Article

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: 2.32). 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.

1 Bookmark
 · 
135 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Adherence is an important factor contributing to the effectiveness of exercise-based rehabilitation. However, there appears to be a lack of reliable, validated measures to assess self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises.
    BMJ Open 01/2014; 4(6):e005044. · 2.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To investigate complementary and alternative medicine (CAM) use amongst a cohort of osteoarthritis (OA) sufferers and to explore reasons for use. Methods A self-administered questionnaire was used to assess CAM use and its relationship with self-rated health status, patient knowledge of OA and attitudes towards OA management. Results Sixty-nine percent of respondents (95% CI, 64%–73%) reported that they had tried CAM, with little difference between age groups and genders. Patients who had a better knowledge of their condition and excellent self-rated health were more likely to use CAM. An aversion to the side effects of conventional medicine, failure to engage in exercise, and a belief in the efficacy of CAM were the principal factors underlying use. Conclusion As CAM use is a key component of the self-management strategies for a substantial proportion of Australians with OA, users need to be more fully informed about evidence of efficacy.
    Complementary Therapies in Clinical Practice. 01/2014;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: For an exercise intervention to be successful, it is important that cancer survivors adhere to the prescribed program. To be able to improve adherence and to preserve achieved beneficial effects, insights into the relevant and modifiable determinants is important. Therefore, we aimed to systematically review determinants of exercise adherence and maintenance in cancer survivors using a socio-ecological approach.Studies were identified in PubMed, Embase, PsycINFO and SPORTDiscus up to July 2013. We included full-text articles that: 1) were conducted among adult cancer survivors; 2) quantitatively assessed factors associated with intervention adherence and maintenance, and 3) were published in English. The methodological quality of the selected studies was examined. A best evidence synthesis was applied.Eighteen studies were included. Median methodological quality was 53 % and ranged from 21-78 % of maximum score. Twelve studies focused on determinants of exercise adherence and evaluated 71 potential determinants: 29 demographic and clinical, 27 psychological, ten physical, four social factors, and one environmental factor. Six studies focused on determinants of exercise maintenance after completion of an intervention, and investigated 63 factors: 22 demographic and clinical, 28 psychosocial, nine physical, three social and one environmental factor. We found moderate evidence for a positive association between exercise history and exercise adherence. Inconsistent findings were found for age, gender and education as well as for psychological factors such as stage of change, perceived behavioral control, self-efficacy, extraversion, attitude, intention, fatigue, and quality of life, and physical factors including cardiovascular fitness, body mass index, and baseline physical activity.Exercise history is positively associated with exercise adherence. Future trials should further study the influence of social and environmental determinants on exercise adherence and maintenance in addition to demographic, psychological and physical determinants.
    International Journal of Behavioral Nutrition and Physical Activity 07/2014; 11(1):80. · 3.58 Impact Factor

Full-text (2 Sources)

Download
90 Downloads
Available from
May 31, 2014