THE Key Elements of the Exercise Prescription Process in Musculoskeletal Rehabilitation in a One-On-One Setting. A Delphi Study of Australian Physiotherapy Specialists.

BACKGROUND

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.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.