Department Health Sciences, Physiotherapy, FH Campus Wien University of Applied Sciences, Favoritenstrasse 226, 1100, Vienna, Austria.
Department Health Sciences, Competence Center INDICATION, FH Campus Wien, University of Applied Sciences, Favoritenstrasse 226, 1100, Vienna, Austria.
Syst Rev. 2024 May 21;13(1):137. doi: 10.1186/s13643-024-02538-9.
Adherence to physiotherapeutic treatment and recommendations is crucial to achieving planned goals and desired health outcomes. This overview of systematic reviews synthesises the wide range of additional interventions and behaviour change techniques used in physiotherapy, exercise therapy and physical therapy to promote adherence and summarises the evidence of their efficacy.
Seven databases (PEDro, PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO and CINAHL) were systematically searched with terms related to physiotherapy, motivation, behaviour change, adherence and efficacy (last searched on January 31, 2023). Only systematic reviews of randomised control trials with adults were included. The screening process and quality assessment with AMSTAR-2 were conducted independently by the two authors. The extracted data was synthesised narratively. In addition, four meta-analyses were pooled in a panoramic meta-analysis.
Of 187 reviews identified in the search, 19 were included, comprising 205 unique trials. Four meta-analyses on the effects of booster sessions, behaviour change techniques, goal setting and motivational interventions showed a significantly small overall effect (SMD 0.24, 95% CI 0.13, 0.34) and no statistical heterogeneity (I = 0%) in the panoramic meta-analysis. Narrative synthesis revealed substantial clinical and methodological diversity. In total, the certainty of evidence is low regarding the efficacy of the investigated interventions and techniques on adherence, due to various methodological flaws. Most of the RCTs that were included in the reviews analysed cognitive and behavioural interventions in patients with musculoskeletal diseases, indicating moderate evidence for the efficacy of some techniques, particularly, booster sessions, supervision and graded exercise. The reviews provided less evidence for the efficacy of educational and psychosocial interventions and partly inconsistent findings. Most of the available evidence refers to short to medium-term efficacy. The combination of a higher number of behaviour change techniques was more efficacious.
The overview of reviews synthesised various potentially efficacious techniques that may be combined for a holistic and patient-centred approach and may support tailoring complex interventions to the patient's needs and dispositions. It also identifies various research gaps and calls for a more holistic approach to define and measure adherence in physiotherapy.
PROSPERO CRD42021267355.
坚持物理治疗的治疗和建议对于实现既定目标和预期健康结果至关重要。本系统评价综述综合了物理治疗、运动疗法和物理疗法中用于促进依从性的各种额外干预措施和行为改变技术，并总结了其疗效的证据。
使用与物理治疗、动机、行为改变、依从性和疗效相关的术语，在 PEDro、PubMed、Cochrane 图书馆、Web of Science、Scopus、PsycINFO 和 CINAHL 这 7 个数据库中进行了系统搜索（最后一次搜索于 2023 年 1 月 31 日进行）。仅纳入了针对成年人的随机对照试验的系统评价。两位作者独立进行了筛选过程和 AMSTAR-2 质量评估。提取的数据以叙述方式进行综合。此外，还对四项荟萃分析进行了全景荟萃分析。
在搜索中确定了 187 篇综述，其中 19 篇被纳入，包括 205 项独特的试验。四项关于强化疗程、行为改变技术、目标设定和动机干预效果的荟萃分析显示，全景荟萃分析中总体效果较小（SMD 0.24，95%CI 0.13，0.34），且无统计学异质性（I=0%）。叙述性综合揭示了大量临床和方法学上的多样性。由于各种方法学上的缺陷，总的来说，关于所调查干预措施和技术对依从性的疗效，证据的确定性较低。纳入综述的大多数 RCT 分析了肌肉骨骼疾病患者的认知和行为干预措施，这表明某些技术具有中等证据，特别是强化疗程、监督和分级运动。该综述提供的关于教育和心理社会干预措施的疗效证据较少，且结果不一致。大多数现有证据都指向短期到中期的疗效。结合更多的行为改变技术更有效。
该综述综合了各种潜在有效的技术，这些技术可以结合起来，采用整体和以患者为中心的方法，并可以根据患者的需求和倾向来调整复杂的干预措施。它还确定了各种研究差距，并呼吁采用更全面的方法来定义和衡量物理治疗中的依从性。
PROSPERO CRD42021267355。
Zotero 插件
