Facilitators and barriers for adherence of shoulder pain patients to a home-based exercise program: cross-sectional study
Facilitadores e barreiras para a adesão de pacientes com dor no ombro a um programa de exercícios domiciliares: estudo transversal
Giovanna Santello; Jaqueline Martins; Denise Martineli Rossi; Marcela Camargo Tozzo; Anamaria Siriani de Oliveira
Abstract
BACKGROUND AND OBJECTIVES: Home-based exercises can improve function and quality of life in shoulder pain patients. Knowing the facilitators and barriers is crucial for adherence to shoulder pain treatment. It is believed that individuals who adhere to home exercises have fewer environmental barriers, pain intensity and shoulder disability. The aim of this study is to identify facilitators and barriers for adherence to a home-based exercise program in shoulder pain individuals, and to investigate the influence of environmental barriers, shoulder pain and disability, and kinesiophobia on adherence to a program.
METHODS: This is a cross-sectional study. Shoulder pain individuals performed home-based exercises for eight weeks based on a booklet in addition to supervised physical therapy or as their sole therapy. They reported the perceived facilitators and barriers to home exercises adherence and answered the Craig Hospital Inventory of Environmental Factors (CHIEF), Shoulder Pain and Disability Index (SPADI), and the Tampa Scale for Kinesiophobia (TSK) questionnaires. Logistic regression models analyzed the scores of the CHIEF, SPADI, and TSK as predictors of adherence.
RESULTS: Fifty individuals participated in this study and 88% adhered to the program. The most frequent facilitator and barrier were “having guidance from a professional,” and “lack of available time,” respectively. Pain and disability were the only predictor of adherence (p=0.044), and an increase of one point in SPADI reduced the likelihood of adherence to home exercises by 14% (Exp(B) =0.86).
CONCLUSION: Individuals reported facilitators and barriers to the exercise program. Environmental barriers assessed using the CHIEF and kinesiophobia were not predictors of adherence.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: Os exercícios domiciliares podem melhorar a função e a qualidade de vida de pacientes com dor no ombro. Conhecer facilitadores e barreiras é fundamental para adesão ao tratamento da dor no ombro. Acredita-se que indivíduos que aderem aos exercícios domiciliares apresentem poucas barreiras ambientais, baixa intensidade de dor e incapacidade do ombro. O objetivo deste estudo foi identificar facilitadores e barreiras para a adesão a um programa de exercícios domiciliares em indivíduos com dor no ombro e investigar a influência de barreiras ambientais, da dor e incapacidade no ombro, e da cinesiofobia na adesão ao programa.
MÉTODOS: Neste estudo transversal, indivíduos com dor no ombro realizaram exercícios domiciliares por oito semanas com base em uma cartilha além da fisioterapia supervisionada ou como sua única terapia. Os indivíduos relataram facilitadores e barreiras percebidos para a adesão aos exercícios em casa e responderam ao Craig Hospital Inventory of Environmental Factors-Brasil (CHIEF-Br), Shoulder Pain and Disability Index-Brasil (SPADI-Br) e Escala Tampa de Cinesiofobia (TAMPA). Os escores do CHIEF-Br, SPADI-Br e TAMPA foram analisados como preditores de adesão por meio de modelos de regressão logística.
RESULTADOS: Participaram do estudo 50 indivíduos e 88% aderiram ao programa. O facilitador e a barreira mais frequentes foram “receber orientação de um profissional” e “falta de tempo disponível”, respectivamente. Dor e incapacidade foram os únicos preditores de adesão (p=0,044), e o aumento de um ponto no SPADI-Br reduziu a probabilidade de adesão aos exercícios domiciliares em 14% (Exp(B) =0,86).
CONCLUSÃO: Os indivíduos relataram facilitadores e barreiras ao programa de exercícios. As barreiras ambientais avaliadas por meio do CHIEF-Br e a cinesiofobia não foram preditores da adesão.
Palavras-chave
Referências
1 Gutiérrez-Espinoza H, Araya-Quintanilla F, Cereceda-Muriel C, Álvarez-Bueno C, Martínez-Vizcaíno V, Cavero-Redondo I. Effect of supervised physiotherapy versus home exercise program in patients with subacromial impingement syndrome: a systematic review and meta-analysis. Phys Ther Sport. 2020;41:34-42.
2 Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther. 2010;15(3):220-8.
3 Sabaté E. World Health Organization. Adherence to Long-Term Therapies: Evidence for Action. World Health Organization; 2003.
4 Thompson EL, Broadbent J, Bertino MD, Staiger PK. Do pain-related beliefs influence adherence to multidisciplinary rehabilitation? A systematic review. Clin J Pain. 2016;32(2):164-78.
5 Essery R, Geraghty AWA, Kirby S, Yardley L. Predictors of adherence to home-based physical therapies: a systematic review. Disabil Rehabil. 2017;39(6):519-34.
6 Sandford FM, Sanders TAB, Lewis JS. Exploring experiences, barriers, and enablers to home- and class-based exercise in rotator cuff tendinopathy: a qualitative study. J Hand Ther. 2017;30(2):193-9.
7 World Health Organization. International Classification of Functioning, Disability and Health : ICE
8 Malta M, Cardoso LO, Bastos FI, Magnanini MMF, Silva CMFP Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Rev Saude Publica. 2010;44(3):559-65.
