week. The TPM increase was statistically significant at P ≥ 0.01 between 8th, 10th, and 12th week. The mean satisfaction score was 91%. The mean extensor lag was 0.42°. The mean grip strength of the affected hand was 90.6% compared to that of the unaffected hand. The early controlled mobilization combined with target focused exercise regime was effective in improving the TAM and treatment compliance.
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Kowatsch T, Lohse KM, Erb V, Schittenhelm L, Galliker H, Lehner R, Huang EM. Hybrid Ubiquitous Coaching With a Novel Combination of Mobile and Holographic Conversational Agents Targeting Adherence to Home Exercises: Four Design and Evaluation Studies. J Med Internet Res 2021; 23:e23612. [PMID: 33461957 PMCID: PMC7939948 DOI: 10.2196/23612] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/28/2020] [Accepted: 01/18/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Effective treatments for various conditions such as obesity, cardiac heart diseases, or low back pain require not only personal on-site coaching sessions by health care experts but also a significant amount of home exercises. However, nonadherence to home exercises is still a serious problem as it leads to increased costs due to prolonged treatments. OBJECTIVE To improve adherence to home exercises, we propose, implement, and assess the novel coaching concept of hybrid ubiquitous coaching (HUC). In HUC, health care experts are complemented by a conversational agent (CA) that delivers psychoeducation and personalized motivational messages via a smartphone, as well as real-time exercise support, monitoring, and feedback in a hands-free augmented reality environment. METHODS We applied HUC to the field of physiotherapy and conducted 4 design-and-evaluate loops with an interdisciplinary team to assess how HUC is perceived by patients and physiotherapists and whether HUC leads to treatment adherence. A first version of HUC was evaluated by 35 physiotherapy patients in a lab setting to identify patients' perceptions of HUC. In addition, 11 physiotherapists were interviewed about HUC and assessed whether the CA could help them build up a working alliance with their patients. A second version was then tested by 15 patients in a within-subject experiment to identify the ability of HUC to address adherence and to build a working alliance between the patient and the CA. Finally, a 4-week n-of-1 trial was conducted with 1 patient to show one experience with HUC in depth and thereby potentially reveal real-world benefits and challenges. RESULTS Patients perceived HUC to be useful, easy to use, and enjoyable, preferred it to state-of-the-art approaches, and expressed their intentions to use it. Moreover, patients built a working alliance with the CA. Physiotherapists saw a relative advantage of HUC compared to current approaches but initially did not see the potential in terms of a working alliance, which changed after seeing the results of HUC in the field. Qualitative feedback from patients indicated that they enjoyed doing the exercise with an augmented reality-based CA and understood better how to do the exercise correctly with HUC. Moreover, physiotherapists highlighted that HUC would be helpful to use in the therapy process. The longitudinal field study resulted in an adherence rate of 92% (11/12 sessions; 330/360 repetitions; 33/36 sets) and a substantial increase in exercise accuracy during the 4 weeks. CONCLUSIONS The overall positive assessments from both patients and health care experts suggest that HUC is a promising tool to be applied in various disorders with a relevant set of home exercises. Future research, however, must implement a variety of exercises and test HUC with patients suffering from different disorders.
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Affiliation(s)
- Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland.,Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Kim-Morgaine Lohse
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Valérie Erb
- Graduate School of Culture Technology, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,People and Computing Lab, Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Leo Schittenhelm
- Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Helen Galliker
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Rea Lehner
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Elaine M Huang
- People and Computing Lab, Department of Informatics, University of Zurich, Zurich, Switzerland
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Thacker J, Bosello F, Ridehalgh C. Do behaviour change techniques increase adherence to home exercises in those with upper extremity musculoskeletal disorders? A systematic review. Musculoskeletal Care 2020; 19:340-362. [PMID: 33331093 DOI: 10.1002/msc.1532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate whether behaviour change techniques (BCTs) can influence adherence to home exercise in people with upper extremity musculoskeletal disorders (UEMD). DESIGN A systematic review of randomised control trials, non-randomised control trials, case-control studies and cohort studies. Results were presented narratively. Participants were those with UEMD. The intervention was any home exercise programme, alongside a BCT designed to increase exercise adherence. Any duration of intervention was accepted. The main outcome sought was adherence to home exercise. A systematic search was performed on four online databases. Grey literature was searched. RESULTS The search resulted in 28,755 titles. 77 full-text articles were assessed for eligibility. Six studies were included in the qualitative synthesis. Four studies had Some Concern of Bias, whilst two studies had High Risk of Bias. Three studies found statistically significant differences in exercise adherence (p < 0.05) between the Intervention group and Control group. The BCT 'Social Support (unspecified)' was used within all studies that found significant differences in adherence levels at outcome. However, multiple BCTs were received by the Intervention groups within all studies, making it impossible to identify the effects of any single BCT upon adherence levels. CONCLUSION Social support may be relevant in patients' adherence levels to HEPs. However, confidence in the results is uncertain given the small number of studies found, and their High RoB. Future studies should validate their measurement and definition of adherence, as well as the number of BCTs they use, to provide reproducible evidence.
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Affiliation(s)
| | - Francesca Bosello
- European School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Chung BPH, Chiang WKH, Lau H, Lau TFO, Lai CWK, Sit CSY, Chan KY, Yeung CY, Lo TM, Hui E, Lee JSW. Pilot study on comparisons between the effectiveness of mobile video-guided and paper-based home exercise programs on improving exercise adherence, self-efficacy for exercise and functional outcomes of patients with stroke with 3-month follow-up: A single-blind randomized controlled trial. Hong Kong Physiother J 2020; 40:63-73. [PMID: 32489241 PMCID: PMC7136530 DOI: 10.1142/s1013702520500079] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/20/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To compare the effectiveness of mobile video-guided home exercise program and standard paper-based home exercise program. METHODS Eligible participants were randomly assigned to either experimental group with mobile video-guided home exercise program or control group with home exercise program in a standard pamphlet for three months. The primary outcome was exercise adherence. The secondary outcomes were self-efficacy for exercise by Self-Efficacy for Exercise (SEE) Scale; and functional outcomes including mobility level by Modified Functional Ambulatory Category (MFAC) and basic activities of daily living (ADL) by Modified Barthel Index (MBI). All outcomes were captured by phone interviews at 1 day, 1 month and 3 months after the participants were discharged from the hospitals. RESULTS A total of 56 participants were allocated to the experimental group ( n = 27 ) and control group ( n = 29 ) . There were a significant between-group differences in 3-months exercise adherence (experimental group: 75.6%; control group: 55.2%); significant between-group differences in 1-month SEE (experimental group: 58.4; control group: 43.3) and 3-month SEE (experimental group: 62.2; control group: 45.6). For functional outcomes, there were significant between-group differences in 3-month MFAC gain (experimental group: 1.7; control group: 1.0). There were no between-group differences in MBI gain. CONCLUSION The use of mobile video-guided home exercise program was superior to standard paper-based home exercise program in exercise adherence, SEE and mobility gain but not basic ADL gain for patients recovering from stroke.
