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

Bailey, Daniel; Holden, Melanie; Foster, Nadine E; Quicke, J.G.; Haywood, Kirstie L.; Bishop, Annette

doi:10.1136/bjsports-2017-098742

Cited by 75 publications

(97 citation statements)

References 36 publications

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“…Seven of the 10 (70%) of the isometric group completed at least 80% of the sessions compared with 7/12 (58%) of the isotonic group. Eighty per cent adherence has recently been suggested to be a reasonable threshold in exercise intervention studies 31. All participants, except one in the isometric group, were able to progress the loading intensity of the exercises and used resistance bands.…”

Section: Resultsmentioning

confidence: 99%

Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study

Clifford

Paul

Syme

et al. 2019

BMJ Open Sport Exerc Med

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ObjectivesGreater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain. Limited evidence exists for the effectiveness of exercise for GTPS. This study aimed to compare the effectiveness of isometric and isotonic exercise for individuals with GTPS.MethodsThis randomised controlled pilot trial recruited 30 participants with GTPS. Both programmes consisted of daily, progressive home exercise for 12 weeks with 8 individual physiotherapy sessions over the trial period. The primary outcome measure was the Victorian Institute of Sport Assessment-Gluteal (VISA-G) and secondary outcome measures included the Numeric Pain Rating Scale (0–10) and an 11-point Global Rating of Change Scale. Outcome measures were assessed at baseline, 4 and 12 weeks.ResultsTwenty-three participants completed the trial. After 12 weeks, mean VISA-G scores improved in both groups; 55–65 in the isometric group and 62–72 in the isotonic group. 55% of the isometric group and 58% of the isotonic group achieved a reduction in pain of at least 2 points (minimally clinically important difference (MCID)) on the Numeric Pain Rating Scale. 64% of the isometric group and 75% of the isotonic group had improved by at least 2 points (MCID) on the Global Rating of Change Scale.ConclusionIsometric and isotonic exercise programmes appear to be effective for individuals with GTPS and should be considered in the loading management of patients with this condition.

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Section: Resultsmentioning

confidence: 99%

Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study

Clifford

Paul

Syme

et al. 2019

BMJ Open Sport Exerc Med

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“…Study details, sample characteristics, intervention details, and adherence concepts were described and numerically summarized. A review studying adherence to exercise therapy in adults 5 was used as a template to present intervention and adherence measurement details, allowing for comparison of adherence measurement between youth and adults. Individual adherence barriers, facilitators, and boosting strategies were identified and grouped into prevalent topics.…”

Section: Data Synthesismentioning

confidence: 99%

Sticking to It: A Scoping Review of Adherence to Exercise Therapy Interventions in Children and Adolescents With Musculoskeletal Conditions

Holt

McKay²,

Truong

et al. 2020

J Orthop Sports Phys Ther

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their association with future musculoskeletal pain, 31,35,74 obesity, 92 osteoarthritis, 95 cardiovascular disease, 45 and all-cause mortality. 1,98 Additionally, musculoskeletal pain in adolescence can reduce participation in school and sport 42 and alter career choice later in life. 74 These long-term consequences underlie the importance of appropriate care for youth (ie, children and adolescents) with musculoskeletal conditions. An essential treatment component for musculoskeletal conditions is exercise therapy. Distinct from general physical activity, "exercise therapy" is a regimen or plan of physical activities designed and prescribed in a precise dose to address specific therapeutic goals. 62 In youth with musculoskeletal conditions, exercise therapy effectiveness is associated with adherence, 10,49,76,78 defined as the extent to which someone's behavior corresponds with agreed recommendations from a health care provider. 100 Despite the importance of adherence, consensus on how to define, measure, or improve adherence to exercise therapy is lacking. 5 T he worldwide burden of musculoskeletal conditions (ie, diseases and injuries) is high and impacts people of all ages. 28,33,82 In adolescence, the high prevalence of musculoskeletal pain (estimated to be between 20% and 40%) 17,34,47 and incidence of musculoskeletal injuries (estimated at 30.9 injuries per 100 adolescents per year) 20 are concerning, given

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“…However, adherence to exercise has not been clearly defined from the perspective of any of these stakeholders, and hence the conceptual underpinning which provides an essential framework for measurement is not available. The first step in the development of any future measure of adherence must be to establish or adapt recognised conceptual models and theoretical frameworks42 to the related domains within the concept of exercise adherence for MSDs 46. Development of the conceptual model and framework will be required to address a wide range of issues, including the multifaceted nature of adherence, the focus of the measure (eg, evaluation, categorisation and prognostication) and issues of cross-cultural validity if the measure were to be applied across international settings.…”

Section: Discussionmentioning

confidence: 99%

Use of the nominal group technique to identify UK stakeholder views of the measures and domains used in the assessment of therapeutic exercise adherence for patients with musculoskeletal disorders

et al. 2020

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ObjectivesThe objective was to the undertake nominal group technique (NGT) to evaluate current exercise adherence measures and isolated domains to develop stakeholder consensus on the domains to include in the measurement of therapeutic exercise adherence for patients with musculoskeletal disorders.DesignA 1-day NGT workshop was convened. Six exercise adherence measures were presented to the group that were identified in our recent systematic review. Discussions considered these measures and isolated domains of exercise adherence. Following discussions, consensus voting identified stakeholder agreement on the suitability of the six offered adherence measures and the inclusion of isolated domains of exercise adherence in future measurement.SettingOne stakeholder NGT workshop held in Sheffield, UK.ParticipantsKey stakeholders from the UK were invited to participate from four identified populations. 14 participants represented patients, clinicians, researchers and service managers.ResultsAll six exercise adherence measures were deemed not appropriate for use in clinical research or routine practice with no measure reaching 70% group agreement for suitability, relevance, acceptability or appropriateness. Three measures were deemed feasible to use in clinical practice. 25 constructs of exercise adherence did reach consensus threshold and were supported to be included as domains in the future measurement of exercise adherence.ConclusionA mixed UK-based stakeholder group felt these six measures of exercise adherence were unacceptable. Differences in opinion within the stakeholder group highlighted the lack of consensus as to what should be measured, the type of assessment that is required and whose perspective should be sought when assessing exercise adherence. Previously unused domains may be needed alongside current ones, from both a clinician's and patient’s perspective, to gain understanding and to inform future measurement development. Further conceptualisation of exercise adherence is required from similar mixed stakeholder groups in various socioeconomic and cultural populations.

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

Cited by 75 publications

References 36 publications

Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study

Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study

Sticking to It: A Scoping Review of Adherence to Exercise Therapy Interventions in Children and Adolescents With Musculoskeletal Conditions

Use of the nominal group technique to identify UK stakeholder views of the measures and domains used in the assessment of therapeutic exercise adherence for patients with musculoskeletal disorders

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