A review and user's guide to measurement of rehabilitation adherence following anterior cruciate ligament reconstruction

An Interactive Cognitive-Behavioural Multimedia Program Favourably Affects Pain and Kinesiophobia During Rehabilitation After Anterior Cruciate Ligament Surgery: An Effectiveness Trial

Psychological interventions have been found effective in helping athletes cope with the challenges associated with knee surgery. In this investigation, an interactive cognitive-behavioural multimedia program was evaluated as a means of delivering psychological interventions to individuals experiencing anterior cruciate ligament (ACL) surgery in a field trial with 69 ACL surgery patients (30 women and 39 men; 24 competitive athletes, 41 recreational athletes, and 4 nonathletes; M _age = 35.01, SD = 11.98 years). Results indicated that compared to participants who received standard care, participants who received the multimedia program reported greater preoperative confidence in ability to cope, lower postoperative pain and kinesiophobia, and greater use and perceived utility of patient education materials. The findings suggest that the multimedia program has promise as an economical and effective means of educating and delivering psychological interventions to people experiencing ACL surgery and rehabilitation.

Exploring experiences, barriers, and enablers to home- and class-based exercise in rotator cuff tendinopathy: A qualitative study

STUDY DESIGN

Qualitative study.

INTRODUCTION

Adherence is paramount to the successful outcome of exercise-based treatment.

PURPOSE OF STUDY

The barriers and enablers to adherence to a home- and class-based exercise program were explored in this qualitative study.

METHODS

Semi-structured interviews were carried out to establish common themes relating to the participants' experiences during a year-long randomized controlled trial.

RESULTS/DISCUSSION

Twelve participants were interviewed. The main enablers to exercise were highlighted as equipment, perceived benefit from the exercises, and longer and more intensive monitoring. Barriers included the lack of motivation, lack of equipment, and pain.

CONCLUSIONS

Implications for practice are incorporating enablers and addressing barriers including self-discharge from classes; the importance of longer term follow-up and the benefits of adopting exercise into a well-established routine may provide potential benefits.

LEVEL OF EVIDENCE

N/A.

Individual and intervention-related factors associated with adherence to home exercise in chronic low back pain: a systematic review

BACKGROUND CONTEXT

Exercise has been shown to reduce pain and increase function in patients with chronic low back pain. However up to 70% of patients do not engage in prescribed home exercise. Physiotherapists need to understand more about the complex factors influencing patients' adherence to prescribed home exercise to tailor their exercise interventions more effectively and support patients to self-manage.

PURPOSE

This review identifies factors associated with adherence to health care practitioner-prescribed home exercise in adults with chronic low back pain.

STUDY DESIGN

Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used for the reporting of this review.

PATIENT SAMPLE

We explored literature in which the authors studied adherence to home exercise in adults with CLBP.

OUTCOME MEASURES

Adherence to home exercise was the primary outcome. Additional outcome measures were recorded in the data extraction table.

METHODS

The following databases were searched: Embase, PsychINFO, MEDLINE, PEDro, and the Cochrane Central Register of Controlled Trials. Data were independently extracted and assessed for methodologic quality by two reviewers.

RESULTS

Eleven randomized controlled trials, including 1,088 participants, met the inclusion criteria. Moderate evidence was found for one individual patient subfactor and three intervention-related subfactors associated with increased adherence to home exercise. These subfactors were greater health locus of control, supervision, participation in an exercise program, and participation in a general behavior change program incorporating motivational strategies.

CONCLUSIONS

This is the first systematic review investigating adherence to prescribed home exercise in a chronic low back pain population. It is difficult to draw firm conclusions because the research lacks detailed descriptions of intervention content. The use of a taxonomy of behavior change techniques has been suggested to overcome this key problem. This review has highlighted the lack of standardized measures of adherence to prescribed home exercise. The development of a validated measure of adherence should be a priority because this will provide a better understanding of the multitude of factors that may influence adherence to home exercise.

A critical review of the evidence on the use of videotapes or DVD to promote patient compliance with home programmes

PURPOSE

The purpose of this paper is to critically review published research in order to evaluate the evidence surrounding the provision of video or DVD technology to promote patient compliance with home exercise or health programmes.

METHOD

A literature search of the MEDLINE, CINAHL and Cochrane databases was undertaken. Critical appraisal of selected studies was undertaken using a previously validated tool. Inclusion criteria were: research related to DVD or videotape technology to improve compliance; published in peer-reviewed journals and full-text English language articles. Compliance was the main outcome measure.

RESULTS

Eleven eligible studies were reviewed. All but one, which used a before-after design, were randomised controlled trials. Study quality tended medium to high in the critical appraisal scoring system, but an overall low quality on the Jadad score for randomisation; with only one study from 11 scoring well on both these measures. Research into the use of video or DVD showed mainly positive effects on compliance; however, methodological issues limit clinical applicability.

CONCLUSIONS

Future well-designed randomised controlled trials with adequate sample sizes and reliable outcome measures will provide clearer evidence into the effectiveness of this technology in improving home exercise or health programme compliance, particularly for rural and remote populations.

Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review

Poor adherence to treatment can have negative effects on outcomes and healthcare cost. However, little is known about the barriers to treatment adherence within physiotherapy. The aim of this systematic review was to identify barriers to treatment adherence in patients typically managed in musculoskeletal physiotherapy outpatient settings and suggest strategies for reducing their impact. The review included twenty high quality studies investigating barriers to treatment adherence in musculoskeletal populations. There was strong evidence that poor treatment adherence was associated with low levels of physical activity at baseline or in previous weeks, low in-treatment adherence with exercise, low self-efficacy, depression, anxiety, helplessness, poor social support/activity, greater perceived number of barriers to exercise and increased pain levels during exercise. Strategies to overcome these barriers and improve adherence are considered. We found limited evidence for many factors and further high quality research is required to investigate the predictive validity of these potential barriers. Much of the available research has focussed on patient factors and additional research is required to investigate the barriers introduced by health professionals or health organisations, since these factors are also likely to influence patient adherence with treatment.

Mental Toughness as a Determinant of Beliefs, Pain, and Adherence in Sport Injury Rehabilitation

Objective:

To investigate the relationship between mental toughness, sport injury beliefs, pain, and adherence toward a sport injury rehabilitation program.

Design:

A prospective design was employed that evaluated adherence over the entire rehabilitation period.

Participants:

70 patients undertaking a sport injury rehabilitation program for a tendonitis related injury.

Main Outcome Measures:

Adherence was measured using self report measures of clinic and home based rehabilitation alongside attendance.

Results:

No association was found between mental toughness and coping appraisals, although high mentally tough individuals displayed more positive threat appraisals and were better able to cope with pain than their less mentally tough counterparts. Greater attendance at rehabilitation sessions was displayed by more mentally tough individuals; however, more positive behavior during clinic rehabilitation was characterized by low mental toughness.

Conclusions:

Despite the 0benefits of being mentally tough, sports medicine providers need to be aware that a high degree of mental toughness may have negative consequences upon rehabilitation behavior and subsequently recovery outcomes.