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Affiliation(s)
- Bryan Ping Ho Chung
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Wendy Kam Ha Chiang
- Physiotherapy Department, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Herman Lau
- Hospital Chief Executive, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Titanic Fuk On Lau
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Charles Wai Kin Lai
- Physiotherapy Department, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Claudia Sin Yi Sit
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Ka Yan Chan
- Physiotherapy Department, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Chau Yee Yeung
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Tak Man Lo
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Elsie Hui
- Department of Medicine and Geriatrics, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Jenny Shun Wah Lee
- Department of Medicine and Geriatrics, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
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Peek K, Carey M, Mackenzie L, Sanson-Fisher R. Characteristics associated with high levels of patient-reported adherence to self-management strategies prescribed by physiotherapists. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2018.0098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Physiotherapist-prescribed self-management strategies are an important component of physiotherapy practice but they can only be effective if patients adhere. The aim of this study was to explore patient-reported adherence to physiotherapist-prescribed self-management strategies, and the extent to which patient, physiotherapist, consultation and prescription characteristics are associated with high levels of adherence. Methods A cross-sectional observational study across four private practices; including 14 physiotherapists and 113 patients was conducted. Data were collected in two stages. The first stage consisted of observing a patient at their physiotherapist consultation to collect data regarding the physiotherapist's prescription of self-management strategies. The second stage consisted of a follow-up telephone interview with each observed patient to record the patient-reported level of adherence to each prescribed self-management strategy. Results Prescribed self-management strategies where physiotherapists asked patients to repeat details of the self-management strategy were 6.54 times (95% confidence interval 2.91–14.98) more likely to be highly adhered to than strategies where the physiotherapist did not do this. Prescribed strategies accompanied by printed information were 2.73 times (95% confidence interval 1.24–6.00) more likely to be highly adhered to than strategies that were not. Advice such as to rest from activity (odds ratio=0.18; 95% confidence interval 0.08–0.40) was less likely to be highly adhered to when compared to home-based exercise programmes. Conclusions To improve patient-reported adherence to self-management strategies, physiotherapists should be encouraged to provide supplementary printed information and ask their patients to repeat details of the prescribed strategy.
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Affiliation(s)
- Kerry Peek
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Discipline of Physiotherapy, Faculty of Medicine & Health, University of Sydney, Lidcombe, NSW, Australia
| | - Mariko Carey
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Lisa Mackenzie
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Robert Sanson-Fisher
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Newcastle, Australia
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Gangatharam S. Target-focused exercise regime to improve patient compliance and range of motion in the stiff hand. J Hand Ther 2019; 31:568-571. [PMID: 30318243 DOI: 10.1016/j.jht.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/14/2018] [Indexed: 02/03/2023]
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Ntsiea MV. Current stroke rehabilitation services and physiotherapy research in South Africa. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2019; 75:475. [PMID: 31392288 PMCID: PMC6676941 DOI: 10.4102/sajp.v75i1.475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 04/01/2019] [Indexed: 01/19/2023] Open
Abstract
Background Stroke is one of the most common causes of morbidity and disability in South Africa, with the burden of stroke particularly high in rural South Africa. Objectives The aim of this study was to collate South African (SA) physiotherapy stroke rehabilitation research. Method A narrative review of physiotherapy stroke rehabilitation research conducted within the last 10 years in South Africa. Results Stroke survivors in South Africa have poor functional ability at discharge from the hospital and have poor access to transport, work and education. Their caregivers experience strain and have a poor quality of life. Inpatient rehabilitation services focus on the medical model approach and patients are discharged into family care because of limited rehabilitation facilities. Physiotherapy interventions found to be effective in SA studies: longitudinal shoulder strapping, balance exercises in the community, task-orientated circuit gait training, saccadic eye movement training with visual scanning exercises for unilateral spatial neglect and workplace intervention programmes to increase return to work after stroke. Caregiver education alone and use of pictorial exercise programmes does not improve patients’ functional ability and adherence to home exercise programmes, respectively. Conclusion There is a need to focus physiotherapy stroke rehabilitation on barriers that hinder full social integration of the patient, including return to work and improving carer support. Most research reviewed focused on description of the problems experienced; however, more intervention studies are now underway to develop context-specific interventions with feasible treatment intensity, frequencies and equipment requirements. Future research should explore new ways of improving post-discharge rehabilitation services. Examples of intervention research that may be beneficial in a SA context are mirror therapy, mental practice and patient-directed activities in rehabilitation. Clinical implications Knowledge of interventions that were found to be effective in this context will encourage clinicians to translate these findings into practice. Noting that outcome measures that are core for stroke rehabilitation are not included in some projects may remind researchers to consider them to make comparisons between different research projects.
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Affiliation(s)
- Mokgobadibe V Ntsiea
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Geuens J, Geurts L, Swinnen TW, Westhovens R, Vanden Abeele V. Mobile Health Features Supporting Self-Management Behavior in Patients With Chronic Arthritis: Mixed-Methods Approach on Patient Preferences. JMIR Mhealth Uhealth 2019; 7:e12535. [PMID: 30907737 PMCID: PMC6452281 DOI: 10.2196/12535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 01/10/2023] Open
Abstract
Background Patients with chronic arthritis (CA) ideally apply self-management behaviors between consultations. This enduring, tedious task of keeping track of disease-related parameters, adhering to medication schemes, and engaging in physical therapy may be supported by using a mobile health (mHealth) app. However, further research is needed to determine which self-management features are valued most by adult patients with CA patients. Objective The aim of this study was to determine the preference of features for an mHealth app to support self-management behavior in patients with CA. In addition, we aimed to explore the motives behind these ratings. Methods A mixed-methods approach was used to gather information from 31 adult patients (14 females), aged 23 to 71 years (mean 51 [SD 12.16]), with CA. Structured interviews were conducted to gather data pertaining to preferences of app features. Interviews were analyzed qualitatively, whereas ratings for each of the 28 features studied were analyzed quantitatively. Results In general, patients with CA favored the use of features pertaining to supporting active and direct disease management, (eg, medication intake and detecting and alarming of bad posture), helping them to keep a close watch on their disease status and inform their health care professional (eg, providing a means to log and report disease-related data) and receiving personalized information (eg, offering tailored information based on the patient’s health data). Patients strongly disliked features that provide a means of social interaction or provide incentivization for disease-related actions (eg, being able to compare yourself with other patients, cooperating toward a common goal, and receiving encouragement from friends and/or family). Driving these evaluations is the finding that every patient with CA hurts in his/her own way, the way the disease unfolds over time and manifests itself in the patient and social environment is different for every patient, and patients with CA are well aware of this. Conclusions We have offered an insight into how patients with CA favor mHealth features for self-management apps. The results of this research can inform the design and development of prospective self-management apps for patients with CA.
