Interventions to Improve Long-Term Adherence to Physical Rehabilitation: A Systematic Review

Abstract

Objective: To evaluate the impact of physical rehabilitation interventions, supplemented with one or more adherence-enhancing components, on outcomes among adults with hip or knee osteoarthritis or chronic lower back pain.

Design: Primary literature search from inception of each database to July 27, 2021, guided by relevant search terms and keywords to search titles and abstracts. All articles meeting eligibility criteria were included for data abstraction.

Data sources: MEDLINE, CINAHL Complete, and Embase.

Eligibility criteria for selecting studies: Randomized and nonrandomized trials evaluating adherence-focused intervention components conducted in addition to an index usual care or usual care-like physical rehabilitation program among adults with hip or knee osteoarthritis or chronic low back pain. Eligible studies included a comparator group of the same index physical rehabilitation intervention without the adjunctive adherence components. Included studies measured outcomes at least 3 months after the rehabilitation course.

Results: Of the 10 studies meeting inclusion criteria, 6 interventions were delivered concurrent to an index rehabilitation program and 4 were delivered sequentially. Of the 3 studies that reported a positive effect on long-term adherence, only 1 was a low risk of bias study. There is very limited evidence of a beneficial treatment effect of adjunct adherence interventions on long-term physical function, self-efficacy, or adverse events.

Conclusion: We found inadequate evidence evaluating adherence-enhancing interventions for the specific promotion of long-term adherence to home rehabilitation programs. Future studies should consider testing interventions specifically built to target behavioral maintenance of home rehabilitation programs.

Figure 1.

Literature flowchart. ^aSearch results from Medline (2108), Embase (1,111), and CINAHL (101) were combined.

Figure 2.

Forest plot of adherence outcomes. ^aComputer-based telephone counseling. ^bBennell 2017 outcomes reported at 6 months post-end of rehabilitation. ^cBennell 2017 outcomes reported at 12 months post-end of rehabilitation. Intervention mean and SD as well as control mean and SD are in reference to adherence outcomes. Bennell 2017 outcomes reported at 6 months post-end of rehabilitation—adherence measured with an 11-point numeric rating scale (NRS) (where 0 = not at all and 10 = completely as instructed); Lonsdale 2017 outcomes reported at 3 months post-end of rehabilitation—adherence measured with 7-point rating scales (where 1 = completed none; 5 = completed all); Bennell 2014 outcomes reported at 6 months post-end of rehabilitation—adherence measured as percentage adherence for home exercises completed and an 11-point NRS (where 0 = not at all and 10 = completely as instructed); Bennell 2020 outcomes reported at 6 months post-end of rehabilitation—adherence as the Exercise Adherence Rating Scale (EARS) Section B (0–24, higher number indicating greater adherence); Bennell 2017 outcomes reported at 12 months post-end of rehabilitation—adherence as an 11-point NRS (where 0 = not at all and 10 = completely as instructed); Ben-Ami 2017 outcomes reported at approximately 9 months post-end of rehabilitation—adherence as Baecke Physical Activity Questionnaire (BPAQ) intensity of physical exercise from 1 (very low) to 5 (very high); Baker 2020 outcomes reported at 24 months post-end of rehabilitation—adherence as self-report item scored 0 to 10 (where 0 = not at all and 10 = completely as instructed).