Background
Methods
Identifying relevant articles
Therapeutic Alliance | Adherence | Rehabilitation | Musculoskeletal Diseases (MSK) |
---|---|---|---|
Key words | Key words | Key words | Key words |
[1] Therapeutic alliance (MeSH exploded not focused) (keyword) | [12] Adherence (MeSH exploded not focused) (keyword) | [22] Rehabilitation (explode not focused) (keyword) | [29] Musculoskeletal diseases (MESH exploded not focuses) (keyword) |
[2] Patient therapist relationship | [13] Adherea (keyword) | [23] Physiotherapya
| [30] MSK (keyword) |
[14] compliance | [24] Physical therapya
| [31] List diseases if you like | |
[3] Working alliance | [15] behaviour | [25] Exercise | Combine 29 or 30 or….. ➔ 31 |
[4] Therapeutic relationship | [16] behavior | [26] Exercise therapy | |
[17] concordance | Combine 22 or 23 or 24 or 25 or 26 ➔ 27 |
aCombine 28 and 31 | |
[5] Collaboration | Combine 12 or 13 or 14 or 15 or 16 or 17 ➔ 18 |
aAdd limitations (Inception to May, 2015, Adults aged 18 and above, humans, English Language, real patient and therapists) | |
[6] Helping alliance | 28. Combine 21 and 27 | ||
[7] Patient acceptance of health care (descriptors) | 19. Combine 11 and 18 | ||
20. Adherence – MeSH + Group 2 MeSH | |||
[8] Attitude | |||
[9] Bond | 21. Combine 19 or 20 | ||
[10] Collaboration | |||
Combine 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10➔ 11 |
Study selection
Data abstraction
Analysis
Results
Study characteristics
Study design
Characteristics | Frequency |
PT
|
OT
|
PT + OT
|
---|---|---|---|---|
N (130) (%) | (N = 92) | (N = 21) | (N = 17) | |
Source country of study
| ||||
Australia | 22 (16.9) | 18 | 2 | 2 |
Brazil | 1 (0.7) | 1 | - | - |
Canada | 8 (6.2) | 6 | 2 | - |
Germany | 3 (2) | 2 | - | 1 |
Hong Kong | 2 (1.5) | 2 | - | - |
Iceland | 2 (1.5) | 1 | 1 | - |
Ireland | 2 (1.5) | 2 | - | - |
Netherland | 4 (3.1) | 4 | - | - |
New Zealand | 8 (6.2) | 6 | - | 2 |
Norway | 2 (1.5) | 2 | - | - |
Spain | 3 (2.3) | 3 | - | - |
Switzerland | 2 (1.5) | 1 | - | 1 |
Sweden | 12 (9.2) | 8 | 3 | 1 |
Turkey | 1 (0.7)) | 1 | - | - |
United Kingdom | 27 (20.8) | 23 | 2 | 2 |
USA | 31 (23.8) | 12 | 11 | 8 |
Study design
| ||||
Quantitative methods | 43 (33.1) | 32 | 6 | 5 |
Qualitative methods | 51 (39.2) | 41 | 8 | 2 |
Mixed methods | 8 (6.2) | 4 | 2 | 2 |
Narrative review articles/discussion papers | 24 (18.5) | 11 | 5 | 8 |
Systematic reviews | 4 (3.1) | 4 | - | - |
Setting
| ||||
Community | 11 (10) | 10 | 1 | - |
Long term care | 1 (3) | - | 1 | - |
Outpatient | 25 (21) | 19 | 3 | 1 |
Occupational Health | 3 (4) | 3 | - | 1 |
Primary care | 41 (34) | 33 | 5 | 3 |
Private practice | 17 (18) | 14 | 3 | - |
Rehabilitation | 15 (10) | 8 | 5 | 2 |
Various (multiple settings) | 7 (6) | 4 | 3 | - |
Conditions
| ||||
Spinal disorders | 33 (25.3) | 32 | - | 1 |
Degenerative disease | 27 (20.7) | 22 | - | 2 |
General Various | 19 (14.6) | 17 | - | 2 |
Wrist/Hand | 10 (7.6) | 10 | - | - |
Traumatic injury | 9 (6.9) | 8 | 1 | - |
Upper Limb | 15 (11.5) | 12 | 2 | 1 |
Workplace injury | 2 (1.5) | 2 | - | - |
Conceptualization of therapeutic alliance
Author | Context | Origin | Conceptualization | Description | Therapeutic Alliance Themes |
---|---|---|---|---|---|
Chan et al., 2009 (10s) |
aWhitlock et al. 5A’s framework of behaviour change | Existing literature on the self-determined motivation and engagement in health-promoting behavior. |
bSelf-determination theory | A. CONNECT | 1. Partnership |
Communication style and exercise compliance in physiotherapy | 2. Congruence | ||||
Levy et al., 2008 (30s) |
cPhysiotherapist Psychological | 3. Communication | |||
4. Personalized therapy | |||||
Murray et al., 2015 (33 s) | Support | ||||
B. Ask, Advise, Agree, Assist, Arrange | |||||
Chen et al., 1999 (13 s) |
aCompliance and satisfaction with exercise | Existing literature and empirical study on compliance to home exercise in upper extremity rehabilitation |
cModel of Human Occupation | 1. Input | 1. Communication |
