Original research
Effects of a brief action and coping planning intervention on completion of preventive exercises prescribed by a physiotherapist among people with knee pain

https://doi.org/10.1016/j.jsams.2017.02.008Get rights and content

Abstract

Objectives

The present study aimed to test the efficacy of action and coping planning in promoting engagement with preventive exercises among a sample of people with knee pain.

Design

Experimental trial.

Methods

Individuals who presented to a physiotherapist with knee pain (N = 373, 57% female; M age = 31.54, SD = 10.06, age range = 18–69 years) completed two assessments separated by 14 days. At baseline, participants completed measures of severity of problems associated with the knee (e.g., pain, symptoms) and past behavior. Subsequently, participants were randomly assigned to an action and coping planning or control group. Two weeks later, participants retrospectively reported their preventive exercise behavior over the past 14 days. Analyses revealed that the experimental group reported a higher number of preventive exercise sessions over the 14 day period when compared with the control group.

Results

Participants who planned action and coping strategies reported a greater frequency of completed preventive exercises over a 2-week period than people who did not.

Conclusions

The results of this study underscore the importance of action and coping planning for the enactment of preventive exercises that are designed to manage or prevent knee pain.

Section snippets

Effects of a brief action and coping planning intervention on completion of preventive exercises prescribed by a physiotherapist among people with knee pain

Pain in the knee joint is often associated with joint arthritic changes and knee pathologies.1 Early management of knee pain is paramount to reduce global burden secondary to chronic disabling conditions such as osteoarthritis of the knee, one of the leading causes of disability globally.2, 3 Exercise rehabilitation plays an important role in non-surgical management of knee pain, showing clinically significant improvements in alleviation of pain, functional capacity and quality of life through

Methods

This study was powered for the primary purpose of examining the effects of an ACP activity on exercise preventive behavior. Based on an estimated effect size of d = .31 from related work on physical activity,15 the required sample size in each condition, with a power of 80% at p < .05, was 132 (a total of 264 participants). People who had experienced knee pain accompanied by morning stiffness lasting less than 30 min, crepitus on active movements, and tenderness of the bony margins of the knee joint

Results

The flow of participants through the experimental procedures is shown in Fig. 1. In total, 373 participants were randomized to the experimental group (n = 180) or control condition (n = 193). Approximately 73% of the experimental group completed the time 2 survey; however, for the purposes of the per protocol analysis, 13 participants were excluded because of an incomplete or poor quality ACP (e.g., space left blank, statements such as “I don’t know” or “exercise”), leaving 118 participants in the

Discussion

This study builds on pilot work14 that examined the feasibility of ACP as a practical, feasible, and inexpensive behavior-change technique designed to promote adherence to physiotherapist prescribed self-management strategies for people with knee pain. Consistent with expectations, we demonstrated for the first time that ACP is beneficial for the enactment of preventive exercises that are designed to manage or prevent knee pain. As preventive or rehabilitation programs for knee osteoarthritis

Conclusions

Current findings underscore the importance of self-regulatory strategies for the enactment of preventive exercises that are designed to manage or prevent knee pain. Future research is required to replicate this work with improved methodological features and test the efficacy of ACP across a range of clinical conditions.

Practical implications

  • ACP promoted greater adherence to physiotherapist prescribed self-management strategies for people with knee pain.

  • Clinicians can work with patients at the end of a session to devise ACP strategies to enact the prescribed exercises between visits; patients’ reflections on their efforts can be discussed at the start of each session.

  • Building resources or working on coping strategies may also be required to maximize the benefits of ACP.

Funding statement

Daniel Gucciardi is supported by a Curtin Research Fellowship.

Acknowledgment

The corresponding author is supported by a University Fellowship from his institution.

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