“Sticking to it”: A Scoping Review of Adherence to Exercise Therapy Interventions in Children and Adolescents with Musculoskeletal Conditions.

  • Author / Creator
    Holt, Christopher J
  • Background: Exercise therapy is a core component of treatment for children and adolescents with musculoskeletal conditions. As exercise therapy effectiveness hinges on adherence, improving exercise therapy adherence is crucial for recovery and reducing long-term consequences.
    Objective: This scoping review consolidates the breadth of knowledge about exercise therapy adherence barriers, facilitators, and boosting strategies for youth with musculoskeletal conditions. In doing so, this review will inform clinical practice and future research.
    Methods: This review was guided by Arksey and O’Malley’s 5-stage framework and the PRISMA Extension for Scoping Reviews. Six electronic databases were searched using predetermined search terms and Medical Subject Headings. English studies with original data featuring an adherence barrier, facilitator, or boosting strategy and youth (≤19 years) with musculoskeletal conditions treated with exercise therapy were included. Two authors independently conducted title/abstract and full-text reviews. Study quality was assessed using the Mixed Methods Appraisal Tool. Descriptive consolidation and thematic analysis were completed using the Capability, Opportunity, Motivation and Behaviour (COM-B) framework.
    Results: Of 4,930 potentially relevant records, 34 studies representing 1,563 participants (65% female, 2-19 years of age) with 11 different musculoskeletal conditions and multiple exercise therapy interventions were included. Across studies, adherence concepts were poorly reported with adherence rates ranging from 15%-99% of prescribed exercises. Time constraints, physical environment (e.g., location), and negative exercise experiences were commonly identified adherence barriers, while social support and positive exercise experiences were frequently identified facilitators. Reinforcement, exercise program modification, and education were commonly used adherence boosting strategies, despite being infrequently reported as barriers or facilitators. Exercise experience (positive/negative), time, and environment (physical and social) emerged as important themes related to exercise therapy adherence for youth with musculoskeletal conditions.
    Conclusion: Despite poor reporting of adherence concepts, a diversity of barriers and facilitators to exercise therapy for youth with musculoskeletal conditions exist. Existing strategies to boost adherence are not consistent with identified barriers or facilitators. Making exercise enjoyable, social, and convenient may be important to maximizing adherence in this population. Efforts to match adherence boosting strategies to an individual’s needs should be considered and should respect the key themes.

  • Subjects / Keywords
  • Graduation date
    Spring 2020
  • Type of Item
  • Degree
    Master of Science
  • DOI
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