BackgroundImproving mobility in elderly persons is a primary goal in geriatric rehabilitation. Self-regulated exercises with instruction leaflets are used to increase training volume but adherence is often low. Exergames may improve adherence. This study therefore compared exergames with self-regulated exercise using instruction leaflets. The primary outcome was adherence. Secondary outcomes were enjoyment, motivation and balance during walking.MethodsDesign: single center parallel group non-blinded randomized controlled trial with central stratified randomization. Setting: center for geriatric inpatient rehabilitation. Included were patients over 65 with mobility restrictions who were able to perform self-regulated exercise. Patients were assigned to self-regulated exercise using a) exergames on Windows Kinect® (exergame group EG) or b) instruction leaflets (conventional group CG). During two 30 min sessions physical therapists instructed self-regulated exercise to be conducted twice daily during thirty minutes during ten working days. Patients reported adherence (primary outcome), enjoyment and motivation daily. Balance during walking was measured blind before and after the treatment phase with an accelerometer. Analysis was by intention to treat. Repeated measures mixed models and Cohen’s d effect sizes (ES, moderate if >0.5, large if > 0.8) with 95% CIs were used to evaluate between-group effects over time. Alpha was set at 0.05.ResultsFrom June 2014 to December 2015 217 patients were evaluated and 54 included, 26 in the EG and 28 in the CG. Adverse effects were observed in two patients in the EG who stopped because of pain during exercising. Adherence was comparable at day one (38 min. in the EG and 42 min. in the CG) and significantly higher in the CG at day 10 (54 min. in the CG while decreasing to 28 min. in the EG, p = 0.007, ES 0.94, 0.39–0.151). Benefits favoring the CG were also observed for enjoyment (p = 0.001, ES 0.88, 0.32 – 1.44) and motivation (p = 0.046, ES 0.59, 0.05–1.14)). There was no between-group effect in balance during walking.ConclusionsSelf-regulated exercise using instruction leaflets is superior to exergames regarding adherence, enjoyment and motivation in a geriatric inpatient rehabilitation setting. Effects were moderate to large. There was no between group difference in balance during walking.Trial registrationClinicalTrials.gov, NCT02077049, 6 February 2014.

Exercise interventions have a significant effect on work disability in patients with non-acute non-specific low back pain in the long term. No conclusions can be made regarding exercise types.

The aim of this study involving 170 patients suffering from non-specific low back pain was to test the validity of the spinal function sort (SFS) in a European rehabilitation setting. The SFS, a picture-based questionnaire, assesses perceived functional ability of work tasks involving the spine. All measurements were taken by a blinded research assistant; work status was assessed with questionnaires. Our study demonstrated a high internal consistency shown by a Cronbach's alpha of 0.98, reasonable evidence for unidimensionality, spearman correlations of [0.6 with work activities, and discriminating power for work status at 3 and 12 months by ROC curve analysis (area under curve = 0.760 (95% CI 0.689-0.822), respectively, 0.801 (95% CI 0.731-0.859). The standardised response mean within the two treatment groups was 0.18 and -0.31. As a result, we conclude that the perceived functional ability for work tasks can be validly assessed with the SFS in a European rehabilitation setting in patients with non-specific low back pain, and is predictive for future work status.

The reviewed trials provide strong evidence that exercise significantly reduces sick days during the first follow-up year.

Purpose The aim of this review is to list the factors that influence adherence to home-based exercise, and to make recommendations about how to improve adherence. Materials and Methods A literature search was performed in Web of Science Core Collection (Library of ETH Zurich), PubMed and PEDro databases. The following search categories were used: “physiotherapy”, “home-based exercises”, “adherence”, “effectiveness”, “motivation” and “barriers”. Results A total of 38 studies were identified and title and abstract analysis was performed. 14 studies were included for further analysis. The factors found to contribute to adherence to home-based exercise programmes are: intensive social support and guidance from a physiotherapist; prescription of a low number of exercises (<4); high levels of self-motivation and self-efficacy; and a lack of psychological influences, such as helplessness, depression and anxiety. Conclusion Adherence to home-based exercise could be increased relatively simply, through provision of good support of the patient from physiotherapists, instruction of 2 to a maximum of 4 exercises, and by increasing the patients’ self-motivation and self-efficacy (Recommendation level B+).