Interventions to aid patient adherence to physiotherapist prescribed self-management strategies: a systematic review

Peek, Kerry; Sanson‐Fisher, Rob; Mackenzie, Lisa; Carey, Mariko

doi:10.1016/j.physio.2015.10.003

Cited by 125 publications

(108 citation statements)

References 29 publications

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“…Adherence to non-surgical management is reportedly low 37. The therapeutic effect of a home exercise and/or self-management programme cannot be realised if not enacted by the patient 38.…”

Section: Discussionmentioning

confidence: 99%

Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis

et al. 2019

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ObjectivesTo (i) identify predictors of outcome for the physiotherapy management of shoulder pain and (ii) enable clinicians to subgroup people into risk groups for persistent shoulder pain and disability.Methods1030 people aged ≥18 years, referred to physiotherapy for the management of musculoskeletal shoulder pain were recruited. 810 provided data at 6 months for 4 outcomes: Shoulder Pain and Disability Index (SPADI) (total score, pain subscale, disability subscale) and Quick Disability of the Arm, Shoulder and Hand (QuickDASH). 34 potential prognostic factors were used in this analysis.ResultsFour classification trees (prognostic pathways or decision trees) were created, one for each outcome. The most important predictor was baseline pain and/or disability: higher or lower baseline levels were associated with higher or lower levels at follow-up for all outcomes. One additional baseline factor split participants into four subgroups. For the SPADI trees, high pain self-efficacy reduced the likelihood of continued pain and disability. Notably, participants with low baseline pain but concomitant low pain self-efficacy had similar outcomes to patients with high baseline pain and high pain self-efficacy. Cut-off points for defining high and low pain self-efficacy differed according to baseline pain and disability. In the QuickDASH tree, the association between moderate baseline pain and disability with outcome was influenced by patient expectation: participants who expected to recover because of physiotherapy did better than those who expected no benefit.ConclusionsPatient expectation and pain self-efficacy are associated with clinical outcome. These clinical elements should be included at the first assessment and a low pain self-efficacy response considered as a target for treatment intervention.

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“…Adherence to non-surgical management is reportedly low 37. The therapeutic effect of a home exercise and/or self-management programme cannot be realised if not enacted by the patient 38.…”

Section: Discussionmentioning

confidence: 99%

Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis

et al. 2019

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“…Interventions prescribing exercise or PA improve pain, function, and quality of life in individuals with PMSK, including individuals with low back pain (UK Beam, 2004), lower extremity osteoarthritis (Bearne, Walsh, Jessep, & Hurley, 2011), and fibromyalgia (O'Connor et al, 2015). However, the majority of people with PMSK do not experience the benefits of exercise due to poor adherence to their prescribed programme (Peek, Sanson-Fisher, Mackenzie, & Carey, 2016). Treatment adherence has been defined as observing the behaviour endorsed by a HCP for the recommended duration (World Health Organization, 2003) and has been explored in similar health behaviours, such as medication adherence (Osterberg & Blaschke, 2005).…”

Section: Statement Of Contributionmentioning

confidence: 99%

Behaviour change techniques associated with adherence to prescribed exercise in patients with persistent musculoskeletal pain: Systematic review

Meade

Bearne

Sweeney

et al. 2018

British J Health Psychol

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Limited moderate-quality evidence supports using a small number of BCTs to enhance exercise adherence in people with PMSK. Further research should explore the associations and synergies between BCTs and explicitly report how theory was utilized. This may inform recommendations for health care professionals working with this population. Statement of contribution What is already known on this subject? Exercise (i.e., planned, structured, repetitive movements) improves pain and function in people with persistent musculoskeletal pain (PMSK). Many people with PMSK do not adhere to exercises prescribed by a health care professional. Little research has explored how to enhance adherence to prescribed exercise in people with PMSK. What does this study add? Moderate-quality evidence from eight trials suggests behaviour change interventions enhance exercise adherence. Social support, goal setting, demonstration, instruction, and rehearsal were employed in effective interventions. Interventions with ≤7 behaviour change techniques were more effective at improving adherence than those employing >7.

