Willett Matthew James, Greig Carolyn, Rogers David, Fenton Sally, Duda Joan, Rushton Alison
Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
BMJ Open. 2019 Oct 28;9(10):e029199. doi: 10.1136/bmjopen-2019-029199.
Osteoarthritis (OA) is the leading cause of disability and pain in older adults. Although increasing physical activity (PA) can help reduce symptoms, patients with lower-limb OA are less active than the general public. Although physiotherapists commonly deliver PA programmes, they lack knowledge of key barriers and facilitators to adherence to prescribed PA that patients with lower-limb OA experience while attending physiotherapy appointments (treatment period) and after discharge (post-treatment period). This study aims to explore the perspectives of patients with lower-limb OA of barriers and facilitators to adherence to physiotherapy prescribed PA in the treatment and post-treatment time periods to inform the development of intervention underpinned by behaviour change theory.
A qualitative study, based on phenomenology, will purposively recruit patients with lower-limb OA who have had physiotherapy. In-depth semi-structured interviews will be undertaken following discharge from physiotherapy at a single time point. Participants' perspectives of physiotherapy interventions, including barriers and facilitators to prescribed PA and techniques that they felt optimised adherence to physiotherapist PA prescription will be explored (phase I). The acceptability and feasibility of delivering a physiotherapy intervention incorporating the techniques identified in the semi-structured interviews will then be explored through focus groups conducted with physiotherapists (phase II). Data will be coded following thematic analysis, with barriers and facilitators mapped to the constructs on the theoretical domains framework, and behaviour change techniques identified following definitions from Michie's V1 taxonomy.
Findings from this study will inform development of a physiotherapy intervention underpinned by behaviour change theory aiming to optimise adherence to PA prescription in patients with lower-limb OA during the treatment and post-treatment time periods. This study has ethical approval (IRAS 247904) and results will be disseminated through publications in peer-reviewed journals and presentations at conferences and to study participants.
骨关节炎（OA）是老年人残疾和疼痛的主要原因。尽管增加身体活动（PA）有助于减轻症状，但下肢骨关节炎患者的活动量低于普通人群。虽然物理治疗师通常会提供PA计划，但他们缺乏对下肢骨关节炎患者在接受物理治疗预约（治疗期）和出院后（治疗后期）遵守规定PA的关键障碍和促进因素的了解。本研究旨在探讨下肢骨关节炎患者对在治疗期和治疗后期遵守物理治疗规定PA的障碍和促进因素的看法，以为基于行为改变理论的干预措施的制定提供信息。
一项基于现象学的定性研究将有目的地招募接受过物理治疗的下肢骨关节炎患者。在从物理治疗出院后的单个时间点进行深入的半结构化访谈。将探讨参与者对物理治疗干预的看法，包括规定PA的障碍和促进因素以及他们认为能优化对物理治疗师PA处方遵守情况的技巧（第一阶段）。然后，将通过与物理治疗师进行焦点小组讨论来探讨实施包含在半结构化访谈中确定的技巧的物理治疗干预的可接受性和可行性（第二阶段）。数据将按照主题分析进行编码，将障碍和促进因素映射到理论领域框架中的结构上，并根据米基的V1分类法的定义确定行为改变技巧。
本研究的结果将为基于行为改变理论的物理治疗干预措施的开发提供信息，旨在优化下肢骨关节炎患者在治疗期和治疗后期对PA处方的遵守情况。本研究已获得伦理批准（IRAS 247904），研究结果将通过在同行评审期刊上发表、在会议上展示以及向研究参与者公布的方式进行传播。