2. Output | 2. Connectedness | ||||
cHealth locus of control | 3. Environment | 3. Partnership | |||
4. The open system | 4. Influencing factors | ||||
cHealth belief model | |||||
Gorenberg et al., 2014 (109 s) |
aTherapeutic use of self | Conceptual practice model for occupational therapy focused on understanding therapeutic use of self. |
cThe Intentional Relationship Model | 1. Client | 1. Connectedness |
2. Interpersonal events | 2. Roles and responsibilities | ||||
3. Practitioner | 3. Partnership | ||||
4. Occupational engagement | 4. Congruence | ||||
Harman et al., 2012 (63 s) |
aBuilding blocks of health behavior change | Existing literature on, empirical studies about behaviour change and low back pain rehabilitation |
cTranstheoretical model | 1. Need for action | 1. Connectedness |
2. Solutions | 2. Partnership | ||||
3. Support | |||||
cMotivational model of patient self-management | 3. Reducing threat | 4. Partnership | |||
5. Congruence | |||||
Hinman et al., 2015 (65 s) |
cModel of Health Change | Existing literature on motivational interviewing, solution-focused coaching and cognitive behavioural therapy. |
cDimensions of health service delivery | 1. Practice principles, | 1. Connectedness |
2. Essential techniques | 2. Congruence | ||||
3. Step framework | |||||
Hurley et al., 2007 (66 s) |
aUnderstanding of illness | Parallel processing framework with one arm dedicated to cognitive processing of internal and external stimulus and the processing of emotional aspects of that stimulus. |
cLevanthal’s self-regulation model of illness | 1. Identity | 1. Connectedness |
2. Timeline | 2. Partnership | ||||
3. Consequence | 3. Influencing factors | ||||
4. Cause | |||||
5. Control and cure | |||||
6. Illness coherence | |||||
Jackson et al., 2012 (25 s) |
aTripartite efficacy framework in client-therapist rehabilitation interactions | Existing literature and empirical studies on efficacy beliefs |
cTripartite efficacy model | 1. Client-related factors | 1. Connectedness |
2. Role and responsibilities | |||||
2. Therapist related factors | |||||
bSelf-efficacy theory; relation-inferred self-efficacy | 3. Personalized therapy | ||||
4. Emotional support | |||||
5. Communication | |||||
Jensen and Lorish, 1994 (26 s) |
aBehavioral theory- based strategies for enhancing patient treatment cooperation and patient beliefs | Existing literature on compliance, decision-making, cognitive behavioral therapy and the explanatory model of exercise and mailed surveys to PTs |
cProcess Model of collaboration | 1. Therapeutic relationship | 1. Connectedness |
2. Problem solving | |||||
3. Negotiation | |||||
4. Mutual enquiry | |||||
Kidd et al., 2011 (68 s) |
aPatient centred care | Existing literature and empirical studies on patient-centred care |
cBiopsychosocial model | 1. Ability to communicate | 1. Connectedness |
2. Understanding of people and ability to relate | 2. Partnership | ||||
cPatients perception of a good physiotherapist | |||||
3. Knowledge and expertise | 3. Influencing factors | ||||
4. Confidence | 4. Communication | ||||
5. Transparent focus on progress and outcome | 5. Role and responsibility | ||||
Knight et al., 2010 (29 s) |
aClient Satisfaction | Existing literature on satisfaction, and physiotherapy and empirical study on patient satisfaction. |
cConsumer model | 1. Service | 1. connectedness |
2. Satisfaction | 2. Influencing factors | ||||
3. Dissatisfaction | 3. Partnership | ||||
4. Quality | 4. Congruence | ||||
5. Reasons for seeking therapy | 5. Communication | ||||
Neuman et al., 2009 (116 s) |
cEffect model of empathic communication in clinical encounter | Existing literature and hypothesis on clinical empathy |
cModel of empathic understanding and adherence to treatment regimens (nature) | 1. Cognitive action oriented effects | 1. Communication |
2. Affective oriented effects | 2. Partnership | ||||
Niederman et al., 2011 (34 s) |
