Physiotherapy Setting Research Articles

Digital Health Interventions in Physiotherapy: Development of Client and Health Care Provider Survey Instruments.

BackgroundThe advancement of digital health has widened the scope of technology use across multiple frontiers of health care services, including personalized therapeutics, mobile health, eHealth record management, and telehealth consultations. The World Health Organization (WHO) responded to this in 2018 by publishing an inaugural broad classification framework of digital health interventions (DHIs) used to address contemporary health system needs.ObjectiveThis study aims to describe the systematic development of dual survey instruments (clinician and patient) to support data collection, administered in a physiotherapy setting, about perceptions toward DHIs. This is achieved by adapting the WHO framework classification for DHIs for application in real-world research.MethodsUsing a qualitative item review approach, WHO DHI descriptors were adapted and refined systematically to be used in a survey form. This approach was designed to align with the processes of delivering and receiving care in clinical practice, using musculoskeletal physiotherapy as a practical case scenario.ResultsComplementary survey instruments (for health care providers and clients) were developed by adapting descriptor items. These instruments will be used in a larger study exploring the willingness of physiotherapists and patients to use digital technologies in the management of musculoskeletal conditions.ConclusionsThis study builds on the WHO-standardized DHI framework. We developed dual novel survey instruments by adapting and refining the functions of DHIs. These may be deployed to explore the perceived usefulness and application of DHIs for different clinical care functions. Researchers may wish to use these survey instruments to examine digital health use systematically in a variety of clinical fields or technology scenarios in a way that is standardized and generalizable.

AN INTEGRATIVE REVIEW ON PATIENT SATISFACTION MEASURING TOOL FOR PHYSIOTHERAPY CARE AMONG CLIENTS IN THE OUT-PATIENT DEPARTMENT

Background and Aims: Patient satisfaction is acknowledged as the corner stone of quality management and it is the paramount of any quality management program in health care system. This study is aimed to conduct an up-to-date systematic review on different validated tools that provide quantification of patient satisfaction in out-patient physical therapy services. Type: Systematic review Literature survey: An extensive literature search was performed using 3 electronic database systems (Google scholar, PubMed, and PEDro) for articles published between 2000 and 2020. Boolean operator AND was used in compilation with the exhaustive list of search terminologies. A total of 19 studies that investigated any patient satisfaction tool in outpatient physiotherapy settings were included. Methodology: The process of data extraction was performed in accordance with PRISMA guidelines (2009). Results: Consensus based standards for the selection of health status measurement instruments (COSMIN) scoring quantified psychometric property of each study as excellent, good, and fair. 8 studies reflected fair scoring of Cronbach alpha, 3 studies showed excellent whereas, 2 appeared to be poor. Conclusion: The COSMIN scoring quantified multiple patient satisfaction tools. However, no gold standard was found. Nevertheless, physiotherapists working in out-patient care can increase the efficiency of patient-centered treatment by identifying and maximizing these patient satisfaction tool determinants.

Awareness about the Role of Physical Therapy in Post-Partum Females among Gynecologists

Abstract
 
 Background: The role of physiotherapy in obstetrics and gynecology that includes gestation period, childbirth, and antenatal and postnatal care is important. It is essential to create awareness about physiotherapy in hospital setups among gynecologists to provide better health care services to females. Objective: To assess awareness among gynecologists regarding the role of physical therapy in post-partum females. Methods: A cross-sectional study was conducted six months after the approval of the synopsis from September 2020 to January 2021. Data were collected from 75 gynecologists of Lahore and Sahiwal using non-probability convenient sampling. A self-administered questionnaire was used to take data from gynecologists after taking written consent from the participants. Using SPSS version 21, descriptive statistics like frequency and percentage were calculated for categorical variables. For quantitative data, means and standard deviations were estimated. Results: It was shown that postpartum physical therapy services were known to 57(76%) of gynecologists. Among them, 11(14.7%) gynecologists do refer patients, 14(18.7%) do not refer at all, 28(37.3%) refer when required, and 22(29.3%) refer clients very rarely to the physiotherapy department. Conclusion: It was concluded that the majority of the gynecologists were aware of postpartum physical therapy for women. But there is a lack of referral systems in our settings because they do not have any proper gynecological physiotherapy settings affiliated with them. Only a few gynecologists refer patients for Physiotherapy services.
 *Corresponding Author: Ghania Nazar, University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan, Email: ghanianazar555@gmail.com
 Citation: Ghania Nazar. 2021. Awareness about the role of physical therapy in post-partum females among gynecologists. The Healer Journal of Physiotherapy and Rehabilitation Sciences, 1(1):21-26.

