Effectiveness of behaviour change techniques in physiotherapy interventions to promote physical activity adherence in lower limb osteoarthritis patients: A systematic review

Abstract

Background Lower limb osteoarthritis (OA) causes high levels of individual pain and disability and is an increasing socio-economic burden to global healthcare systems. Physical Activity interventions are commonly provided by physiotherapists to help patients with lower limb OA manage their clinical symptoms. Objective To identify and evaluate the effectiveness of behavioural change techniques (BCTs) within physiotherapy interventions to increase physical activity (PA) adherence in patients with lower limb OA. Design A systematic review was conducted, following Cochrane guidelines according to a published and registered protocol (CRD42016039932). Two independent researchers conducted searches, determined eligibility, assessed risk of bias (Cochrane tool), intervention fidelity (NIHBCC checklist), and coded randomised controlled trials (RCTs) for BCTs (V1 taxonomy). BCT effectiveness ratios were calculated and RCT risk of bias and intervention fidelity were summarised narratively. Data sources A highly sensitive search strategy was conducted on Medline, Embase, PsycINFO, CENTRAL, CINAHL and PEDro and grey literature databases from inception to January 2 nd , 2018. Reference lists of included RCTs and relevant articles were reviewed, and a citation search was conducted using Web of Science. Eligibility criteria for selecting studies RCTs that evaluated the effectiveness of a physiotherapy intervention that incorporated ≥1 BCT that promoted home or community-based PA adherence in patients with lower limb osteoarthritis. Results Twenty-four RCTs (n = 2366 participants) of variable risk of bias (RoB) (5 low; 7 moderate; 12 high) and poor intervention reporting from 10 countries were included. Heterogeneity of intervention BCTs and PA adherence outcome measures precluded meta-analysis. Thirty-one distinct BCTs were identified in 31 interventions across RCTs. In general, BCTs demonstrated higher effectiveness ratios for short-term and long-term PA adherence compared with medium-term outcomes. The BCTs ‘behavioural contract’, ‘non-specific reward’, ‘patient-led goal setting’ (behaviour), ‘self-monitoring of behaviour’, and ‘social support (unspecified) demonstrated the highest effectiveness ratios across time points to promote PA adherence. Conclusions BCTs demonstrate higher short and long-term than medium-term effectiveness ratios. Further research involving low RoB RCTs incorporating transparently reported interventions with pre-specified BCTs aimed at optimising lower limb OA patient PA adherence is required.

Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial

“…As our program incorporated several elements, we could not determine which elements were most effective in eliciting the desired exercise behavior. Regular receipt of a message asking to self-report exercise completion can act as a reminder, and self-monitoring behavior increases physical activity adherence in patients with OA [ 46 ] and in adults who are overweight or have obesity [ 47 ]. Our bank of 198 different text messages included 20 behavior change techniques targeting 13 modifiable barriers and 9 facilitators to exercise previously identified in people with OA [ 8 ].…”

Placebos in primary care? a nominal group study explicating UK GP and patient views of six theoretically plausible models of placebo practice

“…Nominal groups were presented six scenarios for voting and discussion. These scenarios were written by the research team using a taxonomy of five domains of placebogenic techniques22–26 derived from experimental and clinical studies27 to create six theoretically plausible placebogenic scenarios for primary care (table 2). Techniques from the five domains22 were used to create the scenarios: (1) The patient’s beliefs and characteristics informed ‘Withholding side effects’, (2) The healthcare setting informed ‘Monitoring’, (3) The practitioner’s beliefs and characteristics informed ‘GP endorsement’, (4) The patient-practitioner interaction informed ‘Idealised consultation’ and (5) Treatment characteristics informed ‘Deceptive’/‘Open-label placebo pills’.…”

Low adherence to exercise may have influenced the proportion of OMERACT-OARSI responders in an integrated osteoarthritis care model: secondary analyses from a cluster-randomised stepped-wedge trial

“…However, improved adherence to exercise in clinical practice is not easily achieved. Previous studies have found small effects of certain behaviour change techniques and booster sessions to improve exercise adherence among patients [33,34]. How to effectively improve exercise adherence in patients with hip and knee OA is a current research priority [35], which should be further studied also within the current setting.…”