Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults

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Jordan, JL ; Holden, MA ; Mason, EE ; Foster, NE (2010)

BACKGROUND: Chronic musculoskeletal pain (CMP) is a major health problem, accounting for approximately one-quarter of general practice (GP) consultations in the United Kingdom (UK). Exercise and physical activity is beneficial for the most common types of CMP, such as back and knee pain. However, poor adherence to exercise and physical activity may limit long-term effectiveness. OBJECTIVES: To assess the effects of interventions to improve adherence to exercise and physical activity for people with chronic musculoskeletal pain. SEARCH STRATEGY: We searched the trials registers of relevant Cochrane Review Groups. In addition, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Science Citation Index and Social Science Citation Index and reference lists of articles to October 2007. We consulted experts for unpublished trials. SELECTION CRITERIA: Randomised or quasi-randomised trials evaluating interventions that aimed to improve adherence to exercise and physical activity in adults with pain for three months and over in the axial skeleton or large peripheral joints. DATA COLLECTION AND ANALYSIS: Two of the four authors independently assessed the quality of each included trial and extracted data. We contacted study authors for missing information. MAIN RESULTS: We included 42 trials with 8243 participants, mainly with osteoarthritis and spinal pain. Methods used for improving and measuring adherence in the included trials were inconsistent. Two of the 17 trials that compared different types of exercise showed positive effects, suggesting that the type of exercise is not an important factor in improving exercise adherence. Six trials studied different methods of delivering exercise, such as supervising exercise sessions, refresher sessions and audio or videotapes of the exercises to take home. Of these, five trials found interventions improved exercise adherence. Four trials evaluated specific interventions targeting exercise adherence; three of these showed a positive effect on exercise adherence. In eight trials studying self-management programmes, six improved adherence measures. One trial found graded activity was more effective than usual care for improving exercise adherence. Cognitive behavioural therapy was effective in a trial in people with whiplash-associated disorder, but not in trials of people with other CMP. In the trials that showed a positive effect on adherence, association between clinical outcomes and exercise adherence was conflicting. AUTHORS' CONCLUSIONS: Interventions such as supervised or individualised exercise therapy and self-management techniques may enhance exercise adherence. However, high-quality, randomised trials with long-term follow up that explicitly address adherence to exercises and physical activity are needed. A standard validated measure of exercise adherence should be used consistently in future studies.
  • References (20)
    20 references, page 1 of 2

    Asenlof 2005 {published data only} Asenlof P, Denison E, Lindberg P. Individually tailored treatment targeting activity, motor behavior, and cognition reduces pain-related disability: a randomized controlled trial in patients with musculoskeletal pain. The Journal of Pain: Official journal of the American Pain Society 2005;6 (9):588-603. [PUBMED: 16139778]

    Barlow 2000 {published data only} Barlow JH, Turner AP, Wright CC. A randomized controlled study of the Arthritis Self-Management Programme in the UK. Health education research 2000;15(6):665-80. [PUBMED: 11142075]

    Basler 2007 {published data only} Basler HD, Bertalanffy H, Quint S, Wilke A, Wolf U. TTMbased counselling in physiotherapy does not contribute to an increase of adherence to activity recommendations in older adults with chronic low back pain--a randomised controlled trial. European Journal of Pain 2007;11(1):31-7. [PUBMED: 16448828]

    Bernaards 2007 {published data only} Bernaards CM, Ariens GA, Hildebrandt VH. The (cost)effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on the recovery from neck and upper limb symptoms in computer workers. BMC Musculoskeletal Disorders 2006;7:80. [PUBMED: 17062141] ∗ Bernaards CM, Ariens GA, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain 2007;132 (1-2):142-53. [PUBMED: 17768009]

    Blixen 2004 {published data only} Blixen CE, Bramstedt KA, Hammel JP, Tilley BC. A pilot study of health education via a nurse-run telephone self-management programme for elderly people with osteoarthritis. Journal of Telemedicine and Telecare 2004;10 (1):44-9. [PUBMED: 15006216]

    Carr 2005 {published data only} Carr JL, Klaber Moffett JA, Howarth E, Richmond SJ, Torgerson DJ, Jackson DA, et al.A randomized trial comparing a group exercise programme for back pain patients with individual physiotherapy in a severely deprived area. Disability and Rehabilitation 2005;27(16):929-37. [PUBMED: 16096246]

    Cohen 1983 {published data only} Cohen MJ, Heinrich RL, Naliboff BD, Collins GA, Bonebakker AD. Group outpatient physical and behavioral

    Psychology 1983;39(3):326-33. [PUBMED: 6223946]

    Medicine 1985;8(1):61-78. [PUBMED: 3156999]

    Ersek 2004 {published data only} Ersek M, Turner JA, Cain KC, Kemp CA. Chronic pain self-management for older adults: a randomized controlled trial [ISRCTN11899548]. BMC Geriatrics 2004;4:7. [PUBMED: 15285783] Ersek M, Turner JA, Cain KC, Kemp CA. Results of a randomized controlled trial to examine the efficacy of a chronic pain self-management group for older adults [ISRCTN11899548]. Pain 2008;138(1):29-40. [PUBMED: 18086516]

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