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Affiliation(s)
- Jonas Geuens
- e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Luc Geurts
- e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Thijs W Swinnen
- Division of Rheumatology, Universitaire Ziekenhuizen Gasthuisberg, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Rene Westhovens
- Division of Rheumatology, Universitaire Ziekenhuizen Gasthuisberg, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Katholieke Universiteit Leuven, Leuven, Belgium
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Peek K, Carey M, Mackenzie L, Sanson-Fisher R. Patient adherence to an exercise program for chronic low back pain measured by patient-report, physiotherapist-perception and observational data. Physiother Theory Pract 2018; 35:1304-1313. [PMID: 29771180 DOI: 10.1080/09593985.2018.1474402] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The effectiveness of exercise programs for chronic low back pain (CLBP) is dependent upon patient adherence which is problematic to measure accurately. This cross-sectional observational study aimed to compare patient-reported levels of adherence with physiotherapists' perceptions of patient adherence; and to explore the proportion of patients who could accurately recall and demonstrate the exercises contained within their prescribed exercise program for CLBP. Participating patients (n = 61) included those attending for a follow-up consultation with a physiotherapist (n = 15) at a consenting practice (n = 6) who had been prescribed an exercise program for CLBP. Patients were asked to self-report their level of adherence to the exercise program which was then compared to their physiotherapist's perception of adherence. Patients were also asked to recall and demonstrate the exercise program to an independent researcher, which was compared to the prescribed program. Results indicated that in total, 24 patients (39%; 95% CI: 27-52%) self-reported as being completely adherent compared with 10 patients (16%; 95% CI: 8-28%) who were perceived by their physiotherapists as completely adherent (raw agreement: 0.21). However, only nine patients (15%, 95% CI: 7-26%) were able to accurately recall and demonstrate their prescribed exercise program to the researcher, of which eight of these nine patients self-reported complete adherence to the exercise program. In comparison, only four of these nine patients were perceived by the physiotherapist to be completely adherent. These results suggest that patient adherence to home-based exercise programs for CLBP might be assessed more accurately using multi-faceted measures which include an observational component.
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Affiliation(s)
- Kerry Peek
- Health Behaviour Research Group, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Australia
| | - Mariko Carey
- Health Behaviour Research Group, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Australia
| | - Lisa Mackenzie
- Health Behaviour Research Group, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Group, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Australia
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Demographics and rates of surgical arthroscopy and postoperative rehabilitative preferences of arthroscopists from the Arthroscopy Association of North America (AANA). J Orthop 2018; 15:591-595. [PMID: 29881200 DOI: 10.1016/j.jor.2018.05.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/06/2018] [Indexed: 11/21/2022] Open
Abstract
Survey of 869 arthroscopists regarding joint-specific arthroscopic procedures and postoperative rehabilitative preferences revealed comparable support for use of supervised physical therapy (SPT) and home exercise programs (HEPs) but stronger preference for joint-specific HEP applications (wrist, knee). Among respondents utilizing HEPs, modality of delivery (verbal/handout/web-based) didn't differ by joint, yet only 2.9% utilized web-based HEPs. This is the first known study to identify postoperative rehabilitation preferences. With 1.77 million estimated arthroscopic procedures annually (mean: 325.4 procedures/respondent), this study highlights under-utilization of web-based HEPs. Reliable, web-based HEPs can improve post-arthroscopic outcomes for patients, arthroscopic surgeons, and rehabilitative specialists while being cost efficient.
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Tieppo Francio V, Dima RS, Towery C, Davani S. Prolotherapy and Low Level Laser Therapy: A Synergistic Approach to Pain Management in Chronic Osteoarthritis. Anesth Pain Med 2017; 7:e14470. [PMID: 29696113 PMCID: PMC5903214 DOI: 10.5812/aapm.14470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/02/2017] [Accepted: 10/09/2017] [Indexed: 12/14/2022] Open
Abstract
Regenerative injection therapy and low level laser therapy are alternative remedies known for their success in the treatment and symptomatic management of chronic musculoskeletal conditions. In response to the growing demand for alternative therapies in the face of the opioid epidemic, the authors conduct a literature review to investigate the potential for prolotherapy and LLLT to be used adjunctively to manage chronic osteoarthritis (OA). OA is a degenerative chronic musculoskeletal condition on the rise in North America, and is frequently treated with opioid medications. The regenerative action of prolotherapy and pain-modulating effects of LLLT may make these two therapies well-suited to synergistically provide improved outcomes for osteoarthritis patients without the side effects associated with opioid use. A narrative descriptive review through multiple medical databases (Google Scholar, PubMed, and MedLine) is conducted, restricted by the use of medical subject headings. 71 articles were selected for reading in full, and 40 articles were selected for use in the study after reading in full. A review of the literature revealed good clinical results in the use of prolotherapy and LLLT separately to manage chronic musculoskeletal pain due to osteoarthritis and other chronic conditions. It is also recognized in the literature that prolotherapy works most effectively when used adjunctively with other treatments. Downsides to the use of prolotherapy include mild side effects of pain, stiffness and bruising and potential adverse events as a result of injection. This study is limited by the lack of clinical trials available involving both LLLT and prolotherapy injections used adjunctively, and by the low number of high impact literature concerning the treatment of (specifically) osteoarthritis by alternative methods. The authors suggest that practicing health care providers consider utilizing LLLT and prolotherapy together as a supplementary method in the management of chronic pain due to osteoarthritis, to minimize the long-term prescription of opioids and emphasize a less invasive treatment for this debilitating condition.
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Affiliation(s)
- Vinicius Tieppo Francio
- University of Science, Arts and Technology - USAT College of Medicine, Olveston, Montserrat, BWI
- Essential Integrative Health - Spine, Orthopaedics and Pain Management, Oklahoma City, OK, USA
- Variety Care - Community Health Center, Oklahoma City, OK, USA
- Corresponding author: Vinicius Tieppo Francio, University of Science, Arts and Technology - USAT College of Medicine - Olveston, Montserrat, BWI. E-mail:
| | - Robert S Dima
- School of Interdisciplinary Sciences - McMaster University, Hamilton, ON, Canada
| | - Chris Towery
- University of Science, Arts and Technology - USAT College of Medicine, Olveston, Montserrat, BWI
| | - Saeid Davani
- University of Science, Arts and Technology - USAT College of Medicine, Olveston, Montserrat, BWI
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Facilitators and barriers to physical activity in people with chronic low back pain: A qualitative study. PLoS One 2017; 12:e0179826. [PMID: 28742820 PMCID: PMC5526504 DOI: 10.1371/journal.pone.0179826] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 06/05/2017] [Indexed: 11/25/2022] Open
Abstract
Background For medical teams, one of the main objectives of rehabilitation for people with chronic low back pain is adherence to physical activity (PA). Objective The objective of this study was to identify PA barriers and facilitators in this population. Methods This qualitative study included 4 discussion groups and 16 semi-structured interviews conducted among people with non-specific chronic low back pain who were involved in a specific rehabilitation program or seen in primary care settings. Results Three main themes were identified: physical factors, psychological factors and socio-environmental factors. The main barrier to PA practice is pain. Psychological barriers were associated with the difficulty in integrating PA in the person’s daily life. Environmental barriers were dominated by lack of time. Facilitators identified associated the supervised nature of the physical activity (supervision by professionals) and group practice, which improved people’s adherence. Conclusion The results of this study will allow teams to target relevant educational objectives for these people and develop dedicated self-management programs.
