1 Netherlands Institute for Health Services Research , Utrecht, The Netherlands .
2 Physical Therapy Sciences Program in Clinical Health Sciences, University Medical Center Utrecht , Utrecht, The Netherlands .
Telemed J E Health. 2017 Dec;23(12):1002-1010. doi: 10.1089/tmj.2016.0264. Epub 2017 May 19.
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.
将基于网络的干预措施嵌入物理治疗中具有潜力，但对于这些干预措施的患者依从性的了解有限。
本研究探讨了哪些患者、干预和环境相关因素是决定患者是否坚持使用 e-Exercise 的在线部分的决定因素，e-Exercise 是一种针对髋部和/或膝部骨关节炎患者的 12 周混合干预措施。
采用收敛混合方法研究，嵌入正在进行的试验中。对接受 e-Exercise 的 109 名参与者的定量数据进行了负二项回归分析。依从性定义为在线评估周数。然后，对与在线部分依从性相关的因素进行了半结构访谈。
由于程序未开始而导致结局数据缺失的 19 名参与者被排除在外。在 90 名分析的参与者中，81.1%至少评估了 8 周。依从性最高的是中等教育程度的参与者、骨关节炎持续时间为 1-5 年的参与者和由物理治疗师招募的参与者。对 10 次分析访谈进行分析，结果表明，有足够的互联网技能、自律、执行锻炼计划、干预措施的可用性、灵活性、有说服力的设计、附加值以及可接受的所需时间以及研究参与都与良好的依从性有关。
尚不清楚坚持在线部分的患者是否也坚持了他们的锻炼计划。未来的研究将解决在线组件的依从性与临床结果之间的关系。
大多数参与者坚持了 e-Exercise 的在线部分，表明其适用性。在物理治疗环境中的整合和干预措施的有说服力的设计似乎在优化患者依从性方面发挥了重要作用。
