Publicatie
Exercise adherence improves long-term patient outcome in patients with osteoarthritis of the hip and/or knee.
Pisters, M., Veenhof, C., Schellevis, F., Twisk, J., Dekker, J., Bakker, D. de. Exercise adherence improves long-term patient outcome in patients with osteoarthritis of the hip and/or knee. Physiotherapy: 2011, 97(suppl. 1), p. s1006. Abstract. World Physical Therapy Congress, 22 juni 2011, Amsterdam.
Lees online
Purpose: To determine the effect of patient exercise adherence, within the prescribed physiotherapy treatment period and after discharge, on patients’ outcome on pain, physical function and patient self-perceived effect in individuals with osteoarthritis (OA) of the hip and/or knee. Relevance: The positive treatment effects of exercise therapy in patients with osteoarthritis of the hip and/or knee seem to decline over time after discharge and finally disappear in the long term. Several authors have hypothesized that non-adherence to recommended exercises and a physically active lifestyle is one of the main reasons for poor longterm effectiveness of exercise therapy in patients with OA. Although it is well documented in the context of other chronic conditions, research to identify the extent to which exercise adherence is a predictor of outcome in the management of OA remains limited. In most existing studies in patients with osteoarthritis, exercise adherence was defined as attendance to treatment sessions and were mainly focused on the relationship between adherence and outcome within the period of treatment. Therefore, the current study focuses on the relationship between adherence to recommended self-directed exercise and patients’ outcome, both within the treatment period and after discharge. Participants: One hundred and fifty patients with osteoarthritis of the hip and/or knee were followed until 60 months follow-up. Patients were recruited by participating primary care physiotherapist and by articles about the study in local newspapers. Methods: Prospective observational follow-up study. All patients were treated with an individually tailored exercise treatment given by primary care physiotherapists, consisting of a 3 months period with a maximum of 18 sessions. Patients were advised to perform home exercises, home activities and a more physically active lifestyle was stimulated. Adherence to home exercises and home activities was measured with a self-report questionnaire. Patients’ level of physical activity was assessed by the SQUASH-questionnaire. Pain and selfreported physical function was measured with theWOMAC. Patient self-perceived effect was assessed by patients on a 8-point scale (1 = vastly worsened; 8 = completely recovered). Assessments took place at baseline, 3, 15 and 60 months follow-up. Analysis: The association between exercise adherence and patients’ outcome on pain, physical function and selfperceived effect was examined using generalized estimating equations (GEE) analyses. Results: Adherence to recommended home exercises and being more physically active was significantly associated with better treatment outcome on pain, self-reported physical function, physical performance and self-perceived effect. The association between adherence and outcome was consistent over time. Adherence to home activities was only associated with better self-perceived effect. Conclusions: Better adherence to recommended home exercises as well as being more physically active improves the long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip and/or knee. Both within and after the treatment period better adherence is associated with better patients’ outcome on pain, physical function, and selfperceived effect. Implications: Since exercise adherence declines over time, future research should focus on how exercise behaviour can be stimulated and maintained in the long-term. Funding acknowledgements: This study was funded by the Dutch Arthritis Association. Ethics approval: The study was approved by the medical ethics committee of the VU University Medical Center, Amsterdam.
Purpose: To determine the effect of patient exercise adherence, within the prescribed physiotherapy treatment period and after discharge, on patients’ outcome on pain, physical function and patient self-perceived effect in individuals with osteoarthritis (OA) of the hip and/or knee. Relevance: The positive treatment effects of exercise therapy in patients with osteoarthritis of the hip and/or knee seem to decline over time after discharge and finally disappear in the long term. Several authors have hypothesized that non-adherence to recommended exercises and a physically active lifestyle is one of the main reasons for poor longterm effectiveness of exercise therapy in patients with OA. Although it is well documented in the context of other chronic conditions, research to identify the extent to which exercise adherence is a predictor of outcome in the management of OA remains limited. In most existing studies in patients with osteoarthritis, exercise adherence was defined as attendance to treatment sessions and were mainly focused on the relationship between adherence and outcome within the period of treatment. Therefore, the current study focuses on the relationship between adherence to recommended self-directed exercise and patients’ outcome, both within the treatment period and after discharge. Participants: One hundred and fifty patients with osteoarthritis of the hip and/or knee were followed until 60 months follow-up. Patients were recruited by participating primary care physiotherapist and by articles about the study in local newspapers. Methods: Prospective observational follow-up study. All patients were treated with an individually tailored exercise treatment given by primary care physiotherapists, consisting of a 3 months period with a maximum of 18 sessions. Patients were advised to perform home exercises, home activities and a more physically active lifestyle was stimulated. Adherence to home exercises and home activities was measured with a self-report questionnaire. Patients’ level of physical activity was assessed by the SQUASH-questionnaire. Pain and selfreported physical function was measured with theWOMAC. Patient self-perceived effect was assessed by patients on a 8-point scale (1 = vastly worsened; 8 = completely recovered). Assessments took place at baseline, 3, 15 and 60 months follow-up. Analysis: The association between exercise adherence and patients’ outcome on pain, physical function and selfperceived effect was examined using generalized estimating equations (GEE) analyses. Results: Adherence to recommended home exercises and being more physically active was significantly associated with better treatment outcome on pain, self-reported physical function, physical performance and self-perceived effect. The association between adherence and outcome was consistent over time. Adherence to home activities was only associated with better self-perceived effect. Conclusions: Better adherence to recommended home exercises as well as being more physically active improves the long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip and/or knee. Both within and after the treatment period better adherence is associated with better patients’ outcome on pain, physical function, and selfperceived effect. Implications: Since exercise adherence declines over time, future research should focus on how exercise behaviour can be stimulated and maintained in the long-term. Funding acknowledgements: This study was funded by the Dutch Arthritis Association. Ethics approval: The study was approved by the medical ethics committee of the VU University Medical Center, Amsterdam.