Interventions to Improve Long-Term Adherence to Physical Rehabilitation: A Systematic Review

Area of Science:

• Rehabilitation Medicine
• Behavioral Science
• Clinical Trials

Background:

• Physical rehabilitation is crucial for managing hip/knee osteoarthritis and chronic lower back pain.
• Adherence to home-based rehabilitation programs is often poor, limiting long-term effectiveness.
• Adherence-enhancing interventions are increasingly explored to improve patient outcomes.

Purpose of the Study:

• To evaluate the impact of physical rehabilitation interventions supplemented with adherence-enhancing components on outcomes in adults with hip/knee osteoarthritis or chronic lower back pain.
• To synthesize evidence from randomized and nonrandomized trials on the effectiveness of these combined interventions.

Main Methods:

• A comprehensive literature search was conducted across MEDLINE, CINAHL Complete, and Embase databases up to July 27, 2021.
• Included studies were randomized and nonrandomized trials comparing physical rehabilitation with and without adherence-enhancing components.
• Outcome measures were assessed at least 3 months post-rehabilitation.

Main Results:

• Ten studies met the inclusion criteria, with interventions delivered concurrently or sequentially to rehabilitation.
• Very limited evidence suggests a beneficial treatment effect of adjunct adherence interventions on long-term physical function, self-efficacy, or adverse events.
• Only one low risk of bias study reported a positive effect on long-term adherence.

Conclusions:

• There is inadequate evidence to support the use of adherence-enhancing interventions for promoting long-term adherence to home rehabilitation programs.
• Future research should focus on developing and testing interventions specifically designed to target the behavioral maintenance of home rehabilitation programs.