aPictorial Representation of Illness and Self Measure | Existing literature on stress, coping strategies and resource utilization |
cHobfil’s resource conservation model | 1. Self | 1. Activating resources |
bSocial learning theory | 2. Resource | 2. Treatment goals | |||
3. Separation | |||||
cSelf management | |||||
Norby and Bellner, 1994 (76 s) |
aDimensions of helping | Existing literature and empirical study on basic assumptions of occupational therapy |
cTentative model of the helping encounter | 1. Basic Professional-Oriented helping | 1. Connectedness |
2. Understanding-Oriented helping | 2. Partnership | ||||
3. Action-Oriented helping | 3. Roles and responsibilities | ||||
Radomski, 2011 (118 s) |
cEcological model for adherence in rehabilitation | Existing literature on adherence and occupational therapy |
cTranstheoretical model of change | 1. Person factors | 1. Congruence |
2. Provider factors | 2. Connectedness | ||||
3. Intervention factors | 3. Communication | ||||
bSelf-determination theory | |||||
4. Technology | 4. Influencing factors | ||||
5. Social | |||||
6. Environmental | |||||
Schoster et al., 2005 (100 s) |
cInformation | Existing literature and empirical studies on predicting HIV-preventive behaviour |
cInformation-Motivation-Behavioural skills model | 1. Exercise information | 1. Connectedness |
Motivation and Behavioural model | |||||
2. Exercise motivation | 2. Roles and responsibilities | ||||
3. Exercise behavioural skills | 3. Influencing factors. | ||||
4. Barriers | 4. Partnership | ||||
5. Exercise behaviour | |||||
Szybek et al., 2000 (121 s) |
cModel of Physiotherapist-patient interactions | Existing literature on Psycho-therapeutic encounters, working alliance, transference and real relationships |
cGelso and Carter model | 1. Interactions | 1. Partnership |
2. Non-insight oriented therapist | 2. Congruence | ||||
3. Insight oriented therapist | |||||
Verkaaik et al., 2010 (123 s) |
aProductive partnership (P2) framework | Existing literature on power distribution in partnerships |
cIndependent living movement model | 1. Context | 1. Partnership |
2. Predicted characteristics | |||||
cConsumer direction model | 3. Autonomy | ||||
4. Knowledge |
Therapeutic alliance themes
Themes (n = 8) | Codes (n = 44) | No of studies N (%) |
---|---|---|
Congruence | Agreement on goals | 32 (24.6) |
Problem identification | 19 (14.6) | |
Agreement on tasks | 27 (20.7) | |
Connectedness | Perceived good relationship | 14 (8.7) |
Friendliness | 21 (20.3) | |
Empathy | 16 (9.7) | |
Caring | 15 (15.5) | |
Warmth | 13 (10) | |
Genuine interest/concerna
| 14 (10.7) | |
Therapist faith/beliefa in patient | 8 (7.7) | |
Honestya
| 2 (1.5) | |
Courtesya
| 4 (3.0) | |
Communication | Nonverbal | 24 (18.4) |
Listening skills | 39 (30) | |
Visual aids | 7 (5.3) | |
Clear explanation and informationa
| 26 (20) | |
Positive feedbacka
| 9 (6.9) | |
Expectation | Therapy | 25 (19.2) |
Outcomes | 22 (16.9) | |
Individualized therapy | Responsiveness | 9 (6.9) |
Holistic practice | 8 (7.7) | |
Influencing factors | ||
External factors | Structures, processes and environment | 17 (13.1) |
Therapist prerequisite | Skill and competence and experience | 30 (23.1) |
Personal characteristics | 13 (10) | |
Humor | 7 (5.3) | |
Life experiences | 7 (5.3) | |
Emotional intelligencea
| 3 (2.3) | |
Patient prerequisite | Personal characteristics | 6 (4.6) |
Existing resources | 10 (7.7) | |
Life experiences | 11 (8.4) | |
Willingness to engage | 11 (8.4) | |
Partnership | Trust/dependability | 23 (17.6) |
Respect | 19 (14) | |
Mutual understanding | 24 (18.4) | |
Knowledge exchange | 19 (14.6) | |
Power balance | 6 (4.6) | |
Active involvement/engagement | 28 (21.5) | |
Roles and responsibilities | Activating patient’s resources | 17 (13.1) |
Motivator/Encouragera
| 26 (20) | |
Professional manner | 13 (10) | |
Educator/Advisera/Guidea
| 11 (8.4) | |
Active follow-upa
| 5 (3.8) | |
Autonomy supporta
| 3 (2.3) |