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An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial. J Physiother 2017; 63:161-167. [PMID: 28662834 DOI: 10.1016/j.jphys.2017.05.015] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 05/04/2017] [Accepted: 05/17/2017] [Indexed: 12/27/2022] Open
Abstract
QUESTION Do people with musculoskeletal conditions better adhere to their home exercise programs when these are provided to them on an app with remote support compared to paper handouts? DESIGN Randomised, parallel-group trial with intention-to-treat analysis. PARTICIPANTS Eighty participants with upper or lower limb musculoskeletal conditions were recruited to the trial. Each participant was prescribed a 4-week home exercise program by a physiotherapist at a tertiary teaching hospital in Australia. Participants were randomly assigned via a computer-generated concealed block randomisation procedure to either intervention (n=40) or control (n=40) groups. INTERVENTION Participants in the intervention group received their home exercise programs on an app linked to the freely available website www.physiotherapyexercises.com. They also received supplementary phone calls and motivational text messages. Participants in the control group received their home exercise programs as a paper handout. OUTCOME MEASURES Blinded assessors collected outcome measures at baseline and 4 weeks. The primary outcome was self-reported exercise adherence. There were five secondary outcomes, which captured functional performance, disability, patient satisfaction, perceptions of treatment effectiveness, and different aspects of adherence. RESULTS Outcomes were available on 77 participants. The mean between-group difference for self-reported exercise adherence at 4 weeks was 1.3/11 points (95% CI 0.2 to 2.3), favouring the intervention group. The mean between-group difference for function was 0.9/11 points (95% CI 0.1 to 1.7) on the Patient-Specific Functional Scale, also favouring the intervention group. There were no significant between-group differences for the remaining outcomes. CONCLUSION People with musculoskeletal conditions adhere better to their home exercise programs when the programs are provided on an app with remote support compared to paper handouts; however, the clinical importance of this added adherence is unclear. TRIAL REGISTRATION ACTRN12616000066482. [Lambert TE, Harvey LA, Avdalis C, Chen LW, Jeyalingam S, Pratt CA, Tatum HJ, Bowden JL, Lucas BR (2017) An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial. Journal of Physiotherapy 63: 161-167].
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Peek K, Carey M, Sanson-Fisher R, Mackenzie L. Aiding patient adherence to physiotherapist-prescribed self-management strategies: an evidence-based behavioural model in practice. PHYSICAL THERAPY REVIEWS 2016. [DOI: 10.1080/10833196.2016.1226537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bruder AM, Shields N, Dodd KJ, Hau R, Taylor NF. A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture: a multi-centre, randomised trial. J Physiother 2016; 62:145-52. [PMID: 27323934 DOI: 10.1016/j.jphys.2016.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 03/02/2016] [Accepted: 05/19/2016] [Indexed: 11/26/2022] Open
Abstract
QUESTION Does a program of exercise and structured advice implemented during the rehabilitation phase following a distal radial fracture achieve better recovery of upper limb activity than structured advice alone? DESIGN A phase I/II, multi-centre, randomised, controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS Thirty-three adults (25 female, mean age 54 years) following distal radial fracture managed in a cast. INTERVENTION The experimental intervention was a 6-week program of progressive exercise and structured advice implemented over three consultations by a physiotherapist. The control intervention was a program of structured advice only, delivered by a physiotherapist over three consultations. OUTCOME MEASURES The primary outcome was upper limb activity limitations, assessed by the Patient-Rated Wrist Evaluation and the shortened version of the Disabilities of the Arm, Shoulder and Hand outcome measure (QuickDASH). The secondary outcomes were wrist range of movement, grip strength and pain. All measures were completed at baseline (week 0), after the intervention (week 7) and at 6 months (week 24). RESULTS There were no significant between-group differences in upper limb activity as measured by the Patient-Rated Wrist Evaluation at week 7 and week 24 assessments (mean difference -4 units, 95% CI -10 to 2; mean difference 0 units, 95% CI -3 to 3, respectively), or QuickDASH at week 7 and week 24 assessments (mean difference -5 units, 95% CI -16 to 6; mean difference 0.3 units, 95% CI -6 to 7, respectively). The secondary outcomes did not demonstrate any significant between-group effects. CONCLUSION The prescription of exercise in addition to a structured advice program over three physiotherapy consultations may convey no extra benefit following distal radial fracture managed in a cast. TRIAL REGISTRATION ACTRN12612000118808. [Bruder AM, Shields N, Dodd KJ, Hau R, Taylor NF (2016) A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture: a multi-centre, randomised trial.Journal of Physiotherapy62: 145-152].
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Affiliation(s)
| | - Nora Shields
- School of Allied Health, La Trobe University; Department of Allied Health, Northern Health
| | - Karen J Dodd
- College of Science, Health and Engineering, La Trobe University
| | - Raphael Hau
- Department of Orthopaedic Surgery, Northern Health
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
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Kara S, Ntsiea MV. The Effect of a Written and Pictorial Home Exercise Prescription on Adherence for People with Stroke. Hong Kong J Occup Ther 2015. [DOI: 10.1016/j.hkjot.2015.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background/Objective Functional recovery for stroke survivors begins with rehabilitation. It may not be feasible for therapists to supervise all rehabilitation, especially in the home environment. Therefore, adherence to prescribed exercise programmes is important. The objective of this study was to determine the effect of a written and pictorial home exercise prescription on adherence to a home exercise programme in patients with stroke. Methods This was a randomised controlled trial with a blinded assessor. The control group received a home exercise programme with verbal instructions, while the intervention group received the same home exercise programme with verbal instructions but with additional written and pictorial instructions for the exercises. An exercise logbook was used to monitor adherence. The Modified Rivermead Mobility Index (MRMI) and Barthel Index (BI) were used to establish mobility and activities of daily living. Results There were a total of 42 participants, with 21 in each group; mean age was 60.8 ± 15.5 years. Forty (95%) of the participants had suffered a stroke less than 4 months prior to the study. Both control and intervention groups had similar outcomes: there was no significant difference between groups with regard to functional ability (MRMI, p = .40; Bl, p = .65) and adherence (p = .53). The relationship between functional ability (MRMI and Bl) and the level of adherence for both the control and intervention groups was not statistically significant. Conclusion The addition of a written and pictorial home exercise prescription does not lead to better adherence to a home exercise programme compared to having no written and pictorial instructions. Possible reasons may be that patients had caregivers as a support system, and the exercise logbook served as a reminder and motivational track record for patients. There also does not appear to be a relationship between functional ability and level of adherence, which may be due to most of the study participants being within the optimal time frame for spontaneous functional recovery. Further study at different time frames in stroke rehabilitation in different contexts is recommended.
