Conceptualising adherence to exercise for musculoskeletal pain: A concept mapping study

Abstract

Background The concept of adherence to exercise for musculoskeletal (MSK) pain is poorly defined and inadequately measured. This study aimed to, (1) conceptualise adherence to exercise therapy for MSK pain, and (2) identify statements most representative of the new conceptualisation that could be developed into items for a new measurement tool. Methods Concept mapping methodology was used, which is an integrated mixed methods approach. Focus groups with stakeholders generated statements describing adherence to exercise for MSK pain. Statements were grouped according to themes and rated for importance. Data analysis via multidimensional scaling and hierarchical cluster analysis produced a series of concept maps, which were refined during a further stakeholder workshop to produce the final conceptualisation of exercise adherence. Mean importance ratings established statements most suitable for future development. Results Twenty‐eight participants produced 100 unique statements concerning adherence, which were sorted and rated. Analysis of the sort data with further participant refinement concluded that adherence to exercise consists of six domains: communication with experts; targets; how exercise is prescribed; patient knowledge and understanding; motivation and support; and psychological approach and attitudes. Fifty‐six statements were rated with above average importance for inclusion in a new measure of adherence to exercise for MSK pain. Conclusion Adherence to exercise for MSK pain is a complex and multi‐dimensional construct represented by six distinct domains. Statements that best represent these domains have been identified by key stakeholders and will inform the development of a new measure of adherence to exercise for MSK pain.

A new measure of exercise adherence: the ATEMPT (Adherence To Exercise for Musculoskeletal Pain Tool)

“…CFA established that ATEMPT functions as a unidimensional measure of exercise adherence. However, the items retain the original six-domain conceptualisation of exercise adherence to ensure content validity 21. The mean time between completion of the baseline and retest questionnaires (17 days) was considered short enough to expect the participants’ exercise adherence to be similar at the two timepoints,37 with time being considered the most appropriate indicator of adherence stability based on existing research 10…”

“…During our previous study,21 22 56 items across 6 domains of exercise adherence for MSK pain were identified as important for inclusion in a new measure. These 56 items were discussed for readability and comprehensibility within a patient and public involvement and engagement workshop, including 6 patients with MSK pain.…”

“…CFA was conducted on the items using an iterative process to establish the model with the best fit rather than confirming a single model’s fit. Models with one to eight factors were analysed as these had previously been identified via hierarchical clustering in the concept mapping study 21. The factor analysis used Multidimensional Item Response Theory29 via the Quasi-Monte Carlo Estimation Method30 using the graded response model31 as the item link and was undertaken in RStudio 32.…”

“…The lower the value of BIC, the better the data fit to the model. EFA was not used, as the factor structure was predetermined by the findings from the previous concept mapping study 21…”

“…As a first step to robustly measure exercise adherence, we recently undertook a concept mapping study (involving the synthesis of qualitative and quantitative data from patients, physiotherapists and researchers) to conceptualise exercise adherence for MSK pain. Adherence was found to consist of six domains: communication with expert; targets; how exercise is prescribed; patient knowledge and understanding; motivation and support; and psychological approach and attitude 21…”