Therapeutic alliance outcome measures
Articles | Outcome Measure | Therapeutic Alliance Themes | Psychometrics | |||||||
---|---|---|---|---|---|---|---|---|---|---|
C | Cm | E | I | P | Pt | Co | Rr | |||
Adamson et al., 1994 (1 s) | Attitude scale (19-item) | X | X | X | X | X | Yesa
| |||
Stenmar and Nordholm, 1994 (101 s) | ||||||||||
Baker et al., 2001 (4 s) | Participation Method Assessment Instrument (21-item) | X | X | X | X | Yesb
| ||||
Beattie et al., 2005 (6 s) | MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MR-12) (12-item) | X | X | X | X | Yesa
| ||||
Besley et al., 2010 (7 s) | Health Alliance Questionnaire (HAQ) (19-item) | X | X | X | X | X | Yesa
| |||
Bliss, 2010 (8 s) | Working Alliance Inventory (WAI-12) (12-item) | X | X | X | Yesa
| |||||
Besley et al., 2010 (7 s) | ||||||||||
Burns et al., 1999 (9 s) | ||||||||||
Morrison, 2013 (98 s) | ||||||||||
Chan and Can, 2010 (10 s) | Self-developed questionnaire (5-item) | X | X | No | ||||||
Cole and McLean, 2003 (14 s) | Self-developed questionnaire (10-item) | X | X | X | X | X | No | |||
Eklund et al., 2015 (17 s) | Working Relationship Questionnaire (HAqII) (19-item) | X | X | X | X | X | X | X | Yesa
| |
Farin et al., 2011 (57 s) | KOPRA questionnaire (32-item) | X | X | X | X | Yesa
| ||||
Ferreira et al., 2013 (18 s) | Working Alliance Theory of Change Inventory (WATOCI) (16-item) | X | X | X | X | X | Yesb
| |||
Hall et al., 2012 (23 s) | ||||||||||
Yesa
| ||||||||||
Cheing et al., 2010 (12 s) | Pain Rehabilitation Scale (PRES) (54-item) | X | X | X | X | X | X | X | X | Yesa
|
Fuentes et al., 2014 (20 s) | ||||||||||
Vong et al., 2011 (42 s) | ||||||||||
Gorenberg and Taylor, 2013 (109 s) | Clinical Assessment of 5 Modes Scale (23-item) | X | X | X | X | X | Yesa
| |||
Taylor et al., 2011 (39 s) | ||||||||||
Grannis et al., 1981 (22 s) | Q sort questionnaire (28-item) | X | X | X | X | No | ||||
Hills and Kitchen, 2007 (24 s) | Physiotherapy Outpatient Satisfaction Questionnaire (38-item) | X | X | X | X | Yesa
| ||||
Jackson et al., 2012 (25 s) | Relationship Assessment Scale (RAS) (16-item) | X | X | X | X | X | X | Yesa
| ||
Kersten et al., 2012 (27 s) | Consultation and Relational Empathy (CARE) (10-item) | X | X | X | X | Yesa
| ||||
Kerssens et al., 1999 (28 s) | Self-developed questionnaire (11-item) | X | X | X | X | No | ||||
Knight et al., 2010 (29 s) | Service dimension questionnaire (12-item) | X | X | X | X | X | Yesa
| |||
Lysack et al., 2005 (31 s) | Self-developed questionnaire (3-item) | X | X | X | X | No | ||||
Medina-Mirapeix et al., 2015 (32 s) | Patient Experience in Post-Acute Outpatient Physical Therapy (PEPAP-Q) | X | X | X | X | X | X | X | Yesa
| |
Murray et al., 2015 (33 s) | Health Care Climate Questionnaire (HCCQ) (6-items) | X | X | X | X | Yesa
| ||||
Chan et al., 2009 (10 s) | ||||||||||
Levy et al., 2008 (30 s) | ||||||||||
Roberts and Bucksey, 2007 (36 s) | Medical Communication Behaviour System (23-item) | X | X | X | Yesa
| |||||
Roberts et al., 2013 | ||||||||||
Thomson et al., 1997 (40 s) | Barrett-Lennard Relationship Inventory (BLRI) (64-item) | X | X | X | X | No | ||||
Thomson et al., 1997 (40 s) | Truax Accurate Empathy Scale (TAES) (8-item) | X | No | |||||||
Tousignant, 2011 (41 s) | Health Care Satisfaction questionnaire (26-item) | X | X | Yesa
| ||||||
Sluijs et al., 1991 (37 s), 1993 (38 s) | Patient Education checklist (5-item) | X | Yesa
| |||||||
Wright et al., 2013 (43 s) | Medical Interview Satisfaction Scale (26-item) | X | X | X | X | X | Yesa
|
Therapeutic alliance and treatment adherence
Studies | Aim | Population | Design | Therapeutic Alliance Measure | Adherence Measure | Results |
---|---|---|---|---|---|---|
Bliss, 2010 (8 s) | To examine psychosocial variables like attachment style, depression and the working alliance as predictors of treatment outcomes | Chronic knee pain (n = 59) | Correlational study | Working Alliance Inventory | 5-item self-report measure of treatment compliance (α = 0.83) | The transformed WAI scores were significantly positively correlated to pain interference and severity, patient compliance and satisfaction. The transformed WAI accounted for 24% of the variance in patient compliance |
