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Lakke S1,2, Foijer M3,4, Dehner L5, Krijnen W2, Hobbelen H4,6
1Hanze University Allied Health Sciences, International Health Care School, Department of Physical Therapy, Groningen, Netherlands, 2Hanze University Allied Health Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Centre of Expertise Healthy Ageing, Groningen, Netherlands, 3Hanze University Allied Health Sciences, Physical Therapy, Groningen, Netherlands, 4Hanze University Allied Health Sciences, Research group Healthy Ageing, Allied Health Care and Nursing, Centre of Expertise Healthy Ageing, Groningen, Netherlands, 5Mount St. Joseph University, Physical Therapy, Cincinnati, Ohio, United States, 6University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, Netherlands
Background: Lower physical activity levels in older adults are associated with increased co-morbidities and disability. Physical therapists have a critical role in facilitating increases in physical activity. During physical therapy, several types of communication may impact the effectiveness of treatment. Currently, there is no overview for physical therapists of evidence based communication techniques.
Purpose: This study investigates the additional effect of therapist's communication during physical therapy on older adults' physical activity levels.
Methods: Systematic review and meta-analysis. Clinical trials were identified in PubMed, CINAHL, Embase, PsycINFO, PEDro, Cochrane, up to July 2016. Studies included in the review had the following characteristics: older adults at least 60 years of age, an intervention group of exercise plus one or more consciously delivered communication technique, and a control group of similar exercise only. Two reviewers independently assigned the communication techniques used into one of the 16 communication techniques described in the Behavior Change Taxonomy (BCT) by reading the aim of the study and extracting the BCT that was the primary focus of the intervention. Two reviewers independently performed quality assessments with the PEDro-scale. Studies were considered to have a low risk of bias when at least six out of ten PEDro-items were scored as being positive. Agreement between reviewers on the main BCT-category per study and the PEDro-scores of included studies was assessed by Krippendorff's alpha (Kα). Effect sizes were pooled using Cochrane's Review-Manager. Strength of the evidence was analysed using GRADE's criteria.
Results: From 10,482 eligible studies, twelve studies were identified. The main BCTs used were Social support (n = 6), Goals and planning (n = 3), and Generalization of the target behavior (n = 3); defined as communication with the goal to help the patient generalize an exercise from one situation to another at home). Four studies had a high risk of bias and for eight this was low (range PEDro-scores: 3-8). Agreement between reviewers on BCT-categories and PEDro-items was good ( BCT Kα = 0.87; PEDro Kα = 0.82). Overall, communication techniques revealed an immediate effect (ES:0.19), rated as moderate strength of evidence, and long-term effect (ES:0.24), rated as high-quality evidence, on patient self-reported physical activity measures but not on performance-based measures. Divided in the main BCT-categories, Generalization of target behavior had a positive effect on self-reported behavior (ES:0.34), rated as low-quality strength of evidence. Social Support and Goals and planning revealed no effect.
Conclusion(s): Adding a consciously delivered communication technique to physical therapy treatment is effective on self-reported but not on performance-based physical activity measures. Future studies might unravel specific effects of more BCTs in physical therapy.
Implications: In physical therapy, it is recommended to add communication to exercise when the treatment aims to increase older adults perceived physical activity level. Policy makers in various areas (e.g. government, healthcare systems, education) might pay attention to the small additional effects, increase awareness to physical therapists and facilitate funding to further investigate the optimization of effective communication skills.
Keywords: Older adults, Behavioral change, Patient education
Funding acknowledgements: This work was supported by the Hanze University of Applied Sciences, Groningen, the Netherlands.
Purpose: This study investigates the additional effect of therapist's communication during physical therapy on older adults' physical activity levels.
Methods: Systematic review and meta-analysis. Clinical trials were identified in PubMed, CINAHL, Embase, PsycINFO, PEDro, Cochrane, up to July 2016. Studies included in the review had the following characteristics: older adults at least 60 years of age, an intervention group of exercise plus one or more consciously delivered communication technique, and a control group of similar exercise only. Two reviewers independently assigned the communication techniques used into one of the 16 communication techniques described in the Behavior Change Taxonomy (BCT) by reading the aim of the study and extracting the BCT that was the primary focus of the intervention. Two reviewers independently performed quality assessments with the PEDro-scale. Studies were considered to have a low risk of bias when at least six out of ten PEDro-items were scored as being positive. Agreement between reviewers on the main BCT-category per study and the PEDro-scores of included studies was assessed by Krippendorff's alpha (Kα). Effect sizes were pooled using Cochrane's Review-Manager. Strength of the evidence was analysed using GRADE's criteria.
Results: From 10,482 eligible studies, twelve studies were identified. The main BCTs used were Social support (n = 6), Goals and planning (n = 3), and Generalization of the target behavior (n = 3); defined as communication with the goal to help the patient generalize an exercise from one situation to another at home). Four studies had a high risk of bias and for eight this was low (range PEDro-scores: 3-8). Agreement between reviewers on BCT-categories and PEDro-items was good ( BCT Kα = 0.87; PEDro Kα = 0.82). Overall, communication techniques revealed an immediate effect (ES:0.19), rated as moderate strength of evidence, and long-term effect (ES:0.24), rated as high-quality evidence, on patient self-reported physical activity measures but not on performance-based measures. Divided in the main BCT-categories, Generalization of target behavior had a positive effect on self-reported behavior (ES:0.34), rated as low-quality strength of evidence. Social Support and Goals and planning revealed no effect.
Conclusion(s): Adding a consciously delivered communication technique to physical therapy treatment is effective on self-reported but not on performance-based physical activity measures. Future studies might unravel specific effects of more BCTs in physical therapy.
Implications: In physical therapy, it is recommended to add communication to exercise when the treatment aims to increase older adults perceived physical activity level. Policy makers in various areas (e.g. government, healthcare systems, education) might pay attention to the small additional effects, increase awareness to physical therapists and facilitate funding to further investigate the optimization of effective communication skills.
Keywords: Older adults, Behavioral change, Patient education
Funding acknowledgements: This work was supported by the Hanze University of Applied Sciences, Groningen, the Netherlands.
Topic: Older people; Education; Health promotion & wellbeing/healthy ageing
Ethics approval required: No
Institution: Hanze University of Applied Sciences
Ethics committee: Ethical committee of the Hanze University of Applied Sciences
Reason not required: Method is a systematic review
All authors, affiliations and abstracts have been published as submitted.
