Rotator cuff related shoulder pain. Describing home exercise adherence and the use of behavior change interventions to promote home exercise adherence: a systematic review of randomized controlled trials

Abstract

Background

A home exercise program (HEP) is integral in the management of rotator cuff related shoulder pain (RCRSP). There are many methods of measuring HEP adherence and many possible interventions to promote HEP adherence. Understanding the adherence rates to HEP and the strategies used to promote HEP adherence is important in order to interpret the existing evidence for the use of HEP in the management of RCRSP.

Objectives

To report and synthesize home exercise adherence and strategies to promote home exercise adherence in order to understand the limitations of the current evidence base and make recommendations for clinical practice and future research investigating HEPs in the management of RCRSP.

Methods

An electronic search of EMBASE, MEDLINE, PubMed, CINAHL, AMED, and CENTRAL was undertaken. Methodological quality was assessed using the Cochrane RoB 2.0, and BC techniques were coded in accordance with the BC technique taxonomy (version 1).

Results

Seventeen RCTs were retrieved. Forty-seven percent described a formal method of measuring HEP adherence and 29% described adherence rates. The included studies described between three and seventeen BC techniques and the mean number of BC techniques per study was 5.8. Twelve percent of the studies described offering patients an explanation of how the exercise program might help their symptoms resolve.

Conclusions

Poor reporting of adherence and the underutilisation of BC interventions to promote HEP adherence was prevalent. Recommendations for clinicians and researchers include more widespread use and definitive reporting of BC techniques to promote adherence, and the use of objective, patient self-reported, and clinician-assessed measures of adherence when prescribing HEPs.

Keywords:

• Shoulder
• adherence
• compliance
• rehabilitation

Acknowledgements

Open Access funding provided by the Qatar National Library. We thank Sally Reynolds (Western Sussex Hospitals NHS Foundation Trust) for her technical help and support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Kevin Hall is funded by a National Institute for Health Research (NIHR), Clinical Doctoral Research Fellowship (CDRF) award for this research project (CDRF-2014-05-003). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Notes on contributors

Kevin Hall

Kevin Hall (MSc, MACP, NIHR Academy Member) is an advanced physiotherapy practitioner at Western Sussex Hospitals NHS Trust and a National Institute of Health Research (NIHR) Academy Member. This research is part of a larger body of work completed as part of a NIHR Clinical Doctoral Research Fellowship. This works includes a randomized controlled clinical pilot trial investigating the role of posterior shoulder tightness in shoulder pain and disability in patients with rotator cuff related shoulder pain. Kevin’s main areas of research interest are rotator cuff related shoulder pain, exercise rehabilitation, implementing behaviour change theory and promoting adherence and concordance. Kevin’s publications include book chapters, peer reviewed articles, and he has presented his work at national and international conferences.

Anthony Grinstead

Anthony Grinstead (MCSP, MSc, BSc (hons)) has been working as an NHS physiotherapist since 2010. He currently works in Musculoskeletal outpatients and as an advanced physiotherapy practitioner in a spinal clinic and an emergency department. Anthony is due to start work as a First Contact Practitioner in January 2020. He also works privately with a particular interest in running related injuries, working with a lot of local runners and triathletes. Prior to the current systematic review Anthony has previous experience as a treating physiotherapist for a feasibility study on the treatment of posterior shoulder tightness, which has provided insights into clinical research.

Jeremy S. Lewis

Jeremy S. Lewis (PhD FCSP) is a Consultant Physiotherapist and Professor of Musculoskeletal Research (University of Hertfordshire, UK). Born in New Zealand & trained in Australia, he now works in the UK National Health Service. He has been awarded a Fellowship of the Chartered Society of Physiotherapy. He assesses & treats people with complex shoulder problems. Jeremy has also trained as an MSK sonographer (Postgraduate Certificate in Diagnostic Imaging-Ultrasound, University of Leeds, UK), & performs ultrasound guided shoulder injections as part of the rehabilitation process if required and appropriate. He also has completed; MSc (Musculoskeletal Physiotherapy), & Postgraduate Diplomas in; Manipulative Physiotherapy (Melbourne), Sports Physiotherapy (Curtin), & Biomechanics (Scotland), as well as MSc studies in injection therapy for soft tissues & joints. He has also qualified as an Independent (non-medical) Prescriber. His main areas of research interest are rotator cuff related shoulder pain, frozen shoulder, injection therapy, & exercise therapy. He also writes about reframing our care for people with non-traumatic musculoskeletal pain & the medicalisation of ‘normality’ in musculoskeletal practice. In addition to his own research he supervises PhD & MSc students. Jeremy was a co-editor & author for Grieve’s Modern Musculoskeletal Physiotherapy (4th ed).

Chris Mercer

Chris Mercer is a Consultant physiotherapist based at Western Sussex Hospitals Trust on the South Coast of England. He has a particular interest in Advanced Practice roles and serious pathology of the spine, particularly Cauda Equina Syndrome. He is current co-chair of the National Physiotherapy Consultant network, and Chair of the Chartered Society of Physiotherapy Education Awards Panel. He is past Chair of the Musculoskeletal Association of Chartered Physiotherapists and has recently completed a secondment role with NHSE looking at Advanced Practice roles for Allied Health Professionals in primary Care.

Ann Moore

Emeritus Professor Ann Moore (CBE, PhD, Grad.Dip.Phys, MCSP, FCSP, MACP, FMACP, Cert.Ed, Dip.TP, FHEA.DSc Honorary) is a Professor Emerita of Physiotherapy at the University of Brighton. She was awarded a professorship in 1998. From 1998 to her retirement from the UOB in 2015, Ann led and managed the Clinical Research Centre for Health Professions (1998-2013) and then the Centre for Health Research (2013 – 2015). She has specialised in Musculoskeletal Physiotherapy. Ann’s teaching and research interests have focused largely on Non Specific Low Back Pain and her research approaches have included clinical trials, Laboratory based studies, qualitative research and more latterly Art and Health research approaches. Ann has published widely in her field with 7 books, 10 book chapters, 90 Peer reviewed articles, and has made over 200 keynote and invited addresses. Ann was Director of the Council for Allied Health Professions Research (CAHPR) from 2014 -2019 and previously Director of the National Physiotherapy Research Network from 2004 to 2012 and then the Allied Health Professions Research Network from 2012 to 2014) all focused on increasing research capacity in AHPs in the UK. Ann is also Editor in Chief of Musculoskeletal Science and Practice an International Journal of Musculoskeletal Physiotherapy previously Manual Therapy Journal (1995 to date).

Colette Ridehalgh

Dr Colette Ridehalgh is a Principle Physiotherapy Lecturer at the University of Brighton. She qualified in 1992 and has worked in a number of settings both within the NHS, private practice and University. She has a special interest in managing people with nerve related musculoskeletal pain such as sciatica, carpal tunnel syndrome and neck/arm pain. She currently teaches Musculoskeletal Physiotherapy to undergraduate and postgraduate students. She has an MSc in Manipulative Physiotherapy and is a member of the Musculoskeletal association of Chartered Physiotherapists (MACP). She completed her PhD in 2014 exploring Straight Leg Raise treatment for individuals with spinally referred leg pain. Since then she has continued her research in the assessment and management of people with nerve related musculoskeletal disorders. She supervises research students from BSc (Hons) through to PhD. Colette has published widely in her field including book chapters, Peer reviewed articles, and presenting her work at national and international conferences. Colette regularly reviews articles and abstracts for scientific journals and national and international conferences. She is currently Research Officer for the MACP.