Barriers and facilitators of physical activity in knee and hip osteoarthritis: a systematic review of qualitative evidence

Abstract

Physical activity (PA), including engagement in structured exercise, has a key role in the management of hip and knee osteoarthritis (OA). However, maintaining a physically active lifestyle is a challenge for people with OA. PA determinants in this population need to be understood better so that they can be optimised by public health or healthcare interventions and social policy changes.ObjectivesThe primary aim of this study is to conduct a systematic review of the existing qualitative evidence on barriers and facilitators of PA for patients with hip or knee OA. Secondary objective is to explore differences in barriers and facilitators between (1) lifestyle PA and exercise and (2) PA uptake and maintenance.MethodsMedline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Scopus, Grey literature and qualitative journals were searched. Critical Appraisal Skills Programme—Qualitative checklist and Lincoln and Guba’s criteria were used for quality appraisal. Thematic synthesis was applied.FindingsTen studies were included, seven focusing on exercise regimes, three on overall PA. The findings showed a good fit with the biopsychosocial model of health. Aiming at symptom relief and mobility, positive exercise experiences and beliefs, knowledge, a ‘keep going’ attitude, adjusting and prioritising PA, having healthcare professionals’ and social support emerged as PA facilitators. Pain and physical limitations; non-positive PA experiences, beliefs and information; OA-related distress; a resigned attitude; lack of motivation, behavioural regulation, professional support and negative social comparison with coexercisers were PA barriers. All themes were supported by high and medium quality studies. Paucity of data did not allow for the secondary objectives to be explored.ConclusionOur findings reveal a complex interplay among physical, personal including psychological and social-environmental factors corresponding to the facilitation and hindrance of PA, particularly exercise, engagement. Further research on the efficacy of individualised patient education, psychological interventions or social policy change to promote exercise engagement and lifestyle PA in individuals with lower limb OA is required.Trial registration numberCRD42016030024.

Improvements in Objectively Measured Activity Behaviors Do Not Correlate With Improvements in Patient-Reported Outcome Measures Following Total Knee Arthroplasty

“…Nevertheless, increasing activity is important for patients with OA particularly to reduce the health risks associated with known comorbidities that are often present in this population and is an important area of rehabilitation relevant to the patient following TKA [54]. Postsurgery, emphasis should be placed on mitigating patient barriers to and enabling facilitation of PA following TKA in order to drive change in activity behaviors [26,55]. The inability to perform PA and the energetic demands that it places on one's body are cited as barriers to participation in PA [56,57].…”

Harnessing technology to deliver care by physical therapists for people with persistent joint pain: Telephone and video‐conferencing service models

“…Despite clinical guideline recommendations, participation in exercise and physical activity are generally low among people with OA (Basedow & Esterman, 2015;Hinman, Nicolson, Dobson, & Bennell, 2015;Jordan et al, 2004;Mitchell & Hurley, 2008). Although a diverse and multi-factorial range of barriers to exercise participation exist in this patient group (Dobson et al, 2016;Kanavaki et al, 2017), barriers frequently relate to the environmental context, resources, and support available to the individual, as well as to personal beliefs about both capabilities to exercise and consequences of exercise participation. Importantly, lack of health care professional support to exercise is a common barrier.…”

Cardiovascular and Functional Capacity of Patients with Knee Osteoarthritis

“…Inhibitors in interpersonal and psychological factors included non-effective physical activity, harmful or suspicious activity, loss of motivation, and loss of behavioral regulation. Inhibitors in social environment included lack of advice and encouragement from health workers, social comparison as demotivation, and lack of social support [18].…”