Campbell et al., 2001 (48 s) | To understand reasons for compliance and non-compliance with a home-based exercise regimen | Knee osteoarthritis (n = 20) | Grounded theory with thematic analysis | Interviews | Interviews | Compliance were apparent initially when attending PT sessions and later when a number of factors combined to determine continued and long term compliance (or non-compliance). Continued compliance depends on a person’s perception of their symptoms, the effectiveness of the intervention, their ability to incorporate it into everyday life and support from physiotherapists. |
A model of continued compliance was developed. | ||||||
Chan and Can 2010 (11 s) | To evaluate patients’ adherence to home exercise programs in clinical practice and understand factors that affect patients’ adherence to home exercises. | Orthopaedic, sports injury, hand therapy, rheumatology (n = 82) | Cross-sectional survey study | 25 item questionnaire | 5-item exercise performance questionnaire. | Motivation, role of exercise, patients’ understanding of exercises, verbal and visual explanation and satisfaction with PT were found to have a strong effect on patient’s performance of home exercises. |
Chan et al., 2009 (11 s) | To investigate the impact of PT’s autonomy-supportive behaviors on patients’ motivation and rehabilitation adherence | Anterior cruciate ligament injury (n = 115) | Correlational study | Healthcare Climate Questionnaire 15-item | Sport Injury Rehabilitation Adherence Scale (SIRAS) | Autonomous treatment motivation was associated positively with autonomy support but the relationship between autonomy support and controlled treatment motivation was not significant. Autonomous treatment motivation fully mediated the effect of physiotherapists’ autonomy-supportive behaviours on patients’ adherence. |
Patient self-report home-based exercise adherence | ||||||
Crook et al., 1998 (15 s) | To report the problem experienced with patient engagement in PT-led groups undertaking either an aerobic exercise or a stretching and relaxation program. | MSK disorders (n = 228) | Mixed methods study (quasi randomized controlled trial, interviews, checklist) | Individual interviews | Home exercise diary for exercise activity | PTs and patients acknowledge that listening was an importance part of the therapeutic relationship that improved adherence. |
Escolar-Reina et al., 2010 (56 s) | To explore perceptions of people pain about the characteristics of home exercise programs and care-provider style during clinical encounters may affect adherence to exercises. | Chronic neck or low back pain (n = 34) | Grounded theory approach | Interviews | NA | Patient adherence to home-based exercise is more likely to happen when care providers’ style (clinical knowledge, feedback, giving reminders, monitoring adherence and promoting exercise feedback and the content of exercise programme) are positively experienced. |
Freene et al., 2014 (96 s) | To compare a PT-led home-based PA program to usual practice of community group exercise program to determine effectiveness in middle-aged adults for increasing physical activity levels over the short and long term. | Sedentary community dwelling adults (n = 37) | Mixed methods study (quasi randomized trial, focus groups) | Interviews | Self-report on Active Australia Survey | Most participants agreed the physiotherapist was an enabling factor for the home-based intervention, although others did not think this was important. Participants reported a good interaction with the PT and felt they were expert and knowledgeable. |
Reliable and valid national measure. | ||||||