Evaluation of Concurrent Validity between a Smartphone Self-Test Prototype and Clinical Instruments for Balance and Leg Strength

The evolving use of sensors to objectively assess movements is a potentially valuable addition to clinical assessments. We have developed a new self-test application prototype, MyBalance, in the context of fall prevention aimed for use by older adults in order to independently assess balance and functional leg strength. The objective of this study was to investigate the new self-test application for concurrent validity between clinical instruments and variables collected with a smartphone. The prototype has two test procedures: static standing balance test in two positions, and leg strength test performed as a sit-to-stand test. Thirty-one older adults were assessed for balance and functional leg strength, in an outpatient physiotherapy setting, using seven different clinical assessments and three sensor-tests. The results show that clinical instruments and sensor measurements correlate to a higher degree for the smartphone leg strength test. For balance tests, only a few moderate correlations were seen in the Feet Together position and no significant correlations for the Semi Tandem Stance. This study served as a first step to develop a smartphone self-test application for older adults to assess functional balance at home. Further research is needed to test validity, reliability, and user-experience of this new self-test application.

Development of a supervised exercise programme for immigrant women: Feasibility study of a practical intervention in a physiotherapy setting.

BackgroundWhile Denmark is facing growing inequality between Danish women and immigrant women in relation to exercise and health, research on interventions and targeted exercise programmes is limited. This study aimed to test the feasibility of a physiotherapeutic supervised exercise programme for immigrant women.MethodsInspired by improvement research a programme was developed in cooperation with the immigrant women. The intervention was modified continuously according to the women’s wishes and needs.InterventionBaseline focus-group interviews, completion of questionnaire and physical-strength tests, was followed by a 12-week supervised training period. After completion of the training the participants were re-interviewed and re-tested.ResultsTwenty-nine women were recruited to the training programme, and 10 attended follow-up. Mean body mass index was 34 kg/m2. Attendance rate among follow-up tested participants was 70%. The women gained knowledge about their bodies, a healthier lifestyle, and awareness of the importance of active living.ConclusionIt was possible to recruit and maintain immigrant women in the exercise programme. This study demonstrated the importance of involving the women in the process, and revealed important factors, such as privacy, a local setting and trust in the physiotherapists.LAY ABSTRACTWhile Denmark is facing growing inequality between Danish women and immigrant women in relation to exercise and health, research on interventions and targeted exercise programmes is limited. This study tested the usefulness of a physiotherapeutic exercise programme developed in cooperation with immigrant women based on interviews. The intervention was modified continuously according to the women’s wishes and needs. A total of 29 women were included. Attendance rate among follow-up tested participants was 70%. The women gained knowledge about their bodies, a healthier lifestyle, and awareness of the importance of active living. It was possible to recruit and maintain immigrant women in the exercise programme. The study demonstrated the importance of involving the women in the process and revealed important factors for successful execution of the intervention.

Methods matter: population attributable fraction (PAF) in sport and exercise medicine

Physical inactivity kills as many people as smoking —a newspaper heading reads1 following a Lancet publication2 suggesting that more than 5 million deaths would be avoided annually if all inactive...

Challenges and Learning Opportunities of Pre-Registration Physiotherapy Placements in First Contact Settings: The Perspectives of Musculoskeletal First Contact Physiotherapists.

As musculoskeletal first contact physiotherapy is rolled out into primary healthcare in Britain, this could offer up new practice-based educational opportunities for pre-registration physiotherapy students. Thus, the present study sought to explore the perceived challenges and learning opportunities of pre-registration physiotherapy placements in musculoskeletal first contact physiotherapy settings from first contact physiotherapists' perspectives. Using a qualitative strategy, 15 musculoskeletal first contact physiotherapists from different geographical locations in Britain, participated in telephone mediated semi-structured interviews. Participants were self-selected through a Chartered Society of Physiotherapy fortnightly bulletin and online forum for first contact physiotherapists, or recruited via snowball sampling. Interview transcripts were analysed according to framework analysis - and the findings were member-checked by proxy. Three core themes emerged: operational challenges, challenges for pre-registration physiotherapy students and learning opportunities for pre-registration physiotherapy students. Operational challenges included: ensuring sufficient support from first contact physiotherapy practice educators; financial cost implications of placements, and; lack of capacity within the existing first contact physiotherapy workforce to provide placements. Challenges for physiotherapy students involved: time pressures and stressors of a first contact physiotherapy placement; identifying red flags, and; complexity of patient presentations. Identified learning opportunities for physiotherapy students were: experience of a specialised physiotherapy role in a primary healthcare setting; bringing awareness of first contact physiotherapy as a potential career pathway, and; experience multidisciplinary team working in primary care. By seeking the perspectives of first contact physiotherapists, this study provides the first step for the development of placements in an emerging practice area.

