Recommendations for exercise adherence measures in musculoskeletal settings: a systematic review and consensus meeting (protocol)

Systematic Reviews, Feb 2014

Background Exercise programmes are frequently advocated for the management of musculoskeletal disorders; however, adherence is an important pre-requisite for their success. The assessment of exercise adherence requires the use of relevant and appropriate measures, but guidance for appropriate assessment does not exist. This research will identify and evaluate the quality and acceptability of all measures used to assess exercise adherence within a musculoskeletal setting, seeking to reach consensus for the most relevant and appropriate measures for application in research and/or clinical practice settings. Methods/design There are two key stages to the proposed research. First, a systematic review of the quality and acceptability of measures used to assess exercise adherence in musculoskeletal disorders; second, a consensus meeting. The systematic review will be conducted in two phases and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a robust methodology. Phase one will identify all measures that have been used to assess exercise adherence in a musculoskeletal setting. Phase two will seek to identify published and unpublished evidence of the measurement and practical properties of identified measures. Study quality will be assessed against the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. A shortlist of best quality measures will be produced for consideration during stage two: a meeting of relevant stakeholders in the United Kingdom during which consensus on the most relevant and appropriate measures of exercise adherence for application in research and/or clinical practice settings will be sought. Discussion This study will benefit clinicians who seek to evaluate patients’ levels of exercise adherence and those intending to undertake research, service evaluation, or audit relating to exercise adherence in the musculoskeletal field. The findings will impact upon new research studies which aim to understand the factors that predict adherence with exercise and which test different adherence-enhancing interventions. PROSPERO reference: CRD42013006212

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Recommendations for exercise adherence measures in musculoskeletal settings: a systematic review and consensus meeting (protocol)

Systematic Reviews Recommendations for exercise adherence measures in musculoskeletal settings: a systematic review and consensus meeting (protocol) Melanie A Holden 0 Kirstie L Haywood 2 Tanzila A Potia 1 Melanie Gee 3 Sionnadh McLean 1 0 Arthritis Research UK Primary Care Centre, Keele University , Keele ST5 5BG , UK 1 Faculty of Health and Wellbeing, Collegiate Campus, Sheffield Hallam University , Sheffield S10 2BP , UK 2 Royal College of Nursing Research Institute, Warwick Medical School, Warwick University , Coventry CV4 7AL , UK 3 Centre for Health and Social Care Research, Collegiate Campus, Sheffield Hallam University , Sheffield S10 2BP , UK Background: Exercise programmes are frequently advocated for the management of musculoskeletal disorders; however, adherence is an important pre-requisite for their success. The assessment of exercise adherence requires the use of relevant and appropriate measures, but guidance for appropriate assessment does not exist. This research will identify and evaluate the quality and acceptability of all measures used to assess exercise adherence within a musculoskeletal setting, seeking to reach consensus for the most relevant and appropriate measures for application in research and/or clinical practice settings. Methods/design: There are two key stages to the proposed research. First, a systematic review of the quality and acceptability of measures used to assess exercise adherence in musculoskeletal disorders; second, a consensus meeting. The systematic review will be conducted in two phases and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a robust methodology. Phase one will identify all measures that have been used to assess exercise adherence in a musculoskeletal setting. Phase two will seek to identify published and unpublished evidence of the measurement and practical properties of identified measures. Study quality will be assessed against the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. A shortlist of best quality measures will be produced for consideration during stage two: a meeting of relevant stakeholders in the United Kingdom during which consensus on the most relevant and appropriate measures of exercise adherence for application in research and/or clinical practice settings will be sought. Discussion: This study will benefit clinicians who seek to evaluate patients' levels of exercise adherence and those intending to undertake research, service evaluation, or audit relating to exercise adherence in the musculoskeletal field. The findings will impact upon new research studies which aim to understand the factors that predict adherence with exercise and which test different adherence-enhancing interventions. PROSPERO reference: CRD42013006212 © 2014 Holden et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Acceptability; Adherence; Consensus; Exercise; Measurement; Musculoskeletal disorders; Physical activity; Quality; Systematic review - Background Musculoskeletal disorders, such as low back pain, shoulder disorders, and osteoarthritis, are common, with estimates suggesting an average prevalence of 38% [1], which increases markedly with age [1] and is likely to continue to rise due to the ageing population and increasingly sedentary lifestyles [2,3]. Musculoskeletal disorders cause more functional limitations than any other group of disorders within the adult population and lead to enormous healthcare expenditure and loss of work [4]. Clinical guidelines advocate the use of exercise programmes for musculoskeletal disorders [5,6]. Exercise can encompass a wide range of interventions such as general (aerobic) exercise, specific body-region exercises for strengthening and flexibility, continuing normal physical activities, and increasing general physical activity levels [7]. Systematic reviews consistently show the beneficial effects of different types of exercise on key clinical outcomes such as pain, physical function, and quality of life [8-10]. Adherence, defined as “the extent to which a person’s behaviour corresponds with agreed recommendations from a healthcare provider”, is considered to be an important pre-requisite for the success of exercise programmes for musculoskeletal disorders [11,12]. Adhering to an exercise programme enhances its effectiveness, and patients who undertake regular physical activity may be less likely to progress to recurrent, persistent, or disab (...truncated)


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Melanie A Holden, Kirstie L Haywood, Tanzila A Potia, Melanie Gee, Sionnadh McLean. Recommendations for exercise adherence measures in musculoskeletal settings: a systematic review and consensus meeting (protocol), Systematic Reviews, 2014, pp. 10, 3, DOI: 10.1186/2046-4053-3-10