Smith Samantha S, Snodgrass Suzanne J, Osmotherly Peter G
School of Health Sciences, The University of Newcastle, Newcastle, Australia.
Musculoskeletal Care. 2025 Mar;23(1):e70042. doi: 10.1002/msc.70042.
Clinical decision making to develop an exercise program and then prescribe that program should be based on the best evidence available. However, little evidence exists to guide the development of an exercise program, determining optimal dosage parameters or for effective prescription techniques to achieve best patient outcomes possible.
To gain consensus from expert clinical physiotherapists in the field of musculoskeletal rehabilitation on key recommendations for developing and prescribing effective exercise programs in musculoskeletal rehabilitation in a one-on-one setting.
Delphi study method involving three rounds of questionnaires with subsequent rounds developed based upon results of the previous round, aiming to achieve consensus in the final round. The consensus threshold was set at 80% agreement. Participants were physiotherapists considered experts in the field of musculoskeletal rehabilitation as acknowledged by the Australian College of Physiotherapists, being Clinical Fellows of the College in musculoskeletal or sports and exercise physiotherapy.
Thirteen experts completed the three rounds of questionnaires. Most experts reported 'always' prescribing exercises to their patients. The expert clinicians agreed that a clinician should blend evidence-based protocols, clinical experience, and empirical knowledge to develop the exercise program, and then tailor the program further based on individual patient factors. Most experts agreed that it was essential to collaborate with the patient when designing the exercise program.
Future research is needed to determine the effectiveness and necessity of each element of the exercise program in musculoskeletal rehabilitation in a one-on-one setting to achieve best patient outcomes possible.
制定运动计划并随后开具该计划的临床决策应基于现有的最佳证据。然而，几乎没有证据可用于指导运动计划的制定、确定最佳剂量参数或有效的处方技术，以实现可能的最佳患者预后。
就一对一环境下在肌肉骨骼康复中制定和开具有效运动计划的关键建议，征求肌肉骨骼康复领域专家临床物理治疗师的共识。
采用德尔菲研究方法，进行三轮问卷调查，后续轮次根据前一轮结果制定，旨在在最后一轮达成共识。共识阈值设定为80%的一致率。参与者为被澳大利亚物理治疗师协会认可的肌肉骨骼康复领域专家物理治疗师，即该协会肌肉骨骼或运动与锻炼物理治疗领域的临床会员。
13名专家完成了三轮问卷调查。大多数专家报告“总是”为患者开具运动处方。专家临床医生一致认为，临床医生应将循证方案、临床经验和实证知识相结合来制定运动计划，然后根据患者个体因素进一步调整该计划。大多数专家同意，在设计运动计划时与患者合作至关重要。
需要开展进一步研究，以确定一对一环境下运动计划各要素在肌肉骨骼康复中的有效性和必要性，以实现可能的最佳患者预后。
