Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia.
Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
Br J Sports Med. 2017 May;51(10):791-799. doi: 10.1136/bjsports-2016-096458. Epub 2017 Jan 13.
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.
A systematic review and meta-analysis.
Five databases (MEDLINE (PubMed), CINAHL, SportDISCUS (EBSCO), Embase (Ovid) and Cochrane Library) were searched until 1 August 2016.
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.
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=35%).
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.
评估旨在提高治疗性运动依从性的干预措施是否比慢性下背痛和/或髋/膝关节骨关节炎老年患者的等效对照更能提高依从性。
系统评价和荟萃分析。
五个数据库（MEDLINE（PubMed）、CINAHL、SportDISCUS（EBSCO）、Embase（Ovid）和 Cochrane Library）进行了检索，检索时间截至 2016 年 8 月 1 日。
纳入的随机对照试验需单独评估旨在提高≥45 岁慢性下背痛和/或髋/膝关节骨关节炎成人对治疗性运动依从性的干预措施的效果。
在 3899 项研究中，有 9 项研究（1045 名参与者）符合条件。四项研究评估了旨在提高动机或使用行为分级运动的策略，报告了显著更好的运动依从性（d=0.26-1.23）。相比之下，行为咨询、行动应对计划和/或音频/视频运动提示并没有显著提高依从性。使用随机效应模型对两项评估骨关节炎患者物理治疗师强化治疗的研究进行荟萃分析显示，强化治疗对提高依从性有较小到中等显著的 pooled 效果（标准化均数差（SMD）0.39，95%置信区间 0.05 至 0.72，z=2.26，p=0.02，I=35%）。
荟萃分析提供了中等质量的证据，表明物理治疗师强化治疗有助于髋/膝关节骨关节炎患者更好地坚持治疗性运动。个别高质量试验支持在慢性下背痛患者中使用激励策略和在骨关节炎患者中使用行为分级运动来提高运动依从性。
