Abstract
BackgroundNonadherence to treatment remains high among patients with musculoskeletal conditions with negative impact on the treatment outcomes, use of personal and cost of care. An active knowledge translation (KT) strategy may be an effective strategy to support practice change. The purpose of this study was to deliver a brief, interactive, multifaceted and targeted KT program to improve physiotherapist knowledge and confidence in performing adherence enhancing activities related to risk, barriers, assessment and interventions.MethodsWe utilised a 2-phase approach in this KT project. Phase 1 involved the development of an adherence tool kit following a synthesis of the literature and an iterative process involving 47 end-users. Clinicians treating patients with musculoskeletal conditions were recruited from two Physiotherapy and Occupational therapy national conferences in Canada. The intervention, based on the acronym SIMPLE TIPS was tested on 51 physiotherapists in phase 2. A pre- and post-repeated measures design was used in Phase 2. Graham’s knowledge-to-action cycle was used as the conceptual framework. Participants completed a pre—intervention assessment, took part in a 1-h educational session and completed a post—intervention assessment. A questionnaire was used to measure knowledge of evidence—based treatment adherence barriers, interventions and measures and confidence to perform evidence—based adherence practice activities. Data was analysed using descriptive statistics (frequency and percentage), Fisher’s exact test and Wilcoxon Sign-Ranked tests.ResultsBarriers and facilitators of adherence were identified under three domains (therapist, patient, health system) in phase 1. Seventy percent of the participants completed the questionnaire. Results indicated that 46.8% of respondents explored barriers including the use of behaviour change strategies and 45.7% reported that they measured adherence but none reported the use of validated outcomes. A significant improvement in post-self-efficacy scores for the four adherence enhancing activities was observed immediately after the workshop.ConclusionThe use of a multi-modal KT intervention is feasible in an educational setting. A brief interactive educational session was successfully implemented using a toolkit and caused a significant increase in physiotherapists’ knowledge and confidence at performing adherence enhancing activities in the very short-term. Further testing of SIMPLE TIPS on long-term adherence practices could help advance best practices specific to treatment adherence in MSK practice.
Highlights
Nonadherence to treatment remains high among patients with musculoskeletal conditions with negative impact on the treatment outcomes, use of personal and cost of care
When we surveyed the literature in planning this study, we found no resource in terms of a decision aid or tool kit available to support clinician’s in tackling the mounting problem of exercise nonadherence reported in MSK rehabilitation practice and research
PHASE 1: Development of SIMPLE TIPS The process of knowledge product development for this project was initiated by mapping the principles and practices described in the scientific literature on adherence to exercise for MSK conditions with reference to the three topic areas of BIM as follows: 1. Overview of exercise adherence barriers and determinants – Summary of the barriers to adherence and behavioural mechanisms driving adherence related to the patient and the therapist
Summary
Nonadherence to treatment remains high among patients with musculoskeletal conditions with negative impact on the treatment outcomes, use of personal and cost of care. The WHO defines adherence as “the extent to which a person’s behaviour, corresponds with recommendations from a healthcare professional” (HCP) [10] This means the associated barriers, intervention and outcome measures (BIM) for improving adherence will vary based on the nature of the treatment recommendations from the HCP. Likewise, measuring attendance to treatment sessions may be sufficient to track clinic exercise adherence as compared to assessment of the patient’s unsupervised completion of home exercise. These differences would inform the type of strategy developed by the HCP in collaboration with the patient to overcome the challenge of nonadherence to treatment
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