Project-based learning for physiotherapy clinical education quality and capacity

Background: Increasing, supporting and sustaining the capacity for physiotherapy student placements is a priority for universities and the physiotherapy workforce. The interruption, and in some cases, cancellation of placements as a result of Covid-19 has provided an added impetus to consider the use of flexible and adaptive models to meet student learning needs and support new and existing placement host organisations. Project-based learning provides an opportunity to supplement clinical placements through student-led activities that are mutually beneficial for student learning and service delivery needs of the host organisation. Aim: This paper outlines the pedagogical underpinnings of project-based learning and provides tangible examples of activities that have been adopted within physiotherapy host organisations to support clinical placement quality and capacity. Discussion: Clinical placement host organisations require flexible, student-centred approaches to supporting clinical placement efforts during 2020 and beyond. Project-based learning has the potential to be adapted across settings to support student learning and host organisation services and their stakeholders. Universities should aim to encourage and support partnerships between host organisations and their students to adopt, evaluate and sustain project-based learning across physiotherapy settings.

Do therapist effects determine outcome in patients with shoulder pain in a primary care physiotherapy setting?

ObjectivesTo explore whether a therapist effect exists in physiotherapists treating patients with shoulder pain and to identify if personality traits of the physiotherapist influences patients outcome. DesignObservational cohort study. SettingPrimary care physiotherapy practices. ParticipantsData on patients with shoulder complaints that started and finished treatment between 2009 and 2012 were derived from the NIVEL Primary Care Database. Personality traits of the physiotherapist were identified using the Big Five Inventory. Data of 2814 patients and 56 physiotherapists were analysed using multi level linear regression. Main outcome measureSeverity of complaint was measured on a 10-point Likert scale at the start and end of treatment. Change score is used as outcome. ResultsA therapist effect exists in the rehabilitation of patients with shoulder complaints in a physiotherapy setting; the physiotherapist explained 12% of variance and the personality trait extraversion showed a significant association (P=0.03) with change in treatment outcome. ConclusionCurrent explorative study suggests that patients who were treated by therapists that tend to be more outgoing and energetic achieved better treatment results. Additional studies are needed to unravel the interplay between personality traits and other variables of importance, like patients’ personality traits or psychological factors, in treating patients with shoulder complaints.

A novel approach to improve hamstring flexibility: A single-blinded randomised clinical trial.

BackgroundThe hamstrings play a major role in body posture. Shortening or tightness of the hamstrings affects postural alignment and results in possible musculoskeletal pain.ObjectivesThe aim of this study was to develop a novel approach to improve hamstring flexibility in young adults.MethodA single-blinded randomised clinical trial included 60 participants aged 18–24 with shortened hamstrings recruited from the Hashemite University, Zarqa, Jordan. The range of motion of knee extension was measured with the hip at 90° flexion using a simple goniometer to detect the level of hamstring flexibility. Participants received either a passive hamstring stretch (PS), followed by two sets of 10 tibial nerve neurodynamic technique (ND), or PS followed by three sets of 10 repetitions of active knee extension–quadriceps activation (QA), or PS only.ResultsThere was a significant improvement of hamstring flexibility in the QA group compared to the PS group (13.4 ± 12.1° vs. 6.2 ± 6.4°, p = 0.05). There was a significant improvement in hamstring flexibility post-intervention compared to pre-intervention in the PS group by 6.2 ± 6.4 (30.5 ± 10.8° vs. 36.6 ± 9.5°, p = 0.001), ND group by 9.3 ± 6.2 (26.7 ± 10.9° vs. 36.0 ± 9.5°, p = 0.001) and QA group by 13.4 ± 12.1 (20.3 ± 9.0° vs. 33.4 ± 8.9°, p = 0.001).ConclusionQuadriceps muscle activation following passive stretching of the hamstrings appears to be superior to the PS and ND techniques in improving hamstring muscle flexibility.Clinical implicationsQuadriceps activation following passive hamstring stretching can be used in physiotherapy settings to improve hamstring muscle flexibility.

