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Willett M1,2, Duda JL1,3, Fenton SA1,3, Gautrey C4, Greig C1,3,5, Rushton A1,2
1University of Birmingham, School of Sport, Exercise, and Rehabilitation Sciences, Birmingham, United Kingdom, 2Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), University of Birmingham, Birmingham, United Kingdom, 3MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom, 4University of Hertfordshire, School of Life and Medical Sciences, Hatfield, United Kingdom, 5NIHR Birmingham BRC, University of Birmingham, Birmingham, United Kingdom
Background: Osteoarthritis (OA) is a leading cause of individual level disability and contributes substantially to global health care costs. The hip and knee are the primary joints affected by OA, with a point prevalence of 11% and 24% respectively. Physical activity (PA) interventions are key within international guidelines and physical therapists are the primary providers of these interventions. Although PA interventions reduce short-term clinical symptoms, they lack long-term effectiveness. The primary reason for this is likely due to decreased PA adherence when contact with the physical therapist ceases generating a requirement for those with lower-limb OA to self-manage their PA behaviors. However, physical therapists lack knowledge of the most appropriate intervention behavior change techniques (BCTs) to aid people with lower-limb OA to adopt and maintain their PA.
Purpose: To identify and evaluate the effectiveness of BCTs within physical therapy interventions to optimize PA adherence in patients with lower-limb OA.
Methods: A systematic review was conducted, following Cochrane guidelines according to a published and registered protocol (CRD42016039932). Two independent researchers conducted initial searches, determined eligibility, extracted data, assessed risk of bias (Cochrane tool), intervention fidelity (National Institutes of Health Behavior Change Consortium Checklist), and coded randomized controlled trials for BCTs (Michie et al., 2013 taxonomy). A third researcher was consulted when consensus could not be reached. Searches were run using Medline, Embase, PsycINFO, CENTRAL, CINAHL and PEDro, and grey literature databases from inception to 2/1/2018. Reference lists of included trials and relevant articles were reviewed, and a citation search was conducted using Web of Science. Inclusion required trials evaluated the effectiveness of a physical therapy intervention that incorporated ≥1 BCT that promoted home or community-based PA adherence in patients with lower-limb OA. BCT effectiveness ratios were calculated and risk of bias and intervention fidelity were summarised narratively. The overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines.
Results: Twenty-four trials (n=2366 participants) of variable risk of bias (5 low, 7 moderate, 12 high) and poor intervention reporting from 10 countries were included. The heterogeneity of intervention BCTs and PA adherence outcome precluded meta-analysis. Thirty-one distinct BCTs were identified in 31 interventions. In general, BCTs demonstrated higher effectiveness ratios for short-term PA adherence (18>50%) compared with medium-long term outcomes (4>50%). The BCTs ´behavioral contract´ and ´non-specific reward´ demonstrated the highest effectiveness ratios over all time points with ´patient-led goal setting´ and ´problem solving´ emerging as important techniques to promote medium to long-term PA adherence.
Conclusion(s): BCTs are most effective at enhancing short-term PA adherence in patients with lower-limb OA. Future research should incorporate the perspectives of patients with lower-limb OA to identify the most important BCTs to optimize medium-long term PA engagement, and the views of physical therapists on the feasibility of implemented these BCTs into future trials.
Implications: Physical therapists can use BCTs within their interventions to promote short-term PA adherence in patients with lower-limb OA. However, it is not clear which BCTs are most effective at facilitating PA over longer time periods.
Keywords: systematic review, physical activity, behaviour change techniques
Funding acknowledgements: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sector
Purpose: To identify and evaluate the effectiveness of BCTs within physical therapy interventions to optimize PA adherence in patients with lower-limb OA.
Methods: A systematic review was conducted, following Cochrane guidelines according to a published and registered protocol (CRD42016039932). Two independent researchers conducted initial searches, determined eligibility, extracted data, assessed risk of bias (Cochrane tool), intervention fidelity (National Institutes of Health Behavior Change Consortium Checklist), and coded randomized controlled trials for BCTs (Michie et al., 2013 taxonomy). A third researcher was consulted when consensus could not be reached. Searches were run using Medline, Embase, PsycINFO, CENTRAL, CINAHL and PEDro, and grey literature databases from inception to 2/1/2018. Reference lists of included trials and relevant articles were reviewed, and a citation search was conducted using Web of Science. Inclusion required trials evaluated the effectiveness of a physical therapy intervention that incorporated ≥1 BCT that promoted home or community-based PA adherence in patients with lower-limb OA. BCT effectiveness ratios were calculated and risk of bias and intervention fidelity were summarised narratively. The overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines.
Results: Twenty-four trials (n=2366 participants) of variable risk of bias (5 low, 7 moderate, 12 high) and poor intervention reporting from 10 countries were included. The heterogeneity of intervention BCTs and PA adherence outcome precluded meta-analysis. Thirty-one distinct BCTs were identified in 31 interventions. In general, BCTs demonstrated higher effectiveness ratios for short-term PA adherence (18>50%) compared with medium-long term outcomes (4>50%). The BCTs ´behavioral contract´ and ´non-specific reward´ demonstrated the highest effectiveness ratios over all time points with ´patient-led goal setting´ and ´problem solving´ emerging as important techniques to promote medium to long-term PA adherence.
Conclusion(s): BCTs are most effective at enhancing short-term PA adherence in patients with lower-limb OA. Future research should incorporate the perspectives of patients with lower-limb OA to identify the most important BCTs to optimize medium-long term PA engagement, and the views of physical therapists on the feasibility of implemented these BCTs into future trials.
Implications: Physical therapists can use BCTs within their interventions to promote short-term PA adherence in patients with lower-limb OA. However, it is not clear which BCTs are most effective at facilitating PA over longer time periods.
Keywords: systematic review, physical activity, behaviour change techniques
Funding acknowledgements: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sector
Topic: Musculoskeletal: lower limb; Health promotion & wellbeing/healthy ageing
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: No research ethics approval was required for this systematic review as no confidential patient data was used
All authors, affiliations and abstracts have been published as submitted.
