Barriers and facilitators to recommended physical activity in lower-limb osteoarthritis: protocol for a qualitative study exploring patients and physiotherapist perspectives using the theoretical domains framework and behaviour change taxonomy

Willett, Matthew; Greig, Carolyn; Rogers, David; Fenton, Sally A. M.; Duda, Joan L.; Rushton, Alison

doi:10.1136/bmjopen-2019-029199

Cited by 5 publications

(4 citation statements)

References 58 publications

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“…Duong et al emphasise that the implementation of BCT’s, such as booster sessions should be used to improve exercise adherence, which supports the findings of this study [ 31 ]. The study by Willett et al concluded that peoples’ perceived beliefs about their capabilities should be targeted by facilitating psychosocial support and access to resources for PA maintenance post-discharge [ 36 ]. Therefore, the focus of the suggested monthly post-GLA:D GE groups should not only be on GE performance, individual adaptation and regular testing, but also on psychosocial support.…”

Section: Discussionmentioning

confidence: 99%

Facilitators, barriers and support needs to GLA:D exercise adherence – a mixed method study

Matile,

Nast,

Niedermann

2024

BMC Sports Sci Med Rehabil

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Background Knee and hip osteoarthritis (OA) are among the most common musculoskeletal joint diseases worldwide. International guidelines recommend exercise and education as first-line interventions for their management. The Good Life with osteoArthritis Denmark (GLA:D) programme aims to achieve self-management using group exercise and education sessions. It also encourages participants to stay physically active and perform GLA:D exercises (GE) twice weekly after programme end. This study investigated the participants’ self-reported level of physical activity (PA) and self-reported adherence to the GE between five and 17 months after completion of the GLA:D programme and also explored the barriers, facilitators and support needs to achieve long-term adherence to GE. Methods A mixed method study using an exploratory sequential design was performed. A qualitative phase, involving semi-structured interviews and a focus group, led to the development of a questionnaire on participants’ level of PA, as well as ratings of the barriers, facilitators and support needs for the achievement of long-term adherence to GE. In a second quantitative phase, the survey was conducted online with former GLA:D participants from Switzerland. Descriptive statistical analysis and a group comparison between adherent and non-adherent participants to the GE were performed using Fisher’s exact test, odds ratio, and confidence interval. Results Eleven former GLA:D participants attended the interviews and focus group, and former GLA:D participants (30% response rate) participated in the survey. Of these, 84% (n = 285) reported to reach the recommended level of PA and 53% (n = 178) GE adherence. The top barrier to GE adherence was no/little self-discipline to perform GE (40%, n = 112) and the top facilitator was GE are easy to perform (93%, n = 300). The top 3 items regarding support needs to enhance GE adherence were a shortened version (max. 30 min) of the GE home programme (75%, n = 255), monthly continuation of small GE groups under GLA:D physiotherapists’ supervision (65%, n = 221), and monitoring with regular testing of individual progress (65%, n = 221). Conclusions The top barriers and facilitators should be considered by those responsible for the GLA:D programme and may need to be specifically addressed during and after the programme. The development of a shortened version of the GLA:D programme, a post-GLA:D group, and monitoring with regular testing seem crucial for enhancing GE adherence. Clinical Trial Registration not applicable.

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Section: Discussionmentioning

confidence: 99%

Facilitators, barriers and support needs to GLA:D exercise adherence – a mixed method study

Matile,

Nast,

Niedermann

2024

BMC Sports Sci Med Rehabil

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“…First, conducted as a pragmatic, multicentre RCT, SmArt-E is more powerful and less prone to several biases (e.g., local effect bias, selection and performance bias, or concomitant therapy bias) compared to single-centre studies. Second, we evaluate an evidence-based exercise intervention [ 32 ], incorporating the NEMEX programme [ 38 ] and effective behaviour change techniques [ 103 ]. Third, given an overall 12-month intervention period, the implementation of refresher sessions after 6 months shall increase programme adherence.…”

Section: Discussionmentioning

confidence: 99%

Smartphone-assisted training with education for patients with hip and/or knee osteoarthritis (SmArt-E): study protocol for a multicentre pragmatic randomized controlled trial

