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: 1.76). 02/2010; 15(3):220-8. DOI: 10.1016/j.math.2009.12.004
Source: PubMed

ABSTRACT 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.


Available from: Sionnadh Mclean, Jun 16, 2015
1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper describes the development and details of a standardised physiotherapy exercise intervention designed to address pain and disability in patients with difficulty returning to usual activities after arthroscopic decompression surgery for subacromial impingement syndrome. To develop the intervention, the literature was reviewed with respect to the effectiveness of postoperative exercises, components of previous exercise programmes were extracted, and input from clinical physiotherapists in the field was obtained through a series of workshops. The physiotherapy exercise intervention is currently being evaluated within the framework of the Shoulder Intervention Project (ISRCTN55768749). Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
    Physiotherapy 01/2015; DOI:10.1016/ · 2.11 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The orthopedic manual physical therapist approach to knee osteoarthritis (OA) is an effective, well-tolerated, and comprehensive strategy that provides a spectrum of intervention measures, which include guidance on activity selection, as well as selection of manual treatment and exercises to systematically address impairments and increase strength and movement in the knee and other related body regions. This approach integrates manually applied treatment while reinforcing exercise and functional activities that are tailored in scope and dose to each patient. Concepts used in the careful design of this exercise program include emphasizing minimal dosing, avoiding exacerbation, using exercises with multiple effects, effective functional positioning, emphasizing the importance of mid-range movements and end-range challenges, and strategic timing of exercises. Focusing on motion and strength gains through range of motion, along with functional or reinforcing activities, such as walking or biking to maintain motion and strength gains, are keys to long-term success. The overarching theme is that well-tolerated strategies using manual treatment, exercise, and activity require deliberate design and targeting of the most common impairments and functional limitations seen in the knee OA population and, more importantly, tailoring to the individual patient.
    The Physician and sportsmedicine 09/2012; 40(3):12-25. DOI:10.3810/psm.2012.09.1976 · 1.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Purpose: To generate an understanding of the opinions of key people associated with a program for older people transitioning from hospital back to the community and explore their thoughts around training family members to help provide physiotherapy. Method: A qualitative study using focus groups and semi-structured interviews was conducted. Participants included patients admitted to a transitional care program, their family members, physiotherapists working in transitional care and members of a consumer group from the health service where the transitional care program was based. Data were transcribed verbatim and a thematic analysis was conducted. Results: Four patients, four family members, four consumer group members and eight physiotherapists participated in this study. Three themes emerged: family members providing physiotherapy may improve outcomes for patients; training family members to provide physiotherapy should include key elements and be individualised; and involving family members in physiotherapy may impact positively and negatively on people and relationships. Conclusions: Older people transitioning from hospital to the community are at risk of functional decline and may receive very little physiotherapy. Training family members to assist with physiotherapy was perceived as a way to improve patient outcomes and relationships between patients and their family, although there were concerns raised about caregiver stress. Evaluation of the feasibility and effectiveness of this approach is warranted. Implications for Rehabilitation Older people transitioning from hospital to the community are at risk of functional decline and often receive very little physiotherapy. Training family members to assist with simple physiotherapy programs may increase the amount of physiotherapy patients transitioning from hospital to the community can receive and improve functional outcomes for patients. Stakeholders perceive that individualising a program to patient and family member needs is important. Involving family members in physiotherapy may not increase caregiver stress and may improve relationship dynamics between patients and family members.
    Disability and Rehabilitation 01/2015; DOI:10.3109/09638288.2014.996673 · 1.84 Impact Factor