20 hours ago Background: 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. Objectives: A systematic review was conducted to establish what measures were … >> Go To The Portal
The SEHEPS is a 12-item patient-reported questionnaire designed to assess self-efficacy for prescribed home exercise. Patients rated their confidence on a 7-point scale that ranged from 0 (not confident) to 6 (very confident). Total scores ranged from 0 (low self-efficacy) to 72 (high self-efficacy).
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However, there appears to be a lack of reliable, validated measures to assess self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises. Objectives A systematic review was conducted to establish what measures were available and to evaluate their psychometric properties.
Self-report adherence scales have the potential to measure both medication-taking behaviour, and/or identify barriers and beliefs associated with adherence. Selecting an adherence scale requires consideration of what the adherence scale measures and how well it has been validated.
Alternatively adherence could be assessed by others; for example, the Sports Injury Rehabilitation Adherence Scale (SIRAS) 76 comprises a therapist or trainer-rated observation of whether a patient has completed their exercises as instructed.
Adherence scales include items that either elicit information regarding the patient's medication-taking behaviour and/or attempts to identify barriers to good medication-taking behaviour or beliefs associated with adherence.
Self-report medication adherence measures vary substantially in their question phrasing, recall periods, and response items. Self-reports tend to overestimate adherence behavior compared with other assessment methods and generally have high specificity but low sensitivity.
Visek et al11 discuss four measures used for adherence to structured exercise in trials: (1) completion (ie, retention), (2) attendance (the number of sessions attended over the follow-up period), (3) duration adherence (how long they exercise for at each session) and (4) intensity adherence (the physical exertion).
Rehabilitation adherence of stroke patients is a dynamic behavioral process that continuously changes along a time course, with a regular pattern of an “S” curve and includes a rapid increase phase, a slow decrease phase, and a stable phase.
Psychological Symptoms - Depression as a barrier to adherence has strong supporting evidence. Social Support - The social support network of the patient has also been suggested as a possible factor in adherence eg friends and family members, as well as support from the therapist.
A home exercise program (HEP) is an individualized set of therapeutic exercises that a patient is taught by their Physical Therapist to be completed at home, to complement and reinforce their program in the clinic.
Exercise programs attendance and adherence are important predictors of health status and well-being. Health care professionals should understand the variables influencing adherence to exercise in OA and its consequences on health service delivery and outcomes.
The person-level factors associated with better adherence included: demographic factors (higher socioeconomic status, living alone); health status (fewer health conditions, better self-rated health, taking fewer medications); physical factors (better physical abilities); and psychological factors (better cognitive ...
Most of us are familiar with the most common barrier to a regular physical activity routine -- the lack of time. Work, family obligations and other realities of daily life often get in the way of our best intentions to be more active.
The main barriers are on the level of the physical therapist (lack of knowledge; not focusing on the use of outcome measures) and organisation (lack of time; availability; lack of management support). There seems to be a disparity between what physical therapists say and what they do.
Alternative methods of assessing adherence to exercise-based rehabilitation do exist and include attendance at appointments, 75 although this does not necessarily mean the individual is completing the activities they are meant to be doing. Alternatively adherence could be assessed by others; for example, the Sports Injury Rehabilitation Adherence Scale (SIRAS) 76 comprises a therapist or trainer-rated observation of whether a patient has completed their exercises as instructed. Owing to the supervisory element of SIRAS, it is possible that the individual may no longer feel they have a choice to adhere; the constant supervision requires their compliance not their adherence. Conversely in-clinic observations need not be obvious and so could provide insight into an individual's level of motivation to adhere. Either way the in-clinic assessment does not necessarily reflect what happens in an unsupervised environment. In addition to observation by another, objective measurement methods can be used, such as accelerometers to record physical activity. 77 However, these also have limitations for assessing adherence, especially longer term or with large clinical groups, as the devices are expensive and require the participant to adhere to wearing them. In addition the devices act as ‘supervisors’ which may result in a false view of adherence as the individual may no longer feel they have the autonomy to choose whether or not to adhere. 11 Furthermore these devices do not easily capture the movements of therapeutic exercise. The rapid development of smart phone technology and applications may provide a future solution to this issue albeit still at some cost. At present it is clear that there is no cheap and easily available gold standard measurement of unsupervised exercise-based rehabilitation adherence and so, even with its inherent problems, self-report remains an important option.
It is a complex and multidimensional construct that can be affected by a number of factors related to the condition, the person (such as forgetfulness, self-efficacy, attitudes, mood states such as depression and socioeconomic status) and the relationship between the person and healthcare professional. 8
Background 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.
Introduction. Exercise-based rehabilitation improves fitness and functional ability for people with long-term conditions. 1 These outcomes are hugely important because they make a substantial difference to people's lives and to the economy.
Self-reported medication adherence is perhaps the most advanced in the field with questionnaires having been developed and validated although there remains no gold standard measure. 9 A recent review of adherence measures for antihypertensive medication suggested 39% of measures indicated some level of reliability and validity, but 33% had undergone no psychometric testing. 74
The Cochrane database was searched on 7 February 2013 and updated on 9 September 2013. Studies were limited to those that were published in English involving humans over the age of 18.
However, prescribed exercise programmes often comprise a part of home-based rehabilitation or self-management for long-term conditions and are typically unsupervised by health professionals.
Accurate measurement of adherence to prescribed exercise programs is essential. Diaries and self-report rating scales are commonly used, yet little evidence exists to demonstrate their validity and reliability.
To examine the concurrent validity of adherence to home strengthening exercises measured by (1) exercise diaries and (2) a self-report rating scale, compared to adherence measured using an accelerometer concealed in an ankle cuff weight. Test-retest reliability of the self-report rating scale was also assessed.
In this clinical measurement study, 54 adults aged 45 years or older with self-reported chronic knee pain were prescribed a home quadriceps-strengthening program. Over 12 weeks, participants completed paper exercise diaries and, at appointments every 2 weeks, rated their adherence on an 11-point numeric rating scale.
Exercise adherence was significantly overestimated in diaries during the 12 weeks (diary median, 220 exercises; accelerometer, 176; P <.001) and was moderately correlated with accelerometer data ( r = 0.52; 95% confidence interval: 0.26, 0.69). A Bland-Altman plot indicated large between-participant variability in agreement between these measures.
Exercise diaries showed questionable validity and variable levels of agreement compared with accelerometer-measured exercise completion. A self-reported adherence rating scale had limited validity and less than acceptable test-retest reliability. J Orthop Sports Phys Ther 2018;48 (12):943–950. Epub 27 Jul 2018. doi:10.2519/jospt.2018.8275