Predictors of adherence to home-based physical therapies: a systematic review

Abstract

Disability and Rehabilitation F o r P e e r R e v i e w Running head: Adherence to home-based physical therapies Implications for Rehabilitation• Non-adherence to physical rehabilitation therapies is often high -particularly in selfmanaged, home-based programmes, despite good adherence being important in achieving positive outcomes.• The findings of this systematic review indicate that greater self-efficacy, self-motivation, social support, intentions and previous adherence to physical therapies predict higher adherence to HBPTs.• Assessment of these domains before providing individuals with their HBPT regimes may allow identification of 'risk factors' for poor adherence. These can then potentially be addressed or managed prior to, or alongside, the therapy.• Interventions to support patients' self-managed physical rehabilitation should include elements designed to enhance patients' self-efficacy, self-motivation and social support given the evidence that these factors are good predictors of adherence. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 focused largely on clinic-based physiotherapy. The objective of this review, therefore, was to identify specific factors which influence adherence to home-based, self-managed physical therapies. Method: A systematic review was conducted in which eight online databases were searched using combinations of key terms relating to physical therapies, adherence and predictors. Matching records were screened against eligibility criteria and 30 quantitative articles were quality assessed and included in the final review. Relevant data were extracted and a narrative synthesis approach was taken to aggregating findings across studies. Results:There was relatively strong evidence that the following factors predicted adherence to HBPTs: intention to engage in the HBPT, self-motivation, self-efficacy, previous adherence to exercise-related behaviours, and social support. Conclusions: This review has identified a range of factors that appear to be related to patients' adherence to their self-managed physical rehabilitation therapies. Awareness of these factors may inform design of interventions to improve adherence. Key words:Adherence, physiotherapy, self-management, predictors recommendations from a health care provider" [7]. Within the field of rehabilitation, the term 'engagement' is also increasingly used in relation to patients' self-management of their health. This term not only encompasses notions of whether a patient's behaviour is adherent, but also of interaction with professionals and identifying relevant information too [8][9][10]. Whilst important to acknowledge this broader concept of engagement, the focus of this review is primarily upon...

Measurements of self‐efficacy in musculoskeletal rehabilitation: A systematic review

“…The benefits of HEPs include range of motion and strength gains, reinforcement of motor learning, pain reduction and improvements in function (Jack, McLean, Moffett, & Gardiner, ; Muratori, Lamberg, Quinn, & Duff, ). Unfortunately, the literature suggests that patients are non‐adherent to HEPs as often as 70% of the time (Essery, Geraghty, Kirby, & Yardley, ; Sluijs et al, ). Researchers have examined the barriers to patient adherence to HEPs, which include low physical activity levels at baseline; depression; anxiety; helplessness; forgetfulness; increased pain levels during exercise; and low self‐efficacy (Essery et al, ; Jack et al, ).…”

“…Unfortunately, the literature suggests that patients are non‐adherent to HEPs as often as 70% of the time (Essery, Geraghty, Kirby, & Yardley, ; Sluijs et al, ). Researchers have examined the barriers to patient adherence to HEPs, which include low physical activity levels at baseline; depression; anxiety; helplessness; forgetfulness; increased pain levels during exercise; and low self‐efficacy (Essery et al, ; Jack et al, ). Among these psychological barriers to adherence, a patient's level of self‐efficacy toward performing exercises at home is most readily influenced by the rehabilitation clinician (Altmaier, Russell, Kao, Lehmann, & Weinstein, ; Storheim, Brox, Holm, Koller, & Bo, ).…”

A longitudinal, qualitative study exploring sustained adherence to a hand exercise programme for rheumatoid arthritis evaluated in the SARAH trial

“…Possible influences include positive re-enforcement from clinicians and carers/peers, positive experiences of past exercise participation, positive attitudes and beliefs toward exercises, confidence in self-management ability, positive perceptions of health status, fewer comorbidities and good symptom control (5)(6)(7)(8). However, both patients and clinicians report concerns that exercise will exacerbate symptoms, and uncertainty about the optimal type or dose of exercises and who should advise patients about exercising (9,10).…”

Chronic Pain and Exercise: Studies on pain intensity, biochemistry, adherence and attitudes

“…The concepts included in the discussion about adherence in this thesis are outlined in figure 14. Adherence to PA&E as treatment is troublesome [7,174], and possibly even more troublesome in home-based PA&E interventions [238]. Also in paper 1, limited adherence to the PA&E intervention were reported and a successive decline in adherence during time period was obvious.…”

“…Self-efficacy describes an individual's perceived confidence in performing a certain behaviour, or behaviours during certain circumstances. Pain self-efficacy, an individuals confident in performing activities in presence of pain [130], has earlier been studied in research on chronic pain and PA&E, and associations to pain severity, disability and psychological distress has been proposed [131], as well as an association between low self-efficacy and poor adherence to PA&E as treatment [174,238]. However, there are conflicting evidence for the impact of self-efficacy on adherence to treatment in chronic pain [240].…”