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Kiyoshi-Teo H, McMahon SK, Northup-Snyder K, Cohen DJ. Older People's Descriptions of Their Engagement in Fall Prevention. West J Nurs Res 2024; 46:10-18. [PMID: 37950361 DOI: 10.1177/01939459231211803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Evidence-based strategies to decrease fall rates are well established. However, little is understood about how older people engage in fall prevention strategies. Motivational Interviewing (MI) sessions aimed to facilitate individuals' engagement in fall prevention can be analyzed to learn what it means for older people to engage in fall prevention. Thus, the purpose of this study was to explore how older people describe their engagement in fall prevention. Participants in our parent project, MI for Fall Prevention (MI-FP), who received MI sessions were purposively selected for maximum variation in age, sex, fall risks, and MI specialist assigned. The first (of 8) MI sessions from 16 participants were recorded, transcribed, and analyzed using qualitative content analysis. Three researchers first deductively analyzed fall prevention strategies that participants described using an evidence-based fall prevention guideline as a reference. Then, we inductively analyzed the characteristics of these strategies and how participants engaged in them. Finally, we used the Capability, Opportunity, Motivation, Behavior (COM-B) model to organize our results about factors influencing engagement. We found (1) older adults engage in unique combinations of fall prevention strategies and (2) decisions about engagement in fall prevention strategies were influenced by multiple factors that were personal (e.g., who I am, capability, motivation, and opportunities). This study highlighted how fall prevention can be a life-long lifestyle decision for older people. Understanding older people's perspectives about engaging in fall prevention is essential to develop interventions to promote evidence-based fall prevention strategies in real-world settings.
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Affiliation(s)
- Hiroko Kiyoshi-Teo
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | | | | | - Deborah J Cohen
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
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Chester R, Daniell H, Belderson P, Wong C, Kinsella P, McLean S, Hill J, Banerjee A, Naughton F. Behaviour Change Techniques to promote self-management and home exercise adherence for people attending physiotherapy with musculoskeletal conditions: A scoping review and mapping exercise. Musculoskelet Sci Pract 2023; 66:102776. [PMID: 37301059 DOI: 10.1016/j.msksp.2023.102776] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Many patients with musculoskeletal problems do not adhere to home exercises or self-management advice provided by physiotherapists. This is due to numerus factors, many of which can be targeted by Behaviour Change Techniques. OBJECTIVES 1) Undertake a scoping review to identify the modifiable determinants (barriers and facilitators) of home exercise adherence and self-management for the physiotherapy management of people with musculoskeletal problems and map them to the Theoretical Domains Framework and Behaviour Change Techniques. 2) For determinants with supporting evidence from ≥2 studies, provide examples of Behaviour Change Techniques for clinical practice. DESIGN This review follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. METHOD Four electronic databases were searched from inception to December 2022. Two independent reviewers carried out manuscript selection, data extraction, quality assessment, and mapping, the latter using the Theory and Techniques Tool. RESULTS Thirteen modifiable determinants were identified in 28 studies. The most frequently identified were self-efficacy, social support, and task appreciation. Determinants were mapped to 7 of 14 Theoretical Domains Framework categories, which in turn mapped onto 42 of 93 Behaviour Change Techniques, the most common being problem solving and instruction on how to perform behaviour. CONCLUSIONS By identifying determinants to home exercise adherence and self-management and mapping these to Behaviour Change Techniques, this review has improved understanding of their selection, targeting, and potential application to musculoskeletal physiotherapy practice. This provides support for physiotherapists targeting the determinants of importance for the patient in front of them.
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Affiliation(s)
- Rachel Chester
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, United Kingdom.
| | - Helena Daniell
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, United Kingdom; Physiotherapy Department, Norfolk and Norwich University Hospital, NHS Trust, Norwich, United Kingdom.
| | - Pippa Belderson
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, United Kingdom.
| | - Carl Wong
- Department of Therapies, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, United Kingdom.
| | - Paula Kinsella
- Flint House Police Rehabilitation, Reading Road, Goring, Reading, RG8 0LL, United Kingdom; Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Campus, Collegiate Cres, Broomhall, Sheffield, S10 2BP, United Kingdom.
| | - Sionnadh McLean
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Campus, Collegiate Cres, Broomhall, Sheffield, S10 2BP, United Kingdom.
| | - Jonathan Hill
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - Anirban Banerjee
- Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - Felix Naughton
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, United Kingdom.
