Dosage of Preventive or Therapeutic Exercise Interventions: Review of Published Randomized Controlled Trials and Survey of Authors

Gallois, Marion; Davergne, Thomas; Ledinot, Pauline; Ravaud, Philippe; Regnaux, Jean‐Philippe

doi:10.1016/j.apmr.2017.03.030

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…Several studies have shown that proper patient selection influences the effectiveness of treatment due to differences in responses, potentially leading to greater therapy gains 39–42. The impact of both dosage and type of the exercise programme on its effectiveness due to the direct dose response relationship has been well established in the literature 43 44. Also, qualified supervisor (in terms of acquired skills and experience) is known to influence the treatment effects, for example, due to the increased adherence when treated by a trained professional 45–47.…”

Section: Discussionmentioning

confidence: 99%

i-CONTENT tool for assessing therapeutic quality of exercise programs employed in randomised clinical trials

et al. 2020

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ObjectiveWhen appraising the quality of randomised clinical trial (RCTs) on the merits of exercise therapy, we typically limit our assessment to the quality of the methods. However, heterogeneity across studies can also be caused by differences in the quality of the exercise interventions (ie, ‘the potential effectiveness of a specific intervention given the potential target group of patients’)—a challenging concept to assess. We propose an internationally developed, consensus-based tool that aims to assess the quality of exercise therapy programmes studied in RCTs: the international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool.MethodsForty-nine experts (from 12 different countries) in the field of physical and exercise therapy participated in a four-stage Delphi approach to develop the i-CONTENT tool: (1) item generation (Delphi round 1), (2) item selection (Delphi rounds 2 and 3), (3) item specification (focus group discussion) and (4) tool development and refinement (working group discussion and piloting).ResultsOut of the 61 items generated in the first Delphi round, consensus was reached on 17 items, resulting in seven final items that form the i-CONTENT tool: (1) patient selection; (2) qualified supervisor; (3) type and timing of outcome assessment; (4) dosage parameters (frequency, intensity, time); (5) type of exercise; (6) safety of the exercise programme and (7) adherence to the exercise programme.ConclusionThe i-CONTENT-tool is a step towards transparent assessment of the quality of exercise therapy programmes studied in RCTs, and ultimately, towards the development of future, higher quality, exercise interventions.

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Section: Discussionmentioning

confidence: 99%

i-CONTENT tool for assessing therapeutic quality of exercise programs employed in randomised clinical trials

et al. 2020

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“…The majority of exercises were bed exercises which are limited with the transferability to function. In addition, the dosages of exercises were not explicit in their reasoning or premise which is in keeping with a systematic review of the rehabilitation literature [32].…”

Section: Discussionmentioning

confidence: 99%

A Critical Analysis of the Exercise Prescription and Return to Activity Advice That Is Provided in Patient Information Leaflets Following Lumbar Spine Surgery

2019

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Background and objectives: Lumbar spine surgery may be considered if pharmacologic, rehabilitation and interventional approaches cannot provide sufficient recovery from low back-related pain. Postoperative physiotherapy treatment in England is often accompanied by patient information leaflets, which contain important rehabilitation advice. However, in order to be an effective instrument for patients, the information provided in these leaflets must be up to date and based on the best available evidence and clinical practice. This study aims to critically analyse the current postoperative aspects of rehabilitation (exercise prescription and return to normal activity) that are provided in patient information leaflets in England as part of an evaluation of current practice following lumbar spine surgery. Materials and Methods: Patient information leaflets from English National Health Service (NHS) hospitals performing lumbar spine surgery were sourced online. A content analysis was conducted to collect data on postoperative exercise prescription and return to normal activities. Results: Thirty-two patient information leaflets on lumbar surgery were sourced (fusion, n = 11; decompression, n = 15; all lumbar procedures, n = 6). Many of the exercises prescribed within the leaflets were not based on evidence of clinical best practice and lacked a relationship to functional activity. Return to normal activity advice was also wide ranging, with considerable variation in the recommendations and definitions provided. Conclusions: This study highlights a clear variation in the recommendations of exercise prescription, dosage and returning to normal activities following lumbar spine surgery. Future work should focus on providing a consistent and patient-centred approach to recovery.

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“…Dosing can influence the magnitude of the treatment effect size and should always be considered when evaluating a proper course of nonsurgical care, with greater intensity often associated with better outcomes. [46][47][48] However, more does not always mean better. 49 In short, the goals should be to maximize effectiveness of treatment so that the need for surgical intervention is either postponed or eliminated entirely.…”

Section: Rehabilitation Specialistsmentioning

confidence: 99%

Nonoperative Care Including Rehabilitation Should Be Considered and Clearly Defined Prior to Elective Orthopaedic Surgery to Maximize Optimal Outcomes

Rhon

Tucker

2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Orthopaedic surgery has revolutionized the expectations for restoration of physical function after musculoskeletal injury and, along with physical therapy, has transformed the limits of recovery. Many orthopaedic procedures have a high success rate for improving quality of life and patient-reported outcomes, yet these procedures carry some level of risk, including postoperative complications. The stepped-care model of health care delivery, when applied to musculoskeletal care, recommends implementing less-intense and lower-risk treatments with known efficacy, such as promotion and education of self-management strategies and physical therapy, before more-invasive and higher-risk treatments such as surgery. This model of managing musculoskeletal disability can improve efficiency of care delivery and reduce medical costs at the health system level. Unfortunately, there is a documented lack of implementing an appropriate course of conservative care, especially physical therapy, prior to surgery across multiple orthopaedic disciplines including sports, spine, and trauma medicine and joint arthroplasty. Failure to respond to nonsurgical treatment has been suggested as a requisite component of the surgical appropriateness criteria, yet practical application can be elusive. Multiple barriers to adequate utilization of conservative treatment exist, including U.S. payment models that increase out-of-pocket expense for patients, negative patient perception of therapy, unreasonable patient expectations from therapy versus surgery, and communication barriers between patient, surgeon, and therapist. Surgeons should ensure that high-quality guidelineappropriate care is delivered early and adequately to their patients. Rehabilitation professionals have a responsibility to deliver high-value care, properly documenting the type and extent of treatment to improve surgical decision-making between surgeons and patients. Criteria to determine appropriateness for surgery should include a standardized and extensive assessment of failed therapies prior to certain elective surgeries. Improved collaboration between surgeons and rehabilitation professionals can result in improved outcomes for patients with musculoskeletal disorders. Level of Evidence: V, expert opinion

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Dosage of Preventive or Therapeutic Exercise Interventions: Review of Published Randomized Controlled Trials and Survey of Authors

Cited by 5 publications

References 29 publications

i-CONTENT tool for assessing therapeutic quality of exercise programs employed in randomised clinical trials

i-CONTENT tool for assessing therapeutic quality of exercise programs employed in randomised clinical trials

A Critical Analysis of the Exercise Prescription and Return to Activity Advice That Is Provided in Patient Information Leaflets Following Lumbar Spine Surgery

Nonoperative Care Including Rehabilitation Should Be Considered and Clearly Defined Prior to Elective Orthopaedic Surgery to Maximize Optimal Outcomes

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