Weber

Müller

Bahns

et al. 2023

BMC Musculoskelet Disord

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Introduction Hip and knee osteoarthritis are associated with functional limitations, pain and restrictions in quality of life and the ability to work. Furthermore, with growing prevalence, osteoarthritis is increasingly causing (in)direct costs. Guidelines recommend exercise therapy and education as primary treatment strategies. Available options for treatment based on physical activity promotion and lifestyle change are often insufficiently provided and used. In addition, the quality of current exercise programmes often does not meet the changing care needs of older people with comorbidities and exercise adherence is a challenge beyond personal physiotherapy. The main objective of this study is to investigate the short- and long-term (cost-)effectiveness of the SmArt-E programme in people with hip and/or knee osteoarthritis in terms of pain and physical functioning compared to usual care. Methods This study is designed as a multicentre randomized controlled trial with a target sample size of 330 patients. The intervention is based on the e-Exercise intervention from the Netherlands, consists of a training and education programme and is conducted as a blended care intervention over 12 months. We use an app to support independent training and the development of self-management skills. The primary and secondary hypotheses are that participants in the SmArt-E intervention will have less pain (numerical rating scale) and better physical functioning (Hip Disability and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score) compared to participants in the usual care group after 12 and 3 months. Other secondary outcomes are based on domains of the Osteoarthritis Research Society International (OARSI). The study will be accompanied by a process evaluation. Discussion After a positive evaluation, SmArt-E can be offered in usual care, flexibly addressing different care situations. The desired sustainability and the support of the participants’ behavioural change are initiated via the app through audio-visual contact with their physiotherapists. Furthermore, the app supports the repetition and consolidation of learned training and educational content. For people with osteoarthritis, the new form of care with proven effectiveness can lead to a reduction in underuse and misuse of care as well as contribute to a reduction in (in)direct costs. Trial registration German Clinical Trials Register, DRKS00028477. Registered on August 10, 2022.

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“…The in-depth perspectives of patients with lower-limb OA and their individual experiences of attending physiotherapy for the management of their OA related symptoms were sought to propose a theoretically informed intervention [ 40 ]. This study utilised a phenomenological framework [ 41 ], which followed a published protocol [ 42 ], and was reported using the COnsolidated criteria for REporting Qualitative research (COREQ) [ 43 ]. A summary of the study processes is outlined in Fig.…”

Section: Methodsmentioning

confidence: 99%

Utilising the perspectives of patients with lower-limb osteoarthritis on prescribed physical activity to develop a theoretically informed physiotherapy intervention

Willett

Greig

Fenton

et al. 2021

BMC Musculoskelet Disord

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Background Lower-limb osteoarthritis (OA) causes high levels of pain and disability. Physiotherapists are the primary healthcare provider of non-pharmacological treatments, and incorporate strategies to optimise physical activity (PA) to aid patients with lower-limb OA to moderate their clinical symptoms. However, patients with lower-limb OA have low adherence to PA recommendations both during treatment and after discharge. This study aimed to use knowledge of identified barriers and facilitators to physiotherapy prescribed PA (during treatment and post-discharge) to develop a theoretically informed intervention to optimise adherence to PA for patients with lower-limb OA during treatment and post-discharge. Methods 1) A purposive sample of 13 patients with lower-limb OA participated in semi-structured interviews following physiotherapy treatment. Inductive analysis identified themes/subthemes reflecting barriers and facilitators to physiotherapist prescribed PA, which were organised deductively according to personal factors, treatment and post-discharge phases. 2) Themes/subthemes were mapped onto the theoretical domains framework (TDF). 3) Behaviour change techniques (BCTs) were coded from the key identified domains and a theoretically informed physiotherapy intervention addressing barriers and using facilitators, was developed. Results Themes of patient confidence, mind-set, motivation, OA symptoms and PA experiences were primary personal factors that influenced PA adherence; with the TDF domain ‘Beliefs about capabilities’ most important to target. During treatment, the theme of routine formation was the major driver of personal factors; and primarily influenced by developing a positive physiotherapist-patient relationship. Post-discharge, physical factors, psychosocial factors and ongoing access to resources were important themes influencing PA maintenance. ‘Environmental context and resources’ and ‘social influences’ emerged as the key TDF domains to target during treatment and post-discharge. The proposed theoretically informed intervention included 26 BCTs delivered across conceptual phases of adoption, routine formation, and maintenance. Conclusion A theoretically informed physiotherapy intervention was proposed to optimise PA adherence in patients with lower-limb OA. The included BCTs primarily target patients’ perceived beliefs about their capabilities, by developing a PA routine during treatment and facilitating appropriate psychosocial support and access to resources for PA maintenance post-discharge. The feasibility of delivering the intervention in clinical practice will now be evaluated.

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Barriers and facilitators to recommended physical activity in lower-limb osteoarthritis: protocol for a qualitative study exploring patients and physiotherapist perspectives using the theoretical domains framework and behaviour change taxonomy

Cited by 5 publications

References 58 publications

Facilitators, barriers and support needs to GLA:D exercise adherence – a mixed method study

Facilitators, barriers and support needs to GLA:D exercise adherence – a mixed method study

Smartphone-assisted training with education for patients with hip and/or knee osteoarthritis (SmArt-E): study protocol for a multicentre pragmatic randomized controlled trial

Utilising the perspectives of patients with lower-limb osteoarthritis on prescribed physical activity to develop a theoretically informed physiotherapy intervention

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