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Barriers and Facilitators to Exercise Participation in People with Hip and/or Knee Osteoarthritis: Synthesis of the Literature Using Behavior Change Theory

Dobson, Fiona BAppSc(Physio), PhD; Bennell, Kim L. BAppSc(Physio), PhD; French, Simon D. BAppSc(Chiro), MPH, PhD; Nicolson, Philippa J.A. BPhty; Klaasman, Remco N. BSc; Holden, Melanie A. BSc(Hons)(Physiotherapy), PhD; Atkins, Lou BSc(Hons), MA, PhD; Hinman, Rana S. BPhysio(Hons), PhD

American Journal of Physical Medicine & Rehabilitation: May 2016 - Volume 95 - Issue 5 - p 372–389
doi: 10.1097/PHM.0000000000000448
Literature Review

ABSTRACT Exercise is recommended for hip and knee osteoarthritis (OA). Patient initiation of, and adherence to, exercise is key to the success of managing symptoms. This study aimed to (1) identify modifiable barriers and facilitators to participation in intentional exercise in hip and/or knee OA, and (2) synthesize findings using behavior change theory. A scoping review with systematic searches was conducted through March 2015. Two reviewers screened studies for eligibility. Barriers and facilitators were extracted and synthesized according to the Theoretical Domains Framework (TDF) by two independent reviewers. Twenty-three studies (total of 4633 participants) were included. The greatest number of unique barriers and facilitators mapped to the Environmental Context and Resources domain. Many barriers were related to Beliefs about Consequences and Beliefs about Capabilities, whereas many facilitators were related to Reinforcement. Clinicians should take a proactive role in facilitating exercise uptake and adherence, rather than trusting patients to independently overcome barriers to exercise. Strategies that may be useful include a personalized approach to exercise prescription, considering environmental context and available resources, personalized education about beneficial consequences of exercise and reassurance about exercise capability, and use of reinforcement strategies. Future research should investigate the effectiveness of behavior change interventions that specifically target these factors.

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From the Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia (FD, KLB, SDF, PJAN, RSH); School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada (SDF); Faculty of Healthcare, University of Applied Sciences Utrecht, Utrecht, The Netherlands (RNK); Arthritis Research UK Primary Care Centre, Keele University, Keele, UK (MAH); and Research Department of Clinical, Education and Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, London, UK (LA).

All correspondence and requests for reprints should be addressed to: Fiona Dobson, BAppSc(Physio), PhD, Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia.

FD, KLB, RSH, and SDF conceived the study question. FD led the search, data extraction, and initial mapping stages. RK and PJN were the independent study screeners and conducted data extraction and mapping. MAH, SDF, and LA led the mapping of each factor to the domains of the framework. All authors reached consensus and approved the final mapping of factors to the framework. All authors contributed to preparation of the manuscript and read and approved the final manuscript.

This study was presented as an oral presentation at the Osteoarthritis Research Society International (OARSI) World Congress, in May 2015, Seattle, USA.

This study was funded by a National Health and Medical Research Council (NHMRC) Program grant (631717) and Centre of Research Excellence (#1079078). KLB is supported by a NHMRC Fellowship (#1058440). RSH is supported by an Australian Research Council Future Fellowship (FT130100175). SDF was partly supported by a NHMRC Primary Health Care Fellowship (567071) while working on this project. MAH is supported by the National Institute for Health Research (NIHR) School for Primary Care Research. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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