Quality and acceptability of measures of exercise adherence in musculoskeletal settings: a systematic review

Abstract

Objective. To recommend robust and relevant measures of exercise adherence for application in the musculoskeletal field.Method. A systematic review of measures was conducted in two phases. Phase 1 sought to identify all reproducible measures used to assess exercise adherence in a musculoskeletal setting. Phase 2 identified published evidence of measurement and practical properties of identified measures. Eight databases were searched (from inception to February 2016). Study quality was assessed against the Consensus-based Standards for the Selection of Health Measurement Instruments guidelines. Measurement quality was assessed against accepted standards.Results. Phase 1: from 8511 records, 326 full-text articles were reviewed; 45 reproducible measures were identified. Phase 2: from 2977 records, 110 full-text articles were assessed for eligibility; 10 articles provided evidence of measurement/practical properties for just seven measures. Six were exercise adherence-specific measures; one was specific to physical activity but applied as a measure of exercise adherence. Evidence of essential measurement and practical properties was mostly limited or not available. Assessment of relevance and comprehensiveness was largely absent and there was no evidence of patient involvement during the development or evaluation of any measure.Conclusion. The significant methodological and quality issues encountered prevent the clear recommendation of any measure; future applications should be undertaken cautiously until greater clarity of the conceptual underpinning of each measure is provided and acceptable evidence of essential measurement properties is established. Future research should seek to engage collaboratively with relevant stakeholders to ensure that exercise adherence assessment is high quality, relevant and acceptable.

Defining adherence to therapeutic exercise for musculoskeletal pain: a systematic review

“…Three recent systematic reviews of measures of exercise and self-management methods for MSK pain14–16 found that measures of exercise adherence currently used within randomised controlled trials are highly variable (including questionnaires, diaries and class registers), lack evidence of a robust or considered development process and demonstrate inadequate psychometric properties for reliability and validity. There is no existing measure of adherence that is fit for purpose 14–16.…”

“…Three recent systematic reviews of measures of exercise and self-management methods for MSK pain14–16 found that measures of exercise adherence currently used within randomised controlled trials are highly variable (including questionnaires, diaries and class registers), lack evidence of a robust or considered development process and demonstrate inadequate psychometric properties for reliability and validity. There is no existing measure of adherence that is fit for purpose 14–16. A valid and reliable measurement tool for adherence to TE for MSK pain is therefore required to enable interpretation of results from exercise trials and to robustly test the effectiveness of interventions intended to improve exercise adherence 13–16…”

“…There is no existing measure of adherence that is fit for purpose 14–16. A valid and reliable measurement tool for adherence to TE for MSK pain is therefore required to enable interpretation of results from exercise trials and to robustly test the effectiveness of interventions intended to improve exercise adherence 13–16…”

Collaborative Model of Care between Orthopaedics and Allied Healthcare Professionals Trial (CONNACT) – A Feasibility Study in patients with knee osteoarthritis using a mixed method approach

“…Compliance to exercises is a key outcome measure and a potential confounder when interpreting trial results that was not measured in the initial pilot. In the current literature, there is a lack of validated questionnaire that reliably measures exercises compliance or adherence (46). Compliance can be assessed in 2 different ways, either through patient reported measures or clinician assessment.…”

Collaborative Model of Care between Orthopaedics and Allied Healthcare Professionals in Knee Osteoarthritis (CONNACT): Study Protocol for an Effectiveness-Implementation Hybrid Randomized Control Trial

“…Compliance and adherence are key aspects in any exercises-based intervention for MSK conditions and having compliance measures allows for a more accurate interpretation of the results and form a signi cant part of the process evaluation (59). Unfortunately, there is no speci c measure for exercise adherence that has been proven to be high quality, relevant and acceptable (60). In order to give a holistic picture to adherence, the Sports Injury Rehabilitation Adherence Scale (SIRAS)(61) will provide the healthcare providers perspective while a self-administered questionnaire for patients has been designed to obtain patient's input (appendix).…”