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Affiliation(s)
- Sheetal Kara
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Mokgobadibe Veronica Ntsiea
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Peek K, Sanson-Fisher R, Mackenzie L, Carey M. Interventions to aid patient adherence to physiotherapist prescribed self-management strategies: a systematic review. Physiotherapy 2015; 102:127-35. [PMID: 26821954 DOI: 10.1016/j.physio.2015.10.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/06/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physiotherapist prescribed self-management strategies are an important adjunct to 'hands on' treatment. However, treatment outcomes are likely to be related to whether patients adhere to the prescribed strategy. Therefore, physiotherapists should be aware of adherence aiding interventions designed to maximise patient outcomes underpinned by quality research studies. OBJECTIVE To conduct a systematic review of the interventions used to aid patient adherence to all physiotherapist prescribed self-management strategies. DATA SOURCES The search included the databases CINAHL, EMBASE, MEDLINE, PUBMED, PSYCINFO, SPORTSDiscus, the Cochrane Central Register of Controlled Trials, PEDro and Mednar for randomised controlled trials (RCTs) published in a peer reviewed journal from inception to November 2014. DATA EXTRACTION AND SYNTHESIS Data were extracted using a standardised form from twelve included RCTs for patient adherence rates to self-management strategies for interventions used to aid patient adherence and usual care. Two independent reviewers conducted methodological quality assessment. RESULTS Twelve different interventions to aid patient adherence to exercise were recorded from twelve fair to high quality RCTs. Potential adherence aiding interventions include an activity monitor and feedback system, written exercise instructions, behavioural exercise programme with booster sessions and goal setting. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS Despite a number of studies demonstrating interventions to positively influence patient adherence to exercise, there is insufficient data to endorse their use in clinical practice. No RCTs examining adherence aiding interventions to self-management strategies other than exercise were identified, indicating a significant gap in the literature. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42015014516.
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Affiliation(s)
- Kerry Peek
- Health Behaviour Research Group, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Robert Sanson-Fisher
- Health Behaviour Research Group, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Lisa Mackenzie
- Health Behaviour Research Group, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Mariko Carey
- Health Behaviour Research Group, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
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Rizzo J. Patients' mental models and adherence to outpatient physical therapy home exercise programs. Physiother Theory Pract 2015; 31:253-9. [PMID: 25585516 DOI: 10.3109/09593985.2014.1003117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Within physical therapy, patient adherence usually relates to attending appointments, following advice, and/or undertaking prescribed exercise. Similar to findings for general medical adherence, patient adherence to physical therapy home exercise programs (HEP) is estimated between 35 and 72%. Adherence to HEPs is a multifactorial and poorly understood phenomenon, with no consensus regarding a common theoretical framework that best guides empirical or clinical efforts. Mental models, a construct used to explain behavior and decision-making in the social sciences, may serve as this framework. Mental models comprise an individual's tacit thoughts about how the world works. They include assumptions about new experiences and expectations for the future based on implicit comparisons between current and past experiences. Mental models play an important role in decision-making and guiding actions. This professional theoretical article discusses empirical research demonstrating relationships among mental models, prior experience, and adherence decisions in medical and physical therapy contexts. Specific issues related to mental models and physical therapy patient adherence are discussed, including the importance of articulation of patients' mental models, assessment of patients' mental models that relate to exercise program adherence, discrepancy between patient and provider mental models, and revision of patients' mental models in ways that enhance adherence. The article concludes with practical implications for physical therapists and recommendations for further research to better understand the role of mental models in physical therapy patient adherence behavior.
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Affiliation(s)
- Jon Rizzo
- DPT Program, Department of Kinesiology, University of Connecticut , Storrs, CT , USA
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Armand S, Tavcar Z, Turcot K, Allet L, Hoffmeyer P, Genevay S. Effects of unstable shoes on chronic low back pain in health professionals: A randomized controlled trial. Joint Bone Spine 2014; 81:527-32. [DOI: 10.1016/j.jbspin.2014.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 05/18/2014] [Indexed: 11/26/2022]
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Le programme PRESLO de prévention secondaire des lombalgies : évaluation du point de vue des usagers. ARCH MAL PROF ENVIRO 2014. [DOI: 10.1016/j.admp.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ellis KM, Norman C, Van der Merwe A, Jeon M. Increasing Patient Compliance and Satisfaction With Physical Therapy Web-Based Applications. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1541931213571341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Performing independent exercises after clinical visits are crucial for patients recovering from injury. However, patients often fail to comply with physical therapist prescriptions due to lack of time and lack of appropriate feedback. The present study investigated the current medium used for prescribed exercises and compared it to mediums used in web-based applications. In Phase I, we surveyed thirteen practicing physical therapists and twenty-two patients of physical therapy. Responses suggested that video instruction of exercises and video-conference meetings between clinic visits would be beneficial to patient rehabilitation. In Phase II, with fifty-eight undergraduate participants, we examined the influence of self-efficacy and format of instructional materials on willingness to comply, satisfaction with information, and anxiety related to completing rehabilitation. We found that video with text instructions were most satisfying to students. Results are discussed with limitations of the present study and future works.
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Affiliation(s)
| | - Chad Norman
- Michigan Technological University, Houghton, MI
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Sudhagar G, LeBlanc M. Target-focused exercise regime: a motivational strategy to improve patient's adherence to treatment of a stiff thumb interphalangeal joint. J Hand Ther 2013; 25:330-3; quiz 334. [PMID: 22483014 DOI: 10.1016/j.jht.2011.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 12/20/2011] [Accepted: 12/22/2011] [Indexed: 02/09/2023]
Affiliation(s)
- G Sudhagar
- Department of Occupational Therapy, Hamad Medical Corporation, Doha, Qatar.