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Room J, Dawes H, Boulton M, Barker K. The AERO study: A feasibility randomised controlled trial of individually tailored exercise adherence strategies based on a brief behavioural assessment for older people with musculoskeletal conditions. Physiotherapy 2023; 118:88-96. [PMID: 36266133 DOI: 10.1016/j.physio.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/06/2022] [Accepted: 08/25/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Exercise is a widely used treatment modality for older people with musculoskeletal conditions. The effectiveness of exercise programmes is limited by adherence. The aims of this study were to examine the acceptability and feasibility of the AERO intervention in facilitating exercise adherence in older people with musculoskeletal conditions, and to inform the design of a future randomised controlled trial. METHODS A two arm feasibility randomised controlled trial with an embedded qualitative study conducted at one orthopaedic hospital in the South of England. Older adults referred to physiotherapy with musculoskeletal conditions were randomised to receive either usual care consisting of standard physiotherapy only, or the AERO intervention, consisting of usual care with the addition of tailored exercise adherence approaches based on a brief behavioural assessment. Feasibility outcomes included recruitment, randomisation, retention, acceptability, and fidelity to trial protocol. Secondary outcomes included exercise adherence, physical activity, and behavioural regulation. RESULTS 48 participants were recruited to the study with 27 randomised to usual care and 21 to AERO and usual care. On the basis of recruitment, retention, the acceptability to participants and physiotherapists and fidelity, the AERO intervention was determined to be feasible. CONCLUSION The AERO intervention in which participants received tailored adherence strategies based on a behavioural assessment plus standard physiotherapy is feasible and acceptable. It is now ready to be tested in an adequately powered randomised controlled trial. CONTRIBUTION OF THE PAPER CLINICAL TRIAL REGISTRATION NUMBER: This study was registered at clinicaltrials.gov REF: NCT03643432.
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Affiliation(s)
- Jonathan Room
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS FT, Oxford, UK; Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Brookes University, Oxford, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Helen Dawes
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Brookes University, Oxford, UK
| | - Mary Boulton
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS FT, Oxford, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
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Vincenzo JL, Patton SK, Lefler LL, McElfish PA, Wei J, Curran GM. Older Adults' Perceptions and Recommendations Regarding a Falls Prevention Self-Management Plan Template Based on the Health Belief Model: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041938. [PMID: 35206125 PMCID: PMC8871905 DOI: 10.3390/ijerph19041938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 12/10/2022]
Abstract
Falls are the leading cause of fatal and non-fatal injuries among older adults. Self-management plans have been used in different contexts to promote healthy behaviors, but older adults’ perceptions of a falls prevention self-management plan template have not been investigated. Using mixed methods, we investigated older adults’ perceptions and recommendations of a falls prevention self-management plan template aligned with the Health Belief Model. Four focus groups (n = 27, average age 78 years) were conducted using semi-structured interview guides. Participants also ranked the written plan on paper with respect to each item by the level of importance, where item 1 was the most important, and 10 was the least important. Focus groups were transcribed and analyzed. Descriptive statistics were calculated for item rankings. Older adults felt that the plan would raise awareness and help them to engage in falls prevention behaviors. Participants recommended adding graphics and using red to highlight the risk of falling. Participants opined that ranking the items by level of importance was challenging because they felt all items were important. ‘What might happen to me if I fall’ was ranked as the most important item (average 2.6), while ‘How will I monitor progress’ was the least important (average = 6.6). Considering that older adults need support to engage in falls prevention, future research should investigate the impact of implementing an individually tailored falls prevention self-management plan on older adults’ engagement in falls prevention behaviors and outcomes of falls and injuries.
