Nespoli Alessandro [Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Savona, Italy]
Marazzi Davide [Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Savona, Italy]
Giardulli Benedetto [Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Savona, Italy]
Leuzzi Gaia [Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Savona, Italy]
Battista Simone [School of Health and Society, Center for Human Movement and Rehabilitation, University of Salford, Salford, Greater Manchester, United Kingdom]
Osteoarthritis(OA) is the most common form of arthritis globally, predominantly affecting the knee and hip. Most international OA clinical practice guidelines suggest exercise, self-management education and weight loss as first-line treatments. People with OA often experience inadequate adherence to first-line interventions, in particular to exercise. Exercise adherence is one of the primary predictors of long-term exercise outcomes in people with OA, and there is a need to identify strategies to improve adherence to exercise programs. Factors related to adherence are strongly linked to personal preferences. Therefore, several qualitative studies were conducted on this topic, giving voice to one’s experience. This meta-synthesis aims to synthesise the available qualitative evidence exploring the main facilitators and barriers to exercise adherence in people with OA.
The authors conducted a meta-synthesis of qualitative studies. Articles were retrieved from five electronic databases: MEDLINE, Cochrane Central, Embase, CINAHL, and PsychInfo. The search was conducted between October and December 2023. The included qualitative studies were in English, involving adults (age>16 ys) without gender restrictions, with a diagnosis of hip and knee OA, who claimed they performed an exercise program. The Critical Appraisal Skills Programme (CASP) tool ensured the quality of the studies. Thematic Synthesis by Thomas and Harden was used to synthesise the themes.
We included 17 studies (294 participants). We created seven descriptive themes from the thematic analysis that summarised the results of the primary studies (The Role of Beliefs, The experience of the exercise program, Individuals’ mindset, Relationship with the health professional, Social aspects, Environmental Circumstances, Technological support). These descriptive themes were further interpreted to create three analytical themes that went beyond the primary research to answer our research question (barriers and facilitators to exercise adherence). The three analytical themes were: ‘No Body Without Mind’, ‘Wellness Web’ and ‘Ecological Support. The first theme highlighted the importance of cognitive and psychological factors, emphasising education about OA, personalised exercise programs, and a positive mindset. The second theme explored the critical role of social support from healthcare professionals and significant others. The third theme examined external factors, highlighting facilitators such as flexible exercise locations and technological aids, but also barriers like financial and time constraints.
This meta-synthesis underscored the complex nature of exercise adherence in OA, providing information for researchers and clinicians. Future research should focus on creating tailored interventions to foster exercise adherence, starting with insights into people’s stories. Clinicians should provide personalised guidance and flexible home-based exercises and meet people’s needs to improve adherence and health outcomes.
Battista, S., Manoni, M., Dell’Isola, A., Englund, M., Palese, A., & Testa, M. (2022). Giving an account of patients’ experience: A qualitative study on the care process of hip and knee osteoarthritis. Health Expectations, 25(3), 1140–1156. https://doi.org/10.1111/hex.13468
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., Chou, R., Friedenreich, C. M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P. T., Lambert, E., Leitzmann, M., Milton, K., Ortega, F. B., … Willumsen, J. F. (1451). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med, 54, 20. https://doi.org/10.1136/bjsports-2020-102955
Allen Y, K. D., Thoma, L. M., & Golightly, Y. M. (n.d.). Epidemiology of osteoarthritis. https://doi.org/10.1016/j.joca.2021.04.020
Haskins, R., Henderson, J. M., & Bogduk, N. (2014). Health professional consultation and use of conservative management strategies in patients with knee or hip osteoarthritis awaiting orthopaedic consultation. Australian Journal of Primary Health, 20(3), 305–310. https://doi.org/10.1071/PY13064
Hinman, R. S., Jones, S. E., Nelligan, R. K., Campbell, P. K., Hall, M., Foster, N. E., Russell, T., & Bennell, K. L. (2023). Absence of Improvement With Exercise in Some Patients With Knee Osteoarthritis: A Qualitative Study of Responders and Nonresponders. Arthritis Care and Research, 75(9), 1925–1938. https://doi.org/10.1002/acr.25085
Ledingham, A., Cohn, E. S., Baker, K. R., & Keysor, J. J. (2020). Exercise adherence: beliefs of adults with knee osteoarthritis over 2 years. Physiotherapy Theory and Practice, 36(12), 1363–1378. https://doi.org/10.1080/09593985.2019.1566943
Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8. https://doi.org/10.1186/1471-2288-8-45
Wallis, J. A., Ackerman, I. N., Brusco, N. K., Kemp, J. L., Sherwood, J., Young, K., Jennings, S., Trivett, A., & Barton, C. J. (2020). Barriers and enablers to uptake of a contemporary guideline-based management program for hip and knee osteoarthritis: A qualitative study. Osteoarthritis and Cartilage Open, 2(4). https://doi.org/10.1016/j.ocarto.2020.100095
