Aiding patient adherence to physiotherapist-prescribed self-management strategies: an evidence-based behavioural model in practice

Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus

OBJECTIVE

To develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies.

METHOD

We conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK.

RESULTS

In round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains-(1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4.

CONCLUSION

We developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders' experiences and the cost-effectiveness of implementing these strategies.

Characteristics associated with high levels of patient-reported adherence to self-management strategies prescribed by physiotherapists

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.