Advice and support and individually tailored program from the PT and a good relationship with the instructor was important for continued participation in physical activity at home. | ||||||
Gleeson et al., 1991 (21 s) | To develop policies and procedures about management of patient non-attendance in OT. | Hand injuries, burns, rheumatology (n = 100) | Cross-sectional survey study | Survey instrument | Patient and therapist comment on non-adherence | 28% of patients believed that poor communication with the therapist was the reason for non-adherence. |
PTs felt that non- attendance affected continuity of care due to difficulty in evaluating the overall effectiveness of treatment, unmet goals, inability to establish ongoing plans, and concern regarding discharge. PTs saw non-compliance as the result of a need to develop personal skills (empathy, warmth, concern), demonstrating a feeling of responsibility for non-attendance. | ||||||
Harman et al., 2012 (63 s) | To describe the approach used by a PT during a rehab programme for injured members of the military designed to enhance self-efficacy and self-management skills. | Chronic low back pain (n = 12) | Qualitative study with interpretive paradigm | Interviews | NA | Trusting the physiotherapist helped patients continue with their programme despite it getting harder, challenging their confidence, and not showing immediate results. |
Hinman et al., 2015 (65 s) | To explore how patients, PTs and telephone coaches experienced, and made sense of an integrated program of PT-supervised exercise and telephone coaching. | Knee osteoarthritis (n = 6) | Grounded theory with symbolic interactionism | Interviews | Interviews | Patients felt accountable and responsible for meeting goals when perceived attention from PT was individualized and genuine. |
PTs appreciated providing clear information and monitoring progress, incorporation of exercise into daily routine. PTs recognized that collaboration, mutual understanding and emphasising the same treatment with the client as the central character were important. | ||||||
Hurley et al., 2010 (66 s) | To explore the health beliefs, experiences, treatment expectations of people with chronic knee pain, and investigate if, how and why these change after taking part on an integrated exercise-based rehabilitation programme | Chronic knee pain (n = 29 | Grounded Theory with thematic analysis | Interview | Attendance | The care, support and guidance participants received during the informal discussions helped build a trusting, collaborative partnership between patient and PT. This increased participant’ confidence and trust in the PT and belief in the rehabilitation programme. The interpersonal qualities and professional skills of the supervising PT were considered as important to the success of the programme as the content of the programme itself. |
Jackson et al., 2012 (25 s) | To (i). explore potential relationship s between clients’ “tripartite” efficacy constructs, relationship quality with the therapist, and engagement in exercise and, (ii) model actor and partner effects or clients’ and therapists’ efficacy beliefs in relation to relationship quality | Osteoarthritis, osteoporosis, bursitis (n = 68) | Descriptive and Correlational study. | 5-items from the 7-item Relation-ship adherence scale | 3-item Engagement instrument | Increase in perception of relationship quality were directly related to improvements in engagement scores, accounting for 18% of the variance in engagement ratings. |
Jensen et al., 1994 (26 s) | To integrate concepts from research, theory, and practice are integrated into a Process Model for Patient-Practitioner Collaboration for use in clinical practice | Rheumatoid arthritis. | Correlational survey study | Interview | NA | Pleasing the therapist was a reason for adherence to exercises prescribed. |
Osteoarthritis, low back pain (n = 305) | ||||||
PTs (n = 568). | ||||||
