OR Do actions speak louder than words Do therapists actions facilitate or discourage patient adherence Sionnadh McLean Setting the scene exercise adherenceattendance Actions ID: 496733
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Slide1
“Do words speak louder than actions?” OR “Do actions speak louder than words?” Do therapists actions facilitate or discourage patient adherence?
Sionnadh McLeanSlide2
Setting the scene – exercise adherence/attendanceActions which influence exercise adherenceStrategies to improve rehabilitation adherence???Actions to improve rehabilitation adherence
Sheffield Hallam University-Physiotherapy exercise course 2014
Aims Slide3
Exercise is generally considered to be appropriate for most MSK conditions.Improvements in the range 5-12% are commonly reportedOne type of exercise is usually not more effective than other forms of exercise.Exercise is usually not more effective than other treatments.
Short-term effects of exercise commonly decline over time.
Summary: Exercise
is usually effectiveSlide4
Studies suggest that non-adherence with exercise could be as high as 70% (Sluijs et al., 1993); usually around 50% Particularly poor for unsupervised home exercise programmes (Reilly et al., 1989; Nelson et al., 1995
).
Non-attendance at appointments -
9
% to 46% in some
services. (Alexandre et
al
2002; Funch & Gale 1986
). A few statistics about non-adherence
Sheffield Hallam University-Physiotherapy exercise course 2014Slide5
Sheffield Hallam University-Physiotherapy exercise course 2014Actions speak louder than words?
Transtheoretical
Model
of
behaviour
change assesses an individual's readiness to act on a new healthier
behaviour AKA “
Stages of Change” model (Prochaska &
DiClimente
1977)
Do we assume too much?Slide6
Sheffield Hallam University-Physiotherapy exercise course 2014Rational Choice TheorySimply put – Cost v Benefit analysis
Staying the same
Making a changeSlide7
Sheffield Hallam University-Physiotherapy exercise course 2014Rational choice theoryDo we understand patient’s decision making?
Staying the same
Taking actionSlide8
poor social supportlow self-motivation external locus of control (Ahuja et al, submitted to APMR)
Predictors of non-adherence
(
in-clinic)
Sheffield Hallam University-Physiotherapy exercise course 2014Slide9
low in-treatment adherence with exercise,decreased satisfaction with physiotherapist, increased
pain levels during exercise
,
poor social support
,
sedentary lifestyle,
low
self-motivation,
(
Ahuja et al, submitted to APMR)
Predictors of non-adherence (HEP)
Sheffield Hallam University-Physiotherapy exercise course 2014Slide10
More Actions: A qualitative synthesisSheffield Hallam University-Physiotherapy exercise course 2014
(Ahuja et al, in preparation)Slide11
Sheffield Hallam University-Physiotherapy exercise course 2014Strategies for increasing adherence with exercise recommendations
There was conflicting evidence that adherence interventions increase
short-term
adherence
with exercise.
There
was strong evidence that adherence strategies are not effective
at improving
long-term adherence with home exercise.
Due
to the multi-dimensional nature of
non-adherence, the
strategies to improve adherence
are
likely to be broad
in spectrum.
(McLean et al 2010)Slide12
Patients must believe that the prescribed exercise will work for themWithin session changes predict longer term treatment outcome. (Hahne et al 2004; Tuttle 2005)
Exercise
should fit in with the patients lifestyle AND be
welcome
Exercises
should be meaningful
“Actions which may speak
louder than
words”
Sheffield Hallam University-Physiotherapy exercise course 2014Slide13
Consider whether exercise should be hell!!Anxiety, distress etc may significantly increase levels of Delayed Onset Muscle Soreness (Bishop et al 2011;
Goodin
and McGuire 2009)
Be considerate about your starting point for exercise
Spend time with patients on the exercise
programme
.
Sheffield Hallam University-Physiotherapy exercise course 2014“Actions which may speak louder than words
” – BE CONSIDERATESlide14
Sluijs EM, Kok GJ, van der Zee J. Correlates of exercise compliance in physical therapy. Physical Therapy 1993;73(11):771-82.Reilly K, Lovejoy B, Williams R, Roth H. Differences between a supervised and independent strength and conditioning program with chronic low back syndromes. Journal of Occupational Medicine 1989;31(6):547-50. Nelson BW, O’Reilly E, Miller M, Hogan M, Wegner JA, Kelly C. The clinical effects of intensive, specific exercise on chronic low back pain: a controlled study of 895 consecutive patients with 1-year follow up.
Orthopedics
1995;18(10):971-81.
Neubeck
L et al 2012 Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data. European Journal of Preventive Cardiology 2012;19:494–503
Keating A, Lee A, Holland AE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chronic Respiratory Disease 8(2) 89–99
Jack K, McLean SM,
Klaber Moffett JA, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Manual Therapy 2010;15(3):220-8.
Bishop MD, Horn ME, George SZ. Exercise-induced pain intensity predicted
by
pre-exercise
f
ear
of
pain
and
pain
s
ensitivity
. Clinical Journal of Pain 2011;27:398–404
Goodin
BR et al Pain
catastrophizing
m
ediates
the
relationship
b
etween self-reported
s
trenuous
e
xercise
i
nvolvement
and
pain
r
atings
: Moderating
role
of
anxiety sensitivity.
P
sychosomatic
M
edicine 2009;71:1018–1025
Sheffield Hallam University-Physiotherapy exercise course 2014
ReferencesSlide15
Alexandre NM et al (2002). Predictors of compliance with short-term treatment among patients with back pain. Pan American journal of public health, 12(2):86-94.Funch DP, Gale EN (1986). Predicting treatment completion in a behavioral therapy program for chronic temporomandibular pain.
Journal of psychosomatic research
,
30
(1):57-62.
Prochaska
JO;
DiClemente CC (2005) The transtheoretical approach. In: Norcross, JC;
Goldfried, MR. (eds.) Handbook of psychotherapy integration. 2nd ed. New York: Oxford University Press; p. 147–171.
Hahne
AJ, Keating JL et al (2004) Do within session changes in pain intensity and range of motion predict between session changes in patients with LBP. Australian Journal of Physiotherapy 50:
17-23
Tuttle
N (2005)
Do changes within a manual therapy treatment session predict between-session changes for patients with cervical spine pain?
Australian Journal of Physiotherapy
51: 43–48
Sheffield Hallam University-Physiotherapy exercise course 2014