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Pickering RM, Fitton C, Ballinger C, Fazakarley L, Ashburn A. Self reported adherence to a home-based exercise programme among people with Parkinson's disease. Parkinsonism Relat Disord 2013; 19:66-71. [DOI: 10.1016/j.parkreldis.2012.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 07/12/2012] [Accepted: 07/17/2012] [Indexed: 11/15/2022]
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Kingston G, Gray MA, Williams G. A critical review of the evidence on the use of videotapes or DVD to promote patient compliance with home programmes. Disabil Rehabil Assist Technol 2010; 5:153-63. [PMID: 20205545 DOI: 10.3109/17483101003671709] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this paper is to critically review published research in order to evaluate the evidence surrounding the provision of video or DVD technology to promote patient compliance with home exercise or health programmes. METHOD A literature search of the MEDLINE, CINAHL and Cochrane databases was undertaken. Critical appraisal of selected studies was undertaken using a previously validated tool. Inclusion criteria were: research related to DVD or videotape technology to improve compliance; published in peer-reviewed journals and full-text English language articles. Compliance was the main outcome measure. RESULTS Eleven eligible studies were reviewed. All but one, which used a before-after design, were randomised controlled trials. Study quality tended medium to high in the critical appraisal scoring system, but an overall low quality on the Jadad score for randomisation; with only one study from 11 scoring well on both these measures. Research into the use of video or DVD showed mainly positive effects on compliance; however, methodological issues limit clinical applicability. CONCLUSIONS Future well-designed randomised controlled trials with adequate sample sizes and reliable outcome measures will provide clearer evidence into the effectiveness of this technology in improving home exercise or health programme compliance, particularly for rural and remote populations.
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Affiliation(s)
- Gail Kingston
- Discipline of Occupational Therapy, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia.
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McLean SM, Burton M, Bradley L, Littlewood C. Interventions for enhancing adherence with physiotherapy: a systematic review. ACTA ACUST UNITED AC 2010; 15:514-21. [PMID: 20630793 DOI: 10.1016/j.math.2010.05.012] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 05/22/2010] [Accepted: 05/27/2010] [Indexed: 12/20/2022]
Abstract
Poor adherence to treatment is commonplace and may adversely affect outcomes, efficiency and healthcare cost. The aim of this systematic review was to identify strategies to improve adherence with musculoskeletal outpatient treatment. Five suitable studies were identified which provided moderate evidence that a motivational cognitive-behavioural (CB) programme can improve attendance at exercise-based clinic sessions. There was conflicting evidence that adherence interventions increase short-term adherence with exercise. There was strong evidence that adherence strategies are not effective at improving long-term adherence with home exercise. Due to the multi-dimensional nature of non-adherence, the strategies to improve adherence with physiotherapy treatment are likely to be broad in spectrum. Combined interventions may be effective at promoting adherence with clinic appointments and exercise, though further research would be required to confirm this. Further research to increase basic understanding of the factors, which act as a barrier to adherence, could facilitate development of strategies to overcome non-adherence.
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Affiliation(s)
- Sionnadh Mairi McLean
- Faculty of Health and Well Being, Sheffield Hallam University, Broomhall Road, Sheffield S10 2BP, UK.
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Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Jimeno-Serrano FJ, de Oliveira Sousa SL, del Baño-Aledo ME, Lomas-Vega R. How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study. BMC Health Serv Res 2010; 10:60. [PMID: 20219095 PMCID: PMC2847560 DOI: 10.1186/1472-6963-10-60] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 03/10/2010] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study is to explore perceptions of people with chronic neck or low back pain about how characteristics of home exercise programs and care-provider style during clinical encounters may affect adherence to exercises. Methods This is a qualitative study consisting of seven focus groups, with a total of 34 participants presenting chronic neck or low back pain. The subjects were included if they were receiving physiotherapy treatment and were prescribed home-based exercises. Results Two themes emerged: home-based exercise programme conditions and care provider's style. In the first theme, the participants described their positive and negative experiences regarding time consumption, complexity and effects of prescribed exercises. In the second theme, participants perceived more bonding to prescribed exercises when their care provider presented knowledge about the disease, promoted feedback and motivation during exercise instruction, gave them reminders to exercise, or monitored their results and adherence to exercises. Conclusions Our experiential findings indicate that patient's adherence to home-based exercise is more likely to happen when care providers' style and the content of exercise programme are positively experienced. These findings provide additional information to health care providers, by showing which issues should be considered when delivering health care to patients presenting chronic neck or back pain.
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Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. ACTA ACUST UNITED AC 2010; 15:220-8. [PMID: 20163979 PMCID: PMC2923776 DOI: 10.1016/j.math.2009.12.004] [Citation(s) in RCA: 476] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 10/28/2009] [Accepted: 12/14/2009] [Indexed: 02/06/2023]
Abstract
Poor adherence to treatment can have negative effects on outcomes and healthcare cost. However, little is known about the barriers to treatment adherence within physiotherapy. The aim of this systematic review was to identify barriers to treatment adherence in patients typically managed in musculoskeletal physiotherapy outpatient settings and suggest strategies for reducing their impact. The review included twenty high quality studies investigating barriers to treatment adherence in musculoskeletal populations. There was strong evidence that poor treatment adherence was associated with low levels of physical activity at baseline or in previous weeks, low in-treatment adherence with exercise, low self-efficacy, depression, anxiety, helplessness, poor social support/activity, greater perceived number of barriers to exercise and increased pain levels during exercise. Strategies to overcome these barriers and improve adherence are considered. We found limited evidence for many factors and further high quality research is required to investigate the predictive validity of these potential barriers. Much of the available research has focussed on patient factors and additional research is required to investigate the barriers introduced by health professionals or health organisations, since these factors are also likely to influence patient adherence with treatment.
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Affiliation(s)
- Kirsten Jack
- Hull & East Yorkshire Hospital, Anlaby Road, Hull HU3 2JZ, United Kingdom
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Rhodes RE, Fiala B. Building motivation and sustainability into the prescription and recommendations for physical activity and exercise therapy: the evidence. Physiother Theory Pract 2010; 25:424-41. [PMID: 19842866 DOI: 10.1080/09593980902835344] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Client adherence to exercises prescribed by a physical therapist is very important to successful treatment outcomes. Unfortunately, many clients struggle with adherence and thus efficient and effective motivational interventions are desirable. The purpose of this article was to review the available evidence for: 1) the modifiable factors associated with adherence to physical therapy recommended exercise and 2) the efficacy of exercise intervention efforts to make conclusions and suggestions toward practice. Articles were limited to English peer-reviewed journals and published from 1993 to 2008. Major findings from 13 studies were summarized based on common subtopics of: outcome expectations, self-efficacy expectations, cognitive-behavioural and educational interventions, and intervention medium. The review provided evidence for the importance of self-efficacy in exercise adherence to physical therapy, but it showed that current cognitive-behavioural interventions have had limited effectiveness. It was recommended that future research broaden the scope of predictor variables with social ecological designs, increase the length of prospective follow-up in assessments, include larger and more diverse samples, and focus on innovative aesthetic and affective-based intervention strategies.
