Can a brief behavioural assessment and tailored exercise adherence strategies improve adherence to exercise for older people with musculoskeletal conditions?: A feasibility randomised controlled trial

Prescribed exercise is a widely used and effective treatment for older people with musculoskeletal conditions. However, its effectiveness may be limited by adherence or non-adherence to exercise programmes. It is important to develop an understanding of how clinicians can help people change their behaviour and adhere better to their prescribed exercise programmes. The four work packages undertaken as part of this thesis aim to determine what approaches have been currently tested, in addition to exploring the exercise adherence experiences of patients and physiotherapists, in order to inform the development of a theoretically underpinned exercise adherence intervention. Work package one, a systematic review of exercise adherence interventions for older people tested in randomised controlled trials found eleven studies. These studies were categorised based on the interventions they tested using a pre-defined and published behaviour change technique taxonomy. Interventions that were categorised in the Feedback and Monitoring category demonstrated positive results, with three separate studies reporting significantly better adherence to exercise compared to controls. However, the generalizability of these results is limited by the risk of bias. Four of the included studies offered a theoretical justification for their intervention, the other seven did not. The review concluded with the need for improved use, reporting and development of theoretically underpinned interventions in the field of exercise adherence for older people. Work package two, a qualitative study explored how adherence and non-adherence affects physiotherapists and their practice. There are several approaches with the potential to help facilitate adherence to exercise that are underpinned by the interaction between clinicians and patients. It is therefore important to explore this problem from both sides. In the findings, physiotherapists outlined that this is a challenging area of practice, one where they need to be resilient. They spoke about the importance of knowing each individual patient and building a rapport with them. In addition to discussing a range of practical steps they try and take to facilitate improved exercise adherence. The findings highlight the need for robust interventions to help clinicians in this area. Work package three involved the development and testing of a theoretically underpinned exercise adherence intervention for older people with musculoskeletal conditions: The Adherence for Exercise Rehabilitation in Older People (AERO) intervention. This was developed using an Intervention Mapping approach and was underpinned by the COM-B model of behaviour change. It involved offering individually tailored exercise adherence strategies based on a behavioural assessment undertaken as part of a routine physiotherapy appointment. The feasibility, acceptability and thus potential of this new intervention was tested in a feasibility randomised controlled trial involving 48 participants. The intervention and associated trial procedures were found to be feasible. The fourth and final work package consisted of a second qualitative study to investigate the overall acceptability of the AERO trial and to explore exercise adherence from the patient’s perspective. Patients discussed their experience of trying to adhere to an exercise programme and the acceptability of AERO and all its procedures. Some suggestions to consider in a future randomised controlled trial were also outlined along with the difficulties of adhering to exercise programmes. Patients outlined the importance of the approach taken by the physiotherapist, being recognised as an individual, and having a good working relationship with the physiotherapist. This research has shown the importance of exercise adherence for older people with musculoskeletal conditions, the lack of theoretically underpinned interventions in the literature, the challenge that exercise adherence is for both patients and clinicians, and the feasibility of delivering tailored exercise adherence strategies to individual patients based on a brief behavioural assessment. There are several considerations outlined across the work packages that could be of importance to physiotherapists in clinical practice, including monitoring and feedback and the therapeutic relationship. However there remains the need for robust interventions in this area to help clinicians to facilitate better adherence to prescribed exercise. The AERO intervention was tested for its feasibility and acceptability and should now be tested in a robust appropriately powered randomised controlled trial.

Grantor dc:publisher

Oxford Brookes University

Year dc:date

2020

Author dc:creator

• Room, Jonathan F.

Contributors dc:contributor

• Barker, Karen
• Boulton, Mary
• Dawes, Helen

Statement dc:rights

• All rights reserved

Language dc:language

en

DOI dc:identifier

https://doi.org/10.24384/378m-3968

OAI identifier oai:identifier

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