Himler Peer, Lee Griffin T, Rhon Daniel I, Young Jodi L, Cook Chad E, Rentmeester Casey
Bellin College, Doctor of Science in Physical Therapy Program, 3201 Eaton Rd, Green Bay, WI, 54311, USA; Honor Health, Scottsdale, AZ, USA.
Bellin College, Doctor of Science in Physical Therapy Program, 3201 Eaton Rd, Green Bay, WI, 54311, USA; Department of Physical Therapy, College of Health and Human Services, Northern Arizona University Phoenix Biomedical Campus, Phoenix, AZ, USA.
Musculoskelet Sci Pract. 2023 Feb;63:102722. doi: 10.1016/j.msksp.2023.102722. Epub 2023 Jan 21.
Home exercise program (HEP) prescription is commonplace in physical therapy (PT). Adherence to HEPs is generally poor, with non-adherence as high as 70%. Poor adherence may negatively impact outcomes.
To (i) qualitatively assess patients' thoughts and beliefs regarding HEP performance and (ii) quantitatively define the relationship between adherence to HEPs and functional outcomes and identify variables that impact adherence.
Mixed-methods.
Part 1 involved semi-structured interviews with patients attending PT for neck pain. Responses were assessed using thematic analysis. Part 2 involved a retrospective chart review of patients seen in outpatient PT for neck pain. Between-group (adherent and non-adherent) differences in functional scores were analyzed using a linear mixed model. Sex, age, and functional score data was entered into a regression model to explore their ability to predict adherence.
25 participants were interviewed. Qualitative analysis revealed the following themes associated with adherence to a HEP: (i) prior PT, (ii) observability of outcomes, (iii) expectations of PT, and (iv) experience of pain. Retrospective data from 187 patients was analyzed. Functional scores at discharge were significantly higher (p = 0.03, mean difference = 12.4) in the adherent group. Age (OR = 0.98; 95% CI = 0.93-1.02), male sex (OR = 1.23; 95% CI = 0.22-6.91), and functional scores at intake (OR = 0.99; 95% CI = 0.92-1.07) were not significant predictors of non-adherence.
Individual patient experiences such as delayed improvement in symptoms and/or experience of pain associated with HEP performance may contribute to poor adherence to HEPs. Adherence to a HEP was associated with superior functional outcomes compared to non-adherence. Age, sex, and functional scores were not predictors of non-adherence.
家庭锻炼计划（HEP）处方在物理治疗（PT）中很常见。对HEP的依从性通常较差，不依从率高达70%。依从性差可能会对治疗结果产生负面影响。
（i）定性评估患者对HEP执行情况的想法和信念，以及（ii）定量确定HEP依从性与功能结果之间的关系，并识别影响依从性的变量。
混合方法。
第一部分涉及对因颈部疼痛接受PT治疗的患者进行半结构化访谈。使用主题分析评估回答。第二部分涉及对在门诊PT治疗颈部疼痛的患者进行回顾性病历审查。使用线性混合模型分析功能评分在依从组和非依从组之间的差异。将性别、年龄和功能评分数据输入回归模型，以探索它们预测依从性的能力。
采访了25名参与者。定性分析揭示了与HEP依从性相关的以下主题：（i）先前的PT治疗，（ii）结果的可观察性，（iii）对PT的期望，以及（iv）疼痛经历。分析了187名患者的回顾性数据。依从组出院时的功能评分显著更高（p = 0.03，平均差异 = 12.4）。年龄（OR = 0.98；95% CI = 0.93 - 1.02）、男性（OR = 1.23；95% CI = 0.22 - 6.91）和入院时的功能评分（OR = 0.99；95% CI = 0.92 - 1.07）不是不依从的显著预测因素。
个体患者的经历，如症状改善延迟和/或与HEP执行相关的疼痛经历，可能导致对HEP的依从性差。与不依从相比，依从HEP与更好的功能结果相关。年龄、性别和功能评分不是不依从的预测因素。