Karnad and McLean, 2011 (67 s) | To explore PT’s perception of exercise adherence and interventions used in clinical practice. | Chronic MSK conditions | Interpretative Phenomenology | Interviews | Interviews | Most PTs believe that clear communication, faith in the PT, realistic treatment plans, shared goals and pain education are important for adhering to exercise. |
PTS (n = 5) | ||||||
Kingston et al., 2014 (97 s) | To determine whether compliance and understanding of a home exercise program is improved when patients are provided with a DVD. | Traumatic hand injury (n = 53) | Randomized controlled trial | Follow up survey | Compliance measures; diary recording of exercise, checklist for correctness and understanding of exercises, weekly attendance | No significant differences were found in the overall mean exercise compliance score between the groups. |
All participants reported that the instructions provided were easy to use (100%). All respondents (100%) felt that their appointment with their hand therapist was moderately to extremely important and 90.6% felt their appointment was moderate to extremely important in motivating them to do theirexercises. | ||||||
Levy et al., 2008 (30 s) | To investigate the relationship between perceived autonomy support, age, and rehabilitation adherence among sports-related injuries | Tendon related injuries ankle, knee, shoulder, elbow) (n = 70) | Prospective correlational study | Healthcare Climate Questionnaire 15-item | Sport Injury Rehabilitation Adherence Scale (SIRAS) | High autonomy support provided by the physical therapist was related to better clinic-based adherence and attendance but not to home-based adherence. Age was related to all adherence indices and moderated the relationship between perceived autonomy support and clinic-based rehabilitation adherence. |
Clinic attendance | ||||||
Home exercise adherence | ||||||
Liddle et al., 2007 (71 s) | To explore the experiences, opinions and treatment expectations of chronic low back pain patients to identify what components of treatment they consider as being of most value. | Chronic low back pain (n = 18) | Narrative study using focus group | Interviews | NA | Lack of faith in practitioner resulted in participants ignoring advice and failing to adhere to home exercises programs and continuing bad postural habits. Follow-up support and reassurance about correct exercise instructions and assistance with appropriate treatment progression improved exercise adherence. |
Littlewood et al., 2014 (72 s) | To increase knowledge and understanding of the experience of exercising and determine perception of facilitators and barriers to exercise. | Rotator cuff tendinopathy (n = 6) | Phenomenology with framework analysis | Interviews | NA | PTs and patients agreed that ongoing support in the form of providing feedback, proactive follow-up and stimulating further engagement with the self-managed exercise programs when progress was slow were influential on successful outcomes |
Lysack et al., 2005 (31 s) | To compare computer-assisted video instruction and routine rehabilitation practice on compliance and satisfaction with home exercise. | Total joint arthroplasty (n = 40) | Randomized controlled trial | 3-item tool on encouragement, courtesy, and, active involvement | Self-report on exercise performance accuracy, difficulty in remembering exercises, exercise frequency, level of exercise when feeling poorly, and duration of each exercise session | Statistical analysis showed there were no significant differences at follow-up between the video and control groups on any of the exercise compliance items or on any of the patient satisfaction items (p > 0.05 in all cases). Results of this randomized trial suggest that computerized patient education technology may not provide the benefits anticipated. |
Hip [21] | ||||||
Knee [19] | ||||||
Rating of quality of exercise performance | ||||||