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Affiliation(s)
- Ryan E Rhodes
- Behavioural Medicine Laboratory, Faculty of Education, School of Exercise Science, Physical and Health Education, University of Victoria, BC, Canada.
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Medina-Mirapeix F, Escolar-Reina P, Gascón-Cánovas JJ, Montilla-Herrador J, Jimeno-Serrano FJ, Collins SM. Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study. BMC Musculoskelet Disord 2009; 10:155. [PMID: 19995464 PMCID: PMC2796992 DOI: 10.1186/1471-2474-10-155] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 12/09/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests that to facilitate physical activity sedentary people may adhere to one component of exercise prescriptions (intensity, duration or frequency) without adhering to other components. Some experts have provided evidence for determinants of adherence to different components among healthy people. However, our understanding remains scarce in this area for patients with neck or low back pain. The aims of this study are to determine whether patients with neck or low back pain have different rates of adherence to exercise components of frequency per week and duration per session when prescribed with a home exercise program, and to identify if adherence to both exercise components have distinct predictive factors. METHODS A cohort of one hundred eighty-four patients with chronic neck or low back pain who attended physiotherapy in eight primary care centers were studied prospectively one month after intervention. The study had three measurement periods: at baseline (measuring characteristics of patients and pain), at the end of physiotherapy intervention (measuring characteristics of the home exercise program) and a month later (measuring professional behaviors during clinical encounters, environmental factors and self-efficacy, and adherence behavior). RESULTS Adherence to duration per session (70.9% +/- 7.1) was more probable than adherence to frequency per week (60.7% +/- 7.0). Self-efficacy was a relevant factor for both exercise components (p < 0.05). The total number of exercises prescribed was predictive of frequency adherence (p < 0.05). Professional behaviors have a distinct influence on exercise components. Frequency adherence is more probable if patients received clarification of their doubts (adjusted OR: 4.1; p < 0.05), and duration adherence is more probable if they are supervised during the learning of exercises (adjusted OR: 3.3; p < 0.05). CONCLUSION We have shown in a clinic-based study that adherence to exercise prescription frequency and duration components have distinct levels and predictive factors. We recommend additional study, and advise that differential attention be given in clinical practice to each exercise component for improving adherence.
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Abstract
OBJECTIVE The objectives of this study were to assess the effect of unstable sandals on (1) low back pain (LBP) in golfers with undiagnosed moderate LBP, (2) static and dynamic balance, and (3) golf performance. DESIGN This was a 6-week prospective study where subjects were randomized to a control group and an intervention group. SETTING Baseline measurements were recorded in the Human Performance Laboratory. PARTICIPANTS Forty male golfers with nonspecific moderate LBP. INTERVENTION The intervention group wore unstable shoes for 6 weeks, and the control group wore their regular golf shoes. MAIN OUTCOME MEASURES Low back pain, timed balance, and golf performance were assessed at baseline and at 6 weeks. Changes were compared through independent samples t tests. RESULTS (1) There was a significant difference between groups in the change of perceived LBP scores in the laboratory (test group: -17.5/100 mm, control: -3.6/100 mm) and in the comparison of the first week entries to the last week entries recorded in logbooks (test group: -10.7/100 mm, control group: +2.6/100 mm). (2) There was no significant change in the static or dynamic balance times. (3) There was no significant change in golf performance between the intervention and control groups. CONCLUSION The results indicate that unstable sandals can be used to reduce moderate lower back pain in this population of golfers without negatively affecting performance.
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Mannion AF, Helbling D, Pulkovski N, Sprott H. Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:1881-91. [PMID: 19609785 DOI: 10.1007/s00586-009-1093-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 04/24/2009] [Accepted: 06/28/2009] [Indexed: 10/20/2022]
Abstract
Exercise rehabilitation is one of the few evidence-based treatments for chronic non-specific low back pain (cLBP), but individual success is notoriously variable and may depend on the patient's adherence to the prescribed exercise regime. This prospective study examined factors associated with adherence and the relationship between adherence and outcome after a programme of physiotherapeutic spine stabilisation exercises. A total of 32/37 patients with cLBP completed the study (mean age, 44.0 (SD = 12.3) years; 11/32 (34%) male). Adherence to the 9-week programme was documented as: percent attendance at therapy, percent adherence to daily home exercises (patient diary) and percent commitment to rehabilitation (Sports Injury Rehabilitation Adherence Scale (SIRAS)). The average of these three measures formed a multidimensional adherence index (MAI). Psychological disturbance, fear-avoidance beliefs, catastrophising, exercise self-efficacy and health locus of control were measured by questionnaire; disability in everyday activities was scored with the Roland-Morris disability scale and back pain intensity with a 0-10 graphic rating scale. Overall, adherence to therapy was very good (average MAI score, 85%; median (IQR), 89 (15)%). The only psychological/beliefs variable showing a unique significant association with MAI was exercise self-efficacy (Rho = 0.36, P = 0.045). Pain intensity and self-rated disability decreased significantly after therapy (each P < 0.01). Adherence to home exercises showed a moderate, positive correlation with the reduction in average pain (Rho = 0.54, P = 0.003) and disability (Rho = 0.38, P = 0.036); higher MAI scores were associated with greater reductions in average pain (Rho = 0.48, P = 0.008) and a (n.s.) tendency for greater reductions in disability (Rho = 0.32, P = 0.07) Neither attendance at therapy nor SIRAS were significantly related to any of the outcomes. The benefits of rehabilitation depended to a large extent on the patient's exercise behaviour outside of the formal physiotherapy sessions. Hence, more effort should be invested in finding ways to improve patients' motivation to take responsibility for the success of their own therapy, perhaps by increasing exercise self-efficacy. Whether the "adherence-outcome" interaction was mediated by improvements in function related to the specific exercises, or by a more "global" effect of the programme, remains to be examined.