9 Field A, Viali L. Descobrindo a Estatística Usando o SPSS, 2ª ed. Grupo A- Bookman; 2000.
10 Santello G, Rossi DM, Martins J, Libardoni TC, de Oliveira AS. Effects on shoulder pain and disability of teaching patients with shoulder pain a home-based exercise program: a randomized controlled trial. Clin Rehabil. 2020;34(10): 1245-55.
11 Martins J, Napoles BV, Hoffman CB, Oliveira AS. The Brazilian version of shoulder pain and disability index - translation, cultural adaptation and reliability | Versão brasileira do shoulder pain and disability index: Tradução, adaptação cultural e confiabilidade. Rev Bras Fisioter. 2010;14(6):527-36.
12 Siqueira FB, Teieira-Salmela LF, Magalhães L C. Análise das propriedades psicométricas da versão brasileira da Escala Tampa de Cinesiofobia. Acta Ortop Bras. 2007;15(l):19-24.
13 Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, Haythornthwaite JA, Jensen MP, Kerns RD, Ader DN, Brandenburg N, Burke LB, Cella D, Chandler J, Cowan P, Dimitrova R, Dionne R, Hertz S, Jadad AR, Katz NP, Kehlet H, Kramer LD, Manning DC, McCormick C, McDermott MP, McQuay HJ, Patel S, Porter L, Quessy S, Rappaport BA, Rauschkolb C, Revicki DA, Rothman M, Schmader KE, Stacey BR, Stauffer JW, von Stein T, White RE, Witter J, Zavisic S. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9(2):105-21.
14 Puga VO, Lopes AD, Shiwa SR, Alouche SR, Costa LO. Clinimetric testing supports the use of 5 questionnaires adapted into Brazilian Portuguese for patients with shoulder disorders. J Orthop Sports Phys Ther. 2013;43(6):404-13.
15 Furtado SRC, Sampaio RF, Vaz DV, Pinho BAS, Nascimento IO, Mancini MC. Versão brasileira do instrumento de avaliação ambiental Craig Hospital Inventory of Environmental Factors (CHIEF): Tradução, adaptação cultural e confiabilidade. Braz J Phys Ther. 2014;18(3):259-67.
16 Weermeijer JD, Meulders A. Clinimetrics: Tampa Scale for Kinesiophobia. J Physiother. 2018;64(2):126.
17 Karlsson L, Gerdle B, Takala EP, Andersson G, Larsson B. Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain. SAGE Open Med. 2016;4:205031211666893.
18 Picorelli AMA, Pereira DS, Felício DC, Gomes DA, Dias RC, Pereira LSM. Adhesion of older women to a home exercise program post ambulatory training. Fisioter Pesq. 201AD;22(3):291-308.
19 Chan D, Can F Patients’ adherence/ compliance to physical therapy home exercises. Fizyoterapi Rehabilitasyon. 2010;21(3): 132-9.
20 Mittaz Hager AG, Mathieu N, Lenoble-Hoskovec C, Swanenburg J, de Bie R, Hilfiker R. Effects of three home-based exercise programmes regarding falls, quality of life and exercise-adherence in older adults at risk of falling: protocol for a randomized controlled trial. BMC Geriatr. 2019;19(1):13.
21 Lien WC, Guo NW, Chang JH, Lin YC, Kuan TS. Relationship of perceived environmental barriers and disability in community-dwelling elderly in Taiwan-a population-based study. BMC Geriatr. 2014;14:59.
22 Roe Y, Bautz-Holter E, Juel NG, Soberg HL. Identification of relevant International Classification of Functioning, Disability and Health Categories in patients with shoulder pain: a cross-sectional study. J Rehabil Med. 2013;45(7):662-9.
23 Roe Y, Soberg HL, Bautz-Holter E, Ostensjo S. A systematic review of measures of shoulder pain and functioning using the international classification of functioning, disability and health (ICF). BMC Musculoskelet Disord. 2013;14:73.
24 Comachio J, Magalhães MO, Campos Carvalho E Silva APM, Marques AP. A cross-sectional study of associations between kinesiophobia, pain, disability, and quality of life in patients with chronic low back pain. Adv Rheumatol. 2018;58(1):8.
25 Nicholas MK, Asghari A, Corbett M, Smeets RJ, Wood BM, Overton S, Perry C, Tonkin LE, Beeston L. Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic painr Eur J Pain. 2011;16(1):93-104.
26 Mannion AF, Helbling D, Pulkovski N, Sprott H. Spinal segmental stabilisation exercises for chronic low back pain: Programme adherence and its influence on clinical outcome. Eurn Spine J. 2009;18(12): 1881-91.
27 Picha KJ, Howell DM. A model to increase rehabilitation adherence to home exercise programmes in patients with varying levels of self-efficacy. Musculoskeletal Care. 2018;16(1):233-37.
28 Dishman RK, Ickes W. Self-motivation and adherence to therapeutic exercise. J Behav Med. 1981;4(4):421-38.
Submetido em:
10/01/2023
Aceito em:
27/02/2023
Facebook
Google+
Twitter
LinkedIn
Mendeley
Email