Dobson Fiona, Bennell Kim L, French Simon D, Nicolson Philippa J A, Klaasman Remco N, Holden Melanie A, Atkins Lou, Hinman Rana S
From the Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia (FD, KLB, SDF, PJAN, RSH); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada (SDF); Faculty of Healthcare, University of Applied Sciences Utrecht, Utrecht, The Netherlands (RNK); Arthritis Research UK Primary Care Centre, Keele University, Keele, UK (MAH); and Research Department of Clinical, Education and Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, London, UK (LA).
Am J Phys Med Rehabil. 2016 May;95(5):372-89. doi: 10.1097/PHM.0000000000000448.
Exercise is recommended for hip and knee osteoarthritis (OA). Patient initiation of, and adherence to, exercise is key to the success of managing symptoms. This study aimed to (1) identify modifiable barriers and facilitators to participation in intentional exercise in hip and/or knee OA, and (2) synthesize findings using behavior change theory. A scoping review with systematic searches was conducted through March 2015. Two reviewers screened studies for eligibility. Barriers and facilitators were extracted and synthesized according to the Theoretical Domains Framework (TDF) by two independent reviewers. Twenty-three studies (total of 4633 participants) were included. The greatest number of unique barriers and facilitators mapped to the Environmental Context and Resources domain. Many barriers were related to Beliefs about Consequences and Beliefs about Capabilities, whereas many facilitators were related to Reinforcement. Clinicians should take a proactive role in facilitating exercise uptake and adherence, rather than trusting patients to independently overcome barriers to exercise. Strategies that may be useful include a personalized approach to exercise prescription, considering environmental context and available resources, personalized education about beneficial consequences of exercise and reassurance about exercise capability, and use of reinforcement strategies. Future research should investigate the effectiveness of behavior change interventions that specifically target these factors.
推荐对髋膝关节骨关节炎（OA）患者进行运动。患者主动开始并坚持运动是症状管理成功的关键。本研究旨在：（1）确定髋和/或膝骨关节炎患者参与有目的运动的可改变障碍和促进因素；（2）运用行为改变理论综合研究结果。通过系统检索进行了一项截至2015年3月的范围综述。两名评审员筛选研究的合格性。两名独立评审员根据理论领域框架（TDF）提取并综合障碍和促进因素。纳入了23项研究（共4633名参与者）。映射到环境背景和资源领域的独特障碍和促进因素数量最多。许多障碍与对后果的信念和对能力的信念有关，而许多促进因素与强化有关。临床医生应积极促进运动的采用和坚持，而不是指望患者独立克服运动障碍。可能有用的策略包括个性化的运动处方方法，考虑环境背景和可用资源，针对运动有益后果的个性化教育以及对运动能力的 reassurance，以及使用强化策略。未来的研究应调查专门针对这些因素的行为改变干预措施的有效性。 （注：“reassurance”此处可能有误，推测可能是“reassurance about exercise capability”为“关于运动能力的保证”之意，但因原文如此，故保留疑问词。）
