Abstract
BackgroundDespite the proven benefits of exercise rehabilitation for numerous health conditions, musculoskeletal injuries and recovery from surgery, patient adherence to such programs is reported to often be less than 35%. Increasing patient engagement therefore has the potential to improve patient health outcomes, benefiting the patient, their carers and the services that support them. The aims of this review were to identify the factors that contribute to ‘patient’ engagement in prescribed exercise rehabilitation using the COM-B (capability, opportunity, motivation-behaviour) framework of behavioural analysis.MethodsFive electronic databases (PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov) were searched. ‘COM-B’ was the key word searched for specifically within titles and abstracts, combined with either ‘physical activity’ OR ‘exercise’ included using the ‘AND’ operation. Records were then filtered and excluded following full-text screening based on the predetermined eligibility criteria.ResultsTwenty studies were included in the review. The main COM-B themes highlighted for improving patient engagement were: capability—improving patient knowledge and cognitive skills for behavioural regulation, such as ‘action planning’ and ‘action control’, which could also benefit time-management; opportunity—a balanced life situation that enabled time to be devoted to the exercise program, social support, easily accessible and affordable resources and services; and motivation—increasing patient levels of self-efficacy and autonomous motivation, which were noted to be influenced by levels of perceived ‘capability’, additionally ‘motivation’ was noted to be influenced by patients perceiving the benefits of the exercise, and adherence to the program was promoted by ‘goal-setting’. Other issues in the ‘capability’ domain included a fear and/or dislike of exercise.ConclusionPatient engagement behavior has been shown to be influenced by both external (opportunity) and intrapersonal variables (capability and motivation). Those prescribing exercises within a rehabilitation program need to discuss these factors with their patients and co-design the exercise rehabilitation program in partnership with the patient, since this is likely to improve patient engagement, and thereby result in superior health outcomes. Furthermore, these factors need to be a consideration in clinical trials, if the findings from such trials are to translate into mainstream healthcare settings.
Highlights
IntroductionDespite the proven benefits of exercise rehabilitation for numerous health conditions, musculoskeletal injuries and recovery from surgery, patient adherence to such programs is reported to often be less than 35%
This lack of compliance with exercise rehabilitation programs means that optimal health outcomes may not be achieved by many patients: a scenario that affects the individual patient, and their carers and support services
For the exercise prescriber, there is a need to understand the potential facilitators and barriers to patient engagement with a prescribed exercise program, and at an individual patient level utilise this understanding in order to promote adherence and thereby benefit the patient, other stakeholders and the healthcare system in general
Summary
Despite the proven benefits of exercise rehabilitation for numerous health conditions, musculoskeletal injuries and recovery from surgery, patient adherence to such programs is reported to often be less than 35%. Prescribed exercise is a fundamental component in the rehabilitation and treatment of numerous health conditions Within these contexts it can be prescribed to target specific physical, metabolic, and neurological issues, as well as being integral to promoting the long-term general health and wellbeing of the patient. Despite the reported benefits of prescribed exercise for each of these, the rates of compliance to such programs have been reported to be less than 35% and can be less than 10% [6] This lack of compliance with exercise rehabilitation programs means that optimal health outcomes may not be achieved by many patients: a scenario that affects the individual patient, and their carers and support services. For the exercise prescriber, there is a need to understand the potential facilitators and barriers to patient engagement with a prescribed exercise program, and at an individual patient level utilise this understanding in order to promote adherence and thereby benefit the patient, other stakeholders and the healthcare system in general
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