Improving Adherence to Exercise: Do People With Knee Osteoarthritis and Physical Therapists Agree on the Behavioral Approaches Likely to Succeed?

Abstract

Objective: To describe which behavior change techniques (BCTs) to promote adherence to exercise have been experienced by people with knee osteoarthritis (OA) or used by physical therapists, and to describe patient- and physical therapist–perceived effectiveness of a range of BCTs derived from behavioral theory. Methods: Two versions of a custom-designed survey were administered in Australia and New Zealand, one completed by adults with symptomatic knee OA and the second by physical therapists who had treated people with knee OA in the past 6 months. Survey questions ascertained the frequency of receiving/prescribing exercise for knee OA, BCTs received/used targeting adherence to exercise, and perceived effectiveness of 36 BCTs to improve adherence to prescribed exercise. Results: A total of 230 people with knee OA and 143 physical therapists completed the survey. Education about the benefits of exercise was the most commonly received/used technique by both groups. People with knee OA rated the perceived effectiveness of all BCTs significantly lower than the physical therapists (mean difference 1.9 [95% confidence interval 1.8–2.0]). When ranked by group mean agreement score, 2 BCTs were among the top 5 for both groups: development of specific goals related to knee pain and function; and review, supervision, and correction of exercise technique at subsequent treatment sessions. Conclusion: Goal-setting techniques related to outcomes were considered to be effective by both respondent groups, and testing of interventions incorporating these strategies should be a research priority.