Learning styles of physiotherapists: a systematic scoping review

BackgroundUnderstanding students’ learning styles, and modifying teaching styles and material accordingly, is an essential to delivering quality education. Knowing more about the learning styles of physiotherapy learners will assist educators’ planning and delivering of learning activities. The purpose of this scoping review was to explore what is published about physiotherapy learning styles.MethodsAn adapted Arksey and O’Malley framework was applied to undertake this systematic scoping review. Nine electronic databases (CINAHL, BIOMED CENTRAL, Cochrane, Web of Science, PROQUEST, PubMed, OTseeker, Scopus, ERIC) were searched using the keywords: ‘learning styles’ and ‘physiotherapy’. English-language, primary research articles that investigated physiotherapy learners’ learning styles were sought.ResultsOf 396 potentially-relevant articles, 15 were included in this review. The studies mostly reflected undergraduate students (910 undergraduates, 361 postgraduates, 23 professionals), in developed countries. Nine articles used the Kolb’s experiential learning theory (ELT); one study applied Honey and Mumford’s approach; two studies used the Gregorc model of cognition and three studies did not specify an underlying theory. Outcome measures included different versions of Kolb’s Learning Style Inventory, the visual-aural-read/write-kinesthetic questionnaire, Gregorc style delineator, Felder Silverman’s Index of Learning Survey, and Honey and Mumford’s Learning Style Questionnaire.The preferred physiotherapy learning styles, according to the ELT, seem to be Converger (learns “hands-on” and applying previously attained knowledge) and Assimilator (gathers and organises information to make the most sense).ConclusionsBoth physiotherapy learners and physiotherapists have specific learning styles of active participation, underpinned with practical examples of theoretical concepts. More research is needed in developing countries, and on postgraduate and professional physiotherapy learners’ learning styles. Also, further research should focus on defining and describing physiotherapy learning styles in a way to be used as an industry standard; and developing valid and reliable learning style outcome measures applicable across physiotherapy learners and settings.

A service evaluation of prescribed only medications (POMs) issued during a 12-month period in a musculoskeletal physiotherapy primary care service

Purpose: Non-medical prescribing was introduced in the United Kingdom (UK) to improve healthcare service efficiency, access to medicines and support service innovation. From 2013, independent prescribing was extended to include physiotherapists. Patients are facing increasingly long waiting times to see their GPs, and delays getting medication to aid their musculoskeletal ailments. This report aims to explore patient satisfaction of this service in a primary care musculoskeletal physiotherapy setting. IPOPS started provision of independent prescribing during physiotherapy sessions by a single physiotherapy practitioner in March 2017.

Effectiveness of Primary Care Interventions Using a Biopsychosocial Approach in Chronic Low Back Pain: A Systematic Review.

Background and ObjectiveRecent systematic reviews show promising effects for multidisciplinary biopsychosocial (BPS) interventions in patients with chronic low back pain (CLBP). Nowadays, BPS interventions have also been developed for primary care physiotherapy settings. Our aim was to systematically review the evidence on the effectiveness of primary care BPS interventions in improving functional disability, pain, and work status for patients with CLBP. Secondly, we aimed to provide an elaborated overview of BPS intervention designs, physiotherapist training programs, and process‐related factors (practical implementation).MethodsWe searched in scientific databases and reference lists. Randomized controlled trials (RCTs) evaluating primary care physiotherapist‐led BPS interventions in adults (≥18 years) with nonspecific CLBP (≥12 weeks) were included.ResultsOur search resulted in 943 references; 7 RCTs were included (1,426 participants). Results show moderate‐quality evidence (3 trials; 991 participants) that a BPS intervention is more effective than education/advice for reducing disability and pain in the short, medium, and long term. Low‐quality evidence (4 trials; 435 participants) was found for no difference with physical activity treatments.Conclusions BPS interventions seem more effective than education/advice and were found to be as effective as physical activity interventions in patients with CLBP. BPS interventions with a clear focus on psychosocial factors (understanding pain, unhelpful thoughts, coping styles, and goal setting) seem most promising. Sufficient delivery of BPS elements is expected when physiotherapists participate in training programs with extensive support prior and during delivery (manual, supervision, and informative resources).

