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

Hull & East Yorkshire Hospital, Anlaby Road, Hull HU3 2JZ, United Kingdom.
Manual therapy (Impact Factor: 1.71). 02/2010; 15(3):220-8. DOI: 10.1016/j.math.2009.12.004
Source: PubMed


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.

Download full-text


Available from: Sionnadh Mclean,
    • "Many health psychologists have strived to explain health-related behaviour in patients (Armitage and Conner 2000). Low self efficacy, low levels of physical activity, psychological factors, pain on exercise and poor social support were some barriers to exercise adherence recognised in previous literature (Jack et al 2010). Studies have also shown that researched interventions are insufficiently effective in improving long-term adherence (McLean et al 2010). "

    Physiotherapy 05/2015; 101:e42-e43. DOI:10.1016/ · 1.91 Impact Factor
  • Source
    • "However, research has shown that both compliance with and attendance at rehabilitation classes is poor [6] [7] compromising the effectiveness of the treatment. Reasons for poor treatment fidelity include a lack of understanding of the content, organisational issues such as location and time causing conflict with everyday commitments, but also the individuals' inability to perceive change in function hampered further by the limited availability of markers of improvement or progression [7] [8]. Markers of improvement are important tools to motivate patients whilst exercising and also represent important outcome measures for clinicians. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of osteoarthritis is increasing globally but current compliance with rehabilitation remains poor. This study explores whether wearable sensors can be used to provide objective measures of performance with a view to using them as motivators to aid compliance to osteoarthritis rehabilitation. More specifically, the use of a novel attachable wearable sensor integrated into clothing and inertial measurement units located in two different positions, at the waist and thigh pocket, was investigated. Fourteen healthy volunteers were asked to complete exercises adapted from a knee osteoarthritis rehabilitation programme whilst wearing the three sensors including five times sit-to-stand test, treadmill walking at slow, preferred and fast speeds. The performances of the three sensors were validated against a motion capture system and an instrumented treadmill. The systems showed a high correlation (r(2) > 0.7) and agreement (mean difference range: -0.02-0.03 m, 0.005-0.68 s) with gold standards. The novel attachable wearable sensor was able to monitor exercise tasks as well as the inertial measurement units (ICC > 0.95). Results also suggested that a functional placement (e.g., situated in a pocket) is a valid position for performance monitoring. This study shows the potential use of wearable technologies for assessing subject performance during exercise and suggests functional solutions to enhance acceptance. Copyright © 2015. Published by Elsevier Ltd.
    Medical Engineering & Physics 04/2015; 18(7). DOI:10.1016/j.medengphy.2015.03.017 · 1.83 Impact Factor
    • "Cela permettrait d'en augmenter encore plus l'observance. Les barrières identifiées dans le tableau III ont e ´galement e ´té citées dans une revue de la littérature [17] dont l'objectif e ´tait de recueillir toutes les barrières susceptibles de diminuer l'observance a ` un traitement de physiothérapie visant des patients en ambulatoire. Ainsi, 22 e ´tudes de cohorte ont e ´té incluses, permettant d'e ´tablir une liste de barrières relativement exhaustive, révélant une importance particulière des barrières d'ordre psychosocial telles que le faible niveau de soutien social, le sentiment d'impuissance, la dépression et le sentiment d'inefficacité des exercices. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim of the study. The objective of this study was to assess the methods of implementation of the PRESLO program from the point of view of users (healthcare workers with a history of low back pain [LBP]) in order to identify potential improvements to the program. Methods. A qualitative study approach was adopted. Twenty-one participants were selected intentionally in different categories of workers. All volunteered to take part in a semi-structured individual interview exploring representations of LBP, expectations, experience of supervised sessions and adherence to the home-based exercises. All interviews were transcribed and analysed using the qualitative analysis software Atlas.ti. Results. Participation in the program was motivated by prior episodes of LBP, relief expectations and the desire to gain autonomy. The impact at 12 months of the education session showed a change in LBP representations among participants. Collective exercise sessions were highly appreciated due to the emulation generated by the group. The attendance to exercise sessions was facilitated by the proximity and accessibility (during working hours in the workplace) and by the information about the program provided in the institution. The autonomy of the participants at the end of the group sessions varied among individuals. The information materials were poorly used. Long-term compliance to the home-based exercises also varied among individuals. The impact of the program was positively evaluated by the participants in terms of empowerment, physical and psychological well-being and pain reduction. The main shortcomings were the lack of booster sessions to maintain autonomy in the practice of exercises and the motivation generated by the group. The suggestions included the need for booster sessions and follow-up in the long term. Conclusion. The results allowed a qualitative assessment of the program's impact and participants' satisfaction in several dimensions. Areas for improvement of the program have been identified. Booster sessions and long-term follow-up seem important to improve exercise compliance over time.
    Archives des Maladies Professionnelles et de l Environnement 09/2014; 75(4):371-381. DOI:10.1016/j.admp.2013.10.006 · 0.09 Impact Factor
Show more