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Affiliation(s)
- Anne F Mannion
- Spine Center Division, Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
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Hammer C, Degerfeldt L, Denison E. Mechanical diagnosis and therapy in back pain: Compliance and social cognitive theory. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/14038190701433241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Katz-Leurer M, Rotem H, Keren O, Meyer S. The effects of a 'home-based' task-oriented exercise programme on motor and balance performance in children with spastic cerebral palsy and severe traumatic brain injury. Clin Rehabil 2009; 23:714-24. [PMID: 19506005 DOI: 10.1177/0269215509335293] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the feasibility and the ability to recruit and retain children with severe traumatic brain injury or cerebral palsy, and their families, to a simple home-based exercise programme and to assess the immediate and short-term effects of such intervention on reducing impairment and improving function. STUDY DESIGN Randomized clinical trial. PARTICIPANTS Twenty children aged 7-13 years, with traumatic brain injury (N = 10) or cerebral palsy (N = 10) who were independent ambulators. Five children from each group were randomly assigned to a control group - regular daily activities, or to an experimental group - regular daily activities plus a home-based task-oriented exercise programme of sit-to-stand and step-up exercise, for six weeks. OUTCOME MEASURES Feasibility: The number of participants who completed the programme protocol. EFFICACY Timed Up and Go Test and Functional Reach Test were used as functional balance tests. Maximal isometric strength was assessed by using a hand-held dynamometer; walking performance was assessed by the 10 m walk test, 2-minute walk test and Energy Expenditure Index. RESULTS Nine children completed all parts of the training programme. At the end of the intervention period an increase of 3-4 cm in the mean Functional Reach Test and a reduction of 1.6 +/- 2.1 seconds in the Timed Up and Go Test were noted (P<0.01) in the experimental group while no changes were noted in the control group. In all other outcomes assessed no significant differences were noted between groups. The positive change in balance performance in the experimental group was maintained during a six-week follow-up period. CONCLUSIONS A home-based task-oriented exercise programme can improve balance performance in children with spastic cerebral palsy or severe traumatic brain injury.
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Affiliation(s)
- Michal Katz-Leurer
- Alyn Hospital, Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel.
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41
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A short questionnaire to identify patient characteristics indicating improved compliance to exercise rehabilitation programs: A pilot investigation. INT J OSTEOPATH MED 2008. [DOI: 10.1016/j.ijosm.2007.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zamani J, Vogel S, Moore A, Lucas K. Analysis of exercise content in undergraduate osteopathic education – A content analysis of UK curricula. INT J OSTEOPATH MED 2007. [DOI: 10.1016/j.ijosm.2007.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Barron CJ, Moffett JAK, Potter M. Patient expectations of physiotherapy: definitions, concepts, and theories. Physiother Theory Pract 2007; 23:37-46. [PMID: 17454797 DOI: 10.1080/09593980601147843] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Expectations are an integral part of the psychosocial makeup of each patient, and there is a growing recognition among physiotherapists that psychosocial issues may impact the outcome of physiotherapy. This article seeks to clarify the term "patient expectation" by providing some definitions and an overview of the literature describing the concepts and theories associated with patients' expectations. These concepts are then related to physiotherapy to highlight the impact that patients' expectations may have on the outcome of physiotherapy, and the implications for physiotherapy are discussed.
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Mohseni-Bandpei MA, Critchley J, Staunton T, Richardson B. A prospective randomised controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain. Physiotherapy 2006. [DOI: 10.1016/j.physio.2005.05.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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45
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Adherence to Rehabilitation after Anterior Cruciate Ligament Reconstructive Surgery: Implications for Outcome. J Sport Rehabil 2005. [DOI: 10.1123/jsr.14.3.202] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective:To investigate the relationship between adherence to rehabilitation and outcome after reconstructive surgery of the anterior cruciate ligament (ACL).Design:A prospective cohort study with adherence to rehabilitation evaluated over 8 weeks correlated with outcomes at 9 and 12 months postsurgery.Participants:68 patients who had undergone ACL-reconstructive surgery.Main Outcome Measures:Adherence was measured to and during appointments and by a self-report diary of home exercise. Outcomes were measured by 6 knee-function scales and 2 hop tests.Results:There was a significant relationship between home-exercise adherence and many outcomes for participants under 30 years of age (rs= .33-.44). For participants age 30 and over there was a negative relationship between home-exercise adherence and outcome. There were no significant relationships between adherence to and during physical therapy appointments and outcome after ACL-reconstructive surgery.Conclusion:Participants under 30 years of age who adhered to their home-exercise regimen had better functional outcome, whereas adherent participants age 30 and over experienced worse outcome with better home-exercise adherence.
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Schoo A, Morris M, Bui Q. The effects of mode of exercise instruction on compliance with a home exercise program in older adults with osteoarthritis. Physiotherapy 2005. [DOI: 10.1016/j.physio.2004.09.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lyngcoln A, Taylor N, Pizzari T, Baskus K. The relationship between adherence to hand therapy and short-term outcome after distal radius fracture. J Hand Ther 2005; 18:2-8; quiz 9. [PMID: 15674780 DOI: 10.1197/j.jht.2004.10.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to examine the relationship between adherence to hand therapy and short-term outcome after fracture of the distal radius. Attendance at hand therapy appointments, therapist-rated adherence during appointments, and home-exercise diaries were used to monitor adherence in 15 people undertaking rehabilitation after a wrist fracture. Outcome measures were change in impairment (wrist extension, grip strength, and pain rating) and change in activity (modified Levine questionnaire, Jebsen Test of Hand Function) from initial assessment (after cast removal) to follow-up (six weeks later). Multiple regression analysis found over 50% of variance in wrist extension change, Levine questionnaire change, and change on the simulated feeding item of the Jebsen Test of Hand Function to be predicted by adherence. Home exercise adherence was the most important predictor of the adherence measures. These results highlight the importance of adherence to home exercises prescribed by a hand therapist after fracture of the distal radius.
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Taylor NF, Dodd KJ, McBurney H, Graham H. Factors influencing adherence to a home-based strength-training programme for young people with cerebral palsy. Physiotherapy 2004. [DOI: 10.1016/j.physio.2003.09.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
This study investigated adherence to low back pain rehabilitation in the clinical setting. Adherence was assessed in 105 (71 male and 34 female) patients attending private physiotherapy clinics for rehabilitation of low back pain. Three aspects of adherence were measured over the 4-week study period: attendance at clinic-based rehabilitation sessions, adherence to a home exercise component of rehabilitation, and adherence to activities and advice during clinic-based rehabilitation. Rehabilitation outcome was measured using the Patients' Measure of Perceived Rehabilitation (McDonald & Hardy 1990) and the Physiotherapists' Measure of Perceived Rehabilitation (McDonald & Hardy 1990). It was found that patients attended 87.7% of their scheduled physiotherapy rehabilitation appointments and reported completing 71.6% of their prescribed home exercises. In relation to adherence to clinic-based rehabilitation activities (as measured by the Sport Injury Rehabilitation Adherence Scale, Brewer et al. 2000), patients scored an average of 11.6/15. Although no gender differences were found, compensable patients adhered significantly less to clinic-based rehabilitation activities than did their non-compensable counterparts. Further, it was found that higher levels of adherence to clinic-based activities significantly predicted both the patients' and physiotherapists' perception of degree of rehabilitation at the end of the 4-week rehabilitation period. These findings are discussed in relation to rehabilitation strategies for physiotherapists.
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Affiliation(s)
- G S Kolt
- Faculty of Health, Auckland University of Technology, New Zealand.
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50
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Adherence to sport injury rehabilitation: implications for sports medicine providers and researchers. Phys Ther Sport 2001. [DOI: 10.1054/ptsp.2001.0062] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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