Petursdottir et al., 2010 (81 s) | To increase knowledge and understanding of the experience of exercising among individuals with osteoarthritis and to determine what they perceive as facilitators and barriers to exercising. | Osteoarthritis (n = 12) | Phenomenology | Facilitator and barrier checklist | NA | Many participants placed emphasis on the fact that the encouragement and understanding they received from their PT were very important. |
Hip/knee (n = 10) | ||||||
Vertebral column (n = 9) | ||||||
Clear communication and a sense of a positive connection were equally as important as the physical results of the therapy and adherence to exercise in physical therapy. Supervision by the PT facilitated exercise maintenance. | ||||||
Hands [6] | ||||||
Other joints [3] | ||||||
Slade et al., 2009 (86 s) | To understand the factors that participants in exercise programs perceive to be important to engage and participate | Chronic low back pain (n = 18) | Grounded theory with focus groups | Audio-taped interviews | Audio-taped interviews | Helpful and empowering care-provider skills are those of the effective educator, motivator and communicator. Care-seekers are empowered by recognition of their own physical capability, motivators, time-management skills, and assertiveness to adhere to exercise |
Sluijs et al., 1993 (38 s) | To investigate whether patent compliance was related to characteristics of the patient’s illness, attitude or physical therapist’s behaviour. | Trauma and postoperative conditions, Radiating back pain, Non-radiating back pain, Neck and shoulder pain (n = 1837) | Correlation study | 5-item questionnaire | 1-item questionnaire | The 5 forms of PT behavior showed no direct, statistically significant relationship with compliance. |
Compliance was significantly related to the positive feedback (therapist satisfaction with and appreciation of exercise performance). | ||||||
PT (n = 300) | ||||||
Observers (n = 3) | ||||||
Stenmar et al., 1994 (101 s) | To find out the kinds of attributions PTs make regarding why PT works and the extent to which attributions are related to background variables. | PTs (n = 140) | Cross-sectional survey study | 22 Likert-type items and various demographic variables. | NA | Majority of the respondents believed that the patient’s own resources and the patient-PT relationship rather than the treatment techniques are the most important factors in explaining why PT works. Other background factors had no relationship to the beliefs and attitudes expressed. |
Veenhof et al., 2006 (91 s) | To understand why patients who have received a behavioural graded activity program successfully integrate activities into their daily lives. | Osteoarthritis (n = 12) | Grounded theory approach | Interview | Self-report on integrating activities into daily life after discharge | Initial motivation, active involvement in the whole process and that the PT coaching role during intervention facilitated adherence to exercises and activities: |
Vong et al., 2011 (42 s) | To examine whether the addition of motivational enhancement therapy (MET) to conventional PT produces better outcomes than PT alone | Chronic low back pain (n = 76) | Randomized, controlled trial | Pain Rehabilitation Expectation Scale (PRES) | Exercise log (frequency) | The MET-plus-PT group produced significantly greater improvements than the PT group in proxy efficacy, working alliance, and treatment expectancy with significantly better performance in lifting capacity, general health and exercise compliance. |
Wright et al., 2013 (43 s) | To identify which factors best explain non-adherence to home rehabilitation for patients with musculoskeletal injuries. | Musculoskeletal injuries (n = 87) | Cross-sectional study | Medical Interview Satisfaction Scale (MISS) | Sports Injury Rehabilitation Scale (SIRAS) | Patients are most likely to adhere to HRE when they perceive a positive relationship with their PT. Self-reported adherence is higher when patient perception of behavioural, cognitive and affective elements of the relationship are positive. |