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“…Although this can be seen as a function of burden of treatment, parents who are interested in habituating the evening delivery of LBT to their sons may benefit from interventions such as written exercise instructions or behavioural interventions with booster sessions and goal setting. 254 Careful work is required to ensure that involvement and mutual responsibility works for parents and is not received by them as part of the 'growing demands' for them 'to organize and co-ordinate their own care'. 113 Carer engagement should not be used as a staging post for rationing by denial, selection, deterrence or dilution, 255 not least because safety concerns (see Chapter 1, Physiotherapy) mean that carers need some level of education in pathology and oversight and treatment.…”

Section: Focus Is On Equality and Narrowing Health Inequalitiesmentioning

confidence: 99%

Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation

Hind

Parkin

Whitworth

et al. 2017

Health Technol Assess

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BackgroundDuchenne muscular dystrophy (DMD) is a rare disease that causes the progressive loss of motor abilities such as walking. Standard treatment includes physiotherapy. No trial has evaluated whether or not adding aquatic therapy (AT) to land-based therapy (LBT) exercises helps to keep muscles strong and children independent.ObjectivesTo assess the feasibility of recruiting boys with DMD to a randomised trial evaluating AT (primary objective) and to collect data from them; to assess how, and how well, the intervention and trial procedures work.DesignParallel-group, single-blind, randomised pilot trial with nested qualitative research.SettingSix paediatric neuromuscular units.ParticipantsChildren with DMD aged 7–16 years, established on corticosteroids, with a North Star Ambulatory Assessment (NSAA) score of 8–34 and able to complete a 10-m walk without aids/assistance. Exclusions: > 20% variation between baseline screens 4 weeks apart and contraindications.InterventionsParticipants were allocated on a 1 : 1 ratio to (1) optimised, manualised LBT (prescribed by specialist neuromuscular physiotherapists) or (2) the same plus manualised AT (30 minutes, twice weekly for 6 months: active assisted and/or passive stretching regime; simulated or real functional activities; submaximal exercise). Semistructured interviews with participants, parents (n = 8) and professionals (n = 8) were analysed using Framework analysis. An independent rater reviewed patient records to determine the extent to which treatment was optimised. A cost-impact analysis was performed. Quantitative and qualitative data were mixed using a triangulation exercise.Main outcome measuresFeasibility of recruiting 40 participants in 6 months, participant and therapist views on the acceptability of the intervention and research protocols, clinical outcomes including NSAA, independent assessment of treatment optimisation and intervention costs.ResultsOver 6 months, 348 children were screened – most lived too far from centres or were enrolled in other trials. Twelve (30% of target) were randomised to AT (n = 8) or control (n = 4). People in the AT (n = 8) and control (n = 2: attrition because of parental report) arms contributed outcome data. The mean change in NSAA score at 6 months was –5.5 [standard deviation (SD) 7.8] for LBT and –2.8 (SD 4.1) in the AT arm. One boy suffered pain and fatigue after AT, which resolved the same day. Physiotherapists and parents valued AT and believed that it should be delivered in community settings. The independent rater considered AT optimised for three out of eight children, with other children given programmes that were too extensive and insufficiently focused. The estimated NHS costs of 6-month service were between £1970 and £2734 per patient.LimitationsThe focus on delivery in hospitals limits generalisability.ConclusionsNeither a full-scale frequentist randomised controlled trial (RCT) recruiting in the UK alone nor a twice-weekly open-ended AT course delivered at tertiary centres is feasible. Further intervention development research is needed to identify how community-based pools can be accessed, and how families can link with each other and community physiotherapists to access tailored AT programmes guided by highly specialised physiotherapists. Bayesian RCTs may be feasible; otherwise, time series designs are recommended.Trial registrationCurrent Controlled Trials ISRCTN41002956.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 27. See the NIHR Journals Library website for further project information.

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Interventions to aid patient adherence to physiotherapist prescribed self-management strategies: a systematic review

Cited by 125 publications

References 29 publications

Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis

Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis

Behaviour change techniques associated with adherence to prescribed exercise in patients with persistent musculoskeletal pain: Systematic review

Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation

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