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Affiliation(s)
- Jennifer L. Vincenzo
- Department of Physical Therapy, College of Health Professions, University of Arkansas for Medical Sciences, Fayetteville, AR 72703, USA
- Correspondence:
| | - Susan K. Patton
- Department of Nursing, College of Education and Health Professions, University of Arkansas, Fayetteville, AR 72703, USA;
| | - Leanne L. Lefler
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Pearl A. McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Fayetteville, AR 72703, USA;
| | - Jeanne Wei
- Department of Geriatrics, Reynolds Institute on Aging, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
- Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114, USA
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Barton CJ, Pazzinatto MF, Crossley KM, Dundules K, Lannin NA, Francis M, Wallis J, Kemp JL. Reported practices related to, and capability to provide, first-line knee osteoarthritis treatments: a survey of 1064 Australian physical therapists. Braz J Phys Ther 2021; 25:854-863. [PMID: 34548210 PMCID: PMC8721054 DOI: 10.1016/j.bjpt.2021.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Physical therapists play a key role in providing first-line knee osteoarthritis treatments, including patient education and exercise therapy. OBJECTIVES Describe Australian physical therapists' awareness of guidelines; reported practices; and beliefs about capability, opportunity, motivation, and evidence. METHODS An online cross-sectional survey was completed by physical therapists prior to attending the Good Living with osteoArthritis from Denmark (GLA:D®) Australia training courses (March 2017 to December 2019). The survey instrument was developed by an expert panel and was informed by the Theoretical Domains Framework. RESULTS 1064 physical therapists from all Australian states and territories participated. 11% (n = 121) could name an accepted guideline, 98% agreed it was their job to deliver patient education and exercise therapy, and 92% agreed this would optimise outcomes. Most reported providing strength exercise (99%), written exercise instructions (95%), treatment goal discussion (88%), and physical activity advice (83%) all or most of the time. Fewer provided aerobic exercise (66%), neuromuscular exercise (54%), and weight management discussion (56%) all or most of the time. Approximately one quarter (23-24%) believed they did not have the skills, knowledge, or confidence to provide education and exercise therapy recommended by guidelines, and just 48% agreed they had been trained to do so. CONCLUSION Australian physical therapists treating knee osteoarthritis typically provide strength-based home exercise with written instructions, alongside goal setting and physical activity advice. Just one in nine could name a guideline. Education and training activities are needed to support physical therapists to access, read and implement guidelines, especially for aerobic and neuromuscular exercise, and weight management.
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Affiliation(s)
- Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia.
| | - Marcella F Pazzinatto
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Karen Dundules
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Natasha A Lannin
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Alfred Health, Melbourne, Australia
| | - Matt Francis
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Jason Wallis
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Clayton, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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Physiotherapists' perceptions of how patient adherence and non-adherence to recommended exercise for musculoskeletal conditions affects their practice: a qualitative study. Physiotherapy 2021; 113:107-115. [PMID: 34571284 DOI: 10.1016/j.physio.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 05/28/2021] [Accepted: 06/06/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to explore physiotherapists' perceptions of how patients' adherence and non-adherence to recommended exercise affects their practice. DESIGN A qualitative study with a focus group and semi-structured interviews. The focus group and interviews were audio recorded and transcribed verbatim. Transcripts were analysed using thematic analysis. SETTING MSK physiotherapy services in the United Kingdom. PARTICIPANTS Focus group: 8 UK registered physiotherapists (age range=24-48; seven female, one male). Semi-structured interviews: 10 UK registered physiotherapists (age range=28-52; eight female, two male). RESULTS Participants described how exercise adherence could be a challenging aspect of clinical practice and how they tried to improve it. Four main themes were identified: 1) A challenge but worth it; 2) It's frustrating but you can't win them all; 3) Striving to see the individual; and 4) Striving to help the patient. The importance of establishing a good working relationship with patients was emphasised. This included working collaboratively with the patient, avoiding blaming them for non-adherence and thinking about the language they used in discussing exercises. CONCLUSION Patient non-adherence to recommended exercise is a challenging aspect of clinical practice. Physiotherapists can acknowledge this difficulty, and the frustrations it may potentially bring, yet remain resilient in the face of it. Clinicians should consider potential approaches and strategies to optimise the potential for behaviour change, and to improve exercise adherence. Robust interventions to help clinicians facilitate better exercise adherence are also needed.
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Rawlinson G, Connell L. Out-patient physiotherapy service delivery post COVID-19: opportunity for a re-set and a new normal? Physiotherapy 2021; 111:1-3. [PMID: 33685739 PMCID: PMC7892307 DOI: 10.1016/j.physio.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Indexed: 02/08/2023]
Affiliation(s)
| | - Louise Connell
- University of Central Lancashire (UCLan), Preston PR1 2HE, UK; East Lancashire Hospitals NHS Trust, Burnley, UK
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