Adherence to therapeutic exercise for lateral elbow tendinopathy – A scoping review

Abstract

Introduction: Exercise is effective in improving pain and function in lateral elbow tendinopathy (LET). One factor that may affect the efficacy of exercise is adherence to the prescribed exercise program. However, consensus around measurement and reporting of adherence in exercise trials for LET has not been formally addressed. This study aimed to discover gaps in the reporting of adherence to direct future research targeted at enhancing the way therapeutic exercise adherence is measured, reported, influenced, and evaluated in published studies of individuals with LET. Methods: We searched the PubMed, Proquest, Web of Science, PEDRO, Embase and Cochrane Library databases from inception to 02 February 2021 to identify randomized controlled studies (RCT) written in English featuring therapeutic exercises for LET in adults. Titles, abstracts and full texts were screened independently by two authors and any disagreements resolved through discussion with all authors. Eligible studies were searched for the term adherence or related terms. The quality of reporting of adherence was rated using criteria specifically developed for this review. Information on the definition, measurement, results and analysis of adherence, as well as the factors that affect adherence were collated and summarized according to the Multidimensional Adherence Model. Results: 60 studies were identified and 19 (32%) of those reported adherence. The overall quality of reporting of adherence was low (average 1.6 out of 4 constructs being adequately described). All studies defined adherence by the frequency of exercise sessions and most measured it using self-reported diaries. Five (26%) studies provided quantitative data, with adherence ranging from 38% to 100%. Only 2 studies statistically analyzed the relationships between adherence and clinical outcomes or other condition-related factors. Another, two studies provided anecdotal information about the impact of pain on exercise adherence. There was limited information on psychological or healthcare system factors affecting adherence according to MAM. Discussion: This scoping review identified that two thirds of published RCTs investigating therapeutic exercise for treatment of LET did not report any information on adherence to exercise, impacting the ability to estimate the true effects of exercise. The other one third demonstrated a series of limitations in the quality of reporting. Variation in the definitions and methods of measuring adherence hampers the ability to compare adherence rates across studies. Finally, there is insufficient information to conclude whether patient, condition, therapy or healthcare system related factors affect adherence to therapeutic exercises for LET. Future research is needed to evaluate whether pain provocation during exercise influences adherence to an exercise program. Impact and application to the field: This scoping review provides recommendations to improve the standard of reporting of adherence to therapeutic exercises for LET. This information will enable future clinical trials to be assessed rigorously in order to determine exercise effectiveness more precisely, therefore leading to improved rehabilitation strategies for LET. Statement of Disclosure: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submissions of this abstract