Pragmatic Combinations of Acupuncture Points for Lateral Epicondylalgia are Unreliable in the Physiotherapy Setting

This study describes the reliability of pragmatic combinations of acupuncture points for lateral epicondylalgia (LE) as prescribed by physiotherapists who were experts in acupuncture. Raters (n = 14; 33–59 years) independently prescribed acupuncture points for 30 simulated human patients with LE who were surveyed via a printed questionnaire. The frequency and cooccurrence of acupuncture points prescribed for patients with lateral epicondylitis were assessed. Absolute agreement and Light's kappa (κLight) with 95% confidence interval (CI) were used to quantify the interrater agreement. Raters prescribed 103 unique acupuncture points in different combinations with a median (min–max) of 5 (0–11) acupuncture points. The most prescribed acupuncture point was LI-11 (297 of 420; 71%), and the most common cooccurring acupuncture points were LI-11 and LI-4 (160 of 420; 38%). The absolute agreement for prescribing the acupuncture points ranged from 70% (point GB-20) to 0% (points LI-10, SP-6, LI-11, GB-34, LI-12, and LI-4). Point LR-3 showed the highest interrater reliability for prescribing the acupuncture points [κLight = 0.112, 95% CI = (0.055–0.194)], whereas point LI-4 showed the lowest reliability [κLight = −0.003, 95% CI = (−0.024 to 0.024)]. These findings suggest that pragmatic prescriptions of acupuncture points for LE are unreliable among physiotherapists who are experts in acupuncture. Explicit, high-level evidence-based rules for prescribing and teaching combinations of acupuncture points for LE are warranted.

Physiotherapist-Led Physical Activity Interventions Are Efficacious at Increasing Physical Activity Levels: A Systematic Review and Meta-analysis.

Physical activity (PA) interventions to address noncommunicable disease (NCD) risk are commonly delivered in private practice and outpatient physiotherapy settings. This study reviewed the efficacy of physiotherapist-led physical activity (PLPA) interventions at improving PA levels. Twelve databases were searched using terms related to both physiotherapy and PA. English-language studies of all designs in adults were included. Meta-analyses were conducted separately for interventions measuring the following: (1) participants meeting recommended PA levels; (2) total PA at short- and long-term follow-up; and (3) total PA achieved after short and long PLPA interventions. Pooled effects were calculated using a fixed-effects model as standardized mean differences (SMDs). Nonstatistical analysis was used to identify the effect of PLPA interventions on the volume of PA performed at different intensities. From an initial 4140 studies, 8 were retained, and risk of bias ranged from low to high. Meta-analysis showed the odds of adults meeting minimum recommended PA levels were doubled in groups provided a PLPA intervention [OR = 2.15, 95% confidence interval (CI) = 1.35-3.43]. Total PA levels were increased in the short term (SMD = 0.15, 95% CI = 0.03-0.27) but not in the long term. Longer term interventions did not improve outcomes. Nonstatistical analysis identified that PLPA interventions were efficacious at increasing the amount of PA adults performed at all intensities. Clinic-based PLPA interventions delivered in private practice, primary care, and outpatient settings were efficacious at increasing PA in adults at risk of NCDs. Improvements did not last long term and were not enhanced with longer interventions.

Developing a class format to improve the management of total knee replacement (TKR) patients in an out-patient physiotherapy setting

Purpose: Historically patients at North Manchester General Hospital received traditional 1:1 Physiotherapy treatments post TKR. Literature suggests a class environment can be more cost effective and yield improved results. Therefore a TKR class was set up in 2015. This poster highlights the findings from the first year demonstrating clinical outcomes, patient satisfaction and cost-effectiveness.

Identification of competencies for patient education in physiotherapy using a Delphi approach

ObjectivesPatient education is a critical part of physiotherapy practice however an empirically derived set of competencies for its use does not exist. This study aimed to generate a set of competencies for patient education in physiotherapy using a consensus approach. Design and participantsA Delphi study with two rounds using a panel of expert physiotherapists within Australia was undertaken. In the first round, the panel of 12 specialist physiotherapists identified competencies required for patient education in the physiotherapy setting. Framework analysis was applied to develop a set of competencies that were assessed in the second round where ≥80% agreement of importance from the panel indicated consensus. ResultsResponse rates of specialist physiotherapists agreeing to participate were 67% for the first round and 100% for the second round. Analysis following the first round produced 25 competencies. The second round resulted in agreement on a final set of 22 competencies. ConclusionsThis study developed a concise list of competencies for patient education with a high level of expert agreement. By identifying the key competencies in this area, there is potential to benchmark patient education training and assessment of physiotherapists for improved educational and professional outcomes.

