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Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or osteoarthritis : a systematic review and meta-analysis

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Abstract
Objective: To evaluate whether interventions aimed at increasing adherence to therapeutic exercise increase adherence greater than a contextually equivalent control among older adults with chronic low back pain and/or hip/knee osteoarthritis. Design: A systematic review and meta-analysis. Data sources: Five databases (MEDLINE (PubMed), CINAHL, SportDISCUS (EBSCO), Embase (Ovid) and Cochrane Library) were searched until 1 August 2016. Eligibility criteria for selecting studies: Randomised controlled trials that isolated the effects of interventions aiming to improve adherence to therapeutic exercise among adults >= 45 years of age with chronic low back pain and/or hip/knee osteoarthritis were included. Results: Of 3899 studies identified, nine studies (1045 participants) were eligible. Four studies, evaluating strategies that aimed to increase motivation or using behavioural graded exercise, reported significantly better exercise adherence (d=0.26-1.23). In contrast, behavioural counselling, action coping plans and/or audio/video exercise cues did not improve adherence significantly. Meta-analysis using a random effects model with the two studies evaluating booster sessions with a physiotherapist for people with osteoarthritis revealed a small to medium significant pooled effect in favour of booster sessions (standardised mean difference (SMD) 0.39, 95% CI 0.05 to 0.72, z=2.26, p=0.02, I-2=35%). Conclusions: Meta-analysis provides moderate-quality evidence that booster sessions with a physiotherapist assisted people with hip/knee osteoarthritis to better adhere to therapeutic exercise. Individual high-quality trials supported the use of motivational strategies in people with chronic low back pain and behavioural graded exercise in people with osteoarthritis to improve adherence to exercise.
Keywords
RANDOMIZED CONTROLLED-TRIAL, BEHAVIOR-CHANGE TECHNIQUES, KNEE OSTEOARTHRITIS, PHYSICAL-ACTIVITY, HOME EXERCISE, MUSCULOSKELETAL PAIN, GRADED ACTIVITY, BEEP TRIAL, PROGRAM, PEOPLE

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MLA
Nicolson, Phillipa JA et al. “Interventions to Increase Adherence to Therapeutic Exercise in Older Adults with Low Back Pain And/or Osteoarthritis : a Systematic Review and Meta-analysis.” BRITISH JOURNAL OF SPORTS MEDICINE 51.10 (2017): 791–799. Print.
APA
Nicolson, P. J., Bennell, K. L., Dobson, F. L., Van Ginckel, A., Holden, M. A., & Henman, R. S. (2017). Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or osteoarthritis : a systematic review and meta-analysis. BRITISH JOURNAL OF SPORTS MEDICINE, 51(10), 791–799.
Chicago author-date
Nicolson, Phillipa JA, Kim L Bennell, Fiona L Dobson, Ans Van Ginckel, Melanie A Holden, and Rana S Henman. 2017. “Interventions to Increase Adherence to Therapeutic Exercise in Older Adults with Low Back Pain And/or Osteoarthritis : a Systematic Review and Meta-analysis.” British Journal of Sports Medicine 51 (10): 791–799.
Chicago author-date (all authors)
Nicolson, Phillipa JA, Kim L Bennell, Fiona L Dobson, Ans Van Ginckel, Melanie A Holden, and Rana S Henman. 2017. “Interventions to Increase Adherence to Therapeutic Exercise in Older Adults with Low Back Pain And/or Osteoarthritis : a Systematic Review and Meta-analysis.” British Journal of Sports Medicine 51 (10): 791–799.
Vancouver
1.
Nicolson PJ, Bennell KL, Dobson FL, Van Ginckel A, Holden MA, Henman RS. Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or osteoarthritis : a systematic review and meta-analysis. BRITISH JOURNAL OF SPORTS MEDICINE. 2017;51(10):791–9.
IEEE
[1]
P. J. Nicolson, K. L. Bennell, F. L. Dobson, A. Van Ginckel, M. A. Holden, and R. S. Henman, “Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or osteoarthritis : a systematic review and meta-analysis,” BRITISH JOURNAL OF SPORTS MEDICINE, vol. 51, no. 10, pp. 791–799, 2017.
@article{8509276,
  abstract     = {Objective: To evaluate whether interventions aimed at increasing adherence to therapeutic exercise increase adherence greater than a contextually equivalent control among older adults with chronic low back pain and/or hip/knee osteoarthritis. 
Design: A systematic review and meta-analysis. 
Data sources: Five databases (MEDLINE (PubMed), CINAHL, SportDISCUS (EBSCO), Embase (Ovid) and Cochrane Library) were searched until 1 August 2016. 
Eligibility criteria for selecting studies: Randomised controlled trials that isolated the effects of interventions aiming to improve adherence to therapeutic exercise among adults >= 45 years of age with chronic low back pain and/or hip/knee osteoarthritis were included. 
Results: Of 3899 studies identified, nine studies (1045 participants) were eligible. Four studies, evaluating strategies that aimed to increase motivation or using behavioural graded exercise, reported significantly better exercise adherence (d=0.26-1.23). In contrast, behavioural counselling, action coping plans and/or audio/video exercise cues did not improve adherence significantly. Meta-analysis using a random effects model with the two studies evaluating booster sessions with a physiotherapist for people with osteoarthritis revealed a small to medium significant pooled effect in favour of booster sessions (standardised mean difference (SMD) 0.39, 95% CI 0.05 to 0.72, z=2.26, p=0.02, I-2=35%). 
Conclusions: Meta-analysis provides moderate-quality evidence that booster sessions with a physiotherapist assisted people with hip/knee osteoarthritis to better adhere to therapeutic exercise. Individual high-quality trials supported the use of motivational strategies in people with chronic low back pain and behavioural graded exercise in people with osteoarthritis to improve adherence to exercise.},
  author       = {Nicolson, Phillipa JA and Bennell, Kim L and Dobson, Fiona L and Van Ginckel, Ans and Holden, Melanie A and Henman, Rana S},
  issn         = {0306-3674},
  journal      = {BRITISH JOURNAL OF SPORTS MEDICINE},
  keywords     = {RANDOMIZED CONTROLLED-TRIAL,BEHAVIOR-CHANGE TECHNIQUES,KNEE OSTEOARTHRITIS,PHYSICAL-ACTIVITY,HOME EXERCISE,MUSCULOSKELETAL PAIN,GRADED ACTIVITY,BEEP TRIAL,PROGRAM,PEOPLE},
  language     = {eng},
  number       = {10},
  pages        = {791--799},
  title        = {Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or osteoarthritis : a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1136/bjsports-2016-096458},
  volume       = {51},
  year         = {2017},
}

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