Effectiveness of behaviour change techniques in physiotherapy interventions to promote physical activity adherence in lower limb osteoarthritis patients: A systematic review.

Matthew Willett,Carolyn Greig,Charlotte Gautrey,Jean-Philippe Regnaux,Alison Rushton,Sally Fenton,Joan Duda

doi:10.1371/journal.pone.0219482

Matthew Willett, Carolyn Greig + Show 5 more

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https://doi.org/10.1371/journal.pone.0219482

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Journal: PloS one	Publication Date: Jul 10, 2019
Citations: 60	License type: CC BY 4.0

Affiliation: University of Birmingham, University of Hertfordshire

Abstract

BackgroundLower limb osteoarthritis (OA) causes high levels of individual pain and disability and is an increasing socio-economic burden to global healthcare systems. Physical Activity interventions are commonly provided by physiotherapists to help patients with lower limb OA manage their clinical symptoms.ObjectiveTo identify and evaluate the effectiveness of behavioural change techniques (BCTs) within physiotherapy interventions to increase physical activity (PA) adherence in patients with lower limb OA.DesignA systematic review was conducted, following Cochrane guidelines according to a published and registered protocol (CRD42016039932). Two independent researchers conducted searches, determined eligibility, assessed risk of bias (Cochrane tool), intervention fidelity (NIHBCC checklist), and coded randomised controlled trials (RCTs) for BCTs (V1 taxonomy). BCT effectiveness ratios were calculated and RCT risk of bias and intervention fidelity were summarised narratively.Data sourcesA highly sensitive search strategy was conducted on Medline, Embase, PsycINFO, CENTRAL, CINAHL and PEDro and grey literature databases from inception to January 2nd, 2018. Reference lists of included RCTs and relevant articles were reviewed, and a citation search was conducted using Web of Science.Eligibility criteria for selecting studiesRCTs that evaluated the effectiveness of a physiotherapy intervention that incorporated ≥1 BCT that promoted home or community-based PA adherence in patients with lower limb osteoarthritis.ResultsTwenty-four RCTs (n = 2366 participants) of variable risk of bias (RoB) (5 low; 7 moderate; 12 high) and poor intervention reporting from 10 countries were included. Heterogeneity of intervention BCTs and PA adherence outcome measures precluded meta-analysis. Thirty-one distinct BCTs were identified in 31 interventions across RCTs. In general, BCTs demonstrated higher effectiveness ratios for short-term and long-term PA adherence compared with medium-term outcomes. The BCTs ‘behavioural contract’, ‘non-specific reward’, ‘patient-led goal setting’ (behaviour), ‘self-monitoring of behaviour’, and ‘social support (unspecified) demonstrated the highest effectiveness ratios across time points to promote PA adherence.ConclusionsBCTs demonstrate higher short and long-term than medium-term effectiveness ratios. Further research involving low RoB RCTs incorporating transparently reported interventions with pre-specified BCTs aimed at optimising lower limb OA patient PA adherence is required.

Highlights

Osteoarthritis (OA) is a progressive degenerative disease associated with a loss of local articular cartilage, a local inflammatory response, and contiguous bone remodelling [1]
Twenty-four randomised controlled trials (RCTs) (n = 2366 participants) of variable risk of bias (RoB) (5 low; 7 moderate; 12 high) and poor intervention reporting from 10 countries were included
Thirtyone distinct behavioural change techniques (BCTs) were identified in 31 interventions across RCTs

Summary

Introduction

Osteoarthritis (OA) is a progressive degenerative disease associated with a loss of local articular cartilage, a local inflammatory response, and contiguous bone remodelling [1]. Exercise interventions improve short-term clinical outcomes, such as reduced pain and increased function, in patients with lower limb OA, these positive effects are generally not maintained at medium (6 months) to long-term ( 12 months) follow up assessments [3,4]. This could be due to several factors including limited long-term effectiveness of the prescribed intervention, progression of OA disease severity, or a gradual reduction in patient adherence to health professional recommendations and an inability to maintain changes in their exercise behaviours [6]. Physical Activity interventions are commonly provided by physiotherapists to help patients with lower limb OA manage their clinical symptoms

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