Microwave diathermy in physiotherapy units: a survey on spatial and time heterogeneity of the electromagnetic field

Microwave diathermy (MWD) is a therapeutic system that has been in use for some decades now in all physiotherapy settings, following the regulations of national facility establishments. The validity of diathermy devices is probably reduced as their working time increases, introducing the need for the device to be controlled/reset by qualified personnel in order to maintain its effectiveness in sessions and to accurately deliver the energy output that the physiotherapist asks for. However, while MWD has been a vital tool for practising physiotherapists, there is no clear evidence of a health burden due to incorrect usability. Additionally, due to the fact that physiotherapy rooms contain physiotherapeutic equipment it is observed that during the use of the diathermy device there is spatial heterogeneity in the interior space. In this work, the results are presented of the first national survey for quality control of MWD systems installed in physiotherapy rooms existing in urban and rural areas in Greece. Serious concerns about the technical status of the equipment as well as staff and patient safety, regarding the levels of non-ionising radiation emitted from MWD devices, are discussed. Additional evaluation is included of measurements in empty physiotherapy rooms while the MWD unit is transmitting at three different input powers (50 W/100 W/150 W—these are the therapeutic protocols used most frequently by physiotherapists) and in fully equipped physiotherapy rooms. Field strengths measured around MWDs normally working at different angles, distances and times compared to international limits revealed great spatial and time heterogeneity, raising serious concerns about the safety of occupational workers or other patients.

Exploring physiotherapists' experiences of implementing a cognitive behavioural approach for managing low back pain and identifying barriers to long-term implementation

ObjectivesOur objectives were two-fold: (i) to describe physiotherapists’ experiences of implementing a cognitive behavioural approach (CBA) for managing low back pain (LBP) after completing an extensive online training course (iBeST), and (ii) to identify how iBeST could be enhanced to support long-term implementation before scale up for widespread use. DesignWe conducted semi-structured interviews with 11 physiotherapists from six National Health Service departments in the Midlands, Oxfordshire and Derbyshire. Questions centred on (i) using iBeST to support implementation, (ii) what barriers they encountered to implementation and (iii) what of information or resources they required to support sustained implementation. Interviews were transcribed and thematically analysed using NVivo. Themes were categorised using the Theoretical Domains Framework (TDF). Evidence-based techniques were identified using the behaviour change technique taxonomy to target relevant TDF domains. ResultsThree themes emerged from interviews: anxieties about using a CBA, experiences of implementing a CBA, and sustainability for future implementation of a CBA. Themes crossed multiple TDF domains and indicated concerns with knowledge, beliefs about capabilities and consequences, social and professional roles, social influences, emotion, and environmental context and resources. We identified evidence-based strategies that may support sustainable implementation of a CBA for LBP in a physiotherapy setting. ConclusionsThis study highlighted potential challenges for physiotherapists in the provision of evidence-based LBP care within the current UK NHS. Using the TDF provided the foundation to develop a tailored, evidence-based, implementation intervention to support long term use of a CBA by physiotherapists managing LBP within UK NHS outpatient departments.

Determinants of Adherence to the Online Component of a Blended Intervention for Patients with Hip and/or Knee Osteoarthritis: A Mixed Methods Study Embedded in the e-Exercise Trial

Embedding Web-based interventions within physiotherapy has potential, but knowledge on patient adherence to these interventions is limited. This study explores which patient-, intervention-, and environment-related factors are determinants of adherence to the online component of e-Exercise, a 12-week blended intervention for patients with hip and/or knee osteoarthritis. A convergent mixed methods study was performed, embedded within an ongoing trial. Quantitative data of 109 participants that received e-Exercise were used for negative binomial regression analysis. Adherence was defined as the number of online evaluated weeks. Next, semistructured interviews on factors related to adherence to the online component were analyzed. Nineteen participants with missing outcome data because their program was not started were excluded. Of the 90 analyzed participants, 81.1% were evaluated for at least 8 weeks. Adherence was highest for participants with middle education, 1-5-year osteoarthritis duration, and participants who were physiotherapist recruited. The 10 analyzed interviews revealed that sufficient Internet skills, self-discipline, execution of the exercise plan, the intervention's usability, flexibility, persuasive design, added value, and acceptable required time, and research participation were linked to favorable adherence. It is unknown if patients who adhered to the online component also adhered to their exercise plans. The relationship between adherence to the online component and clinical outcomes will be addressed in a future study. The majority of the participants adhered to the online component of e-Exercise, illustrating its applicability. The integration within the physiotherapy setting and intervention's persuasive design appear to have an important role in optimizing patient adherence.