Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee
Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee
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DOI：
10.1136/jech.55.2.132
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发表时间：
2001-02-01
影响因子：
6.3
通讯作者：
Donovan, JL
中科院分区：
文献类型：
--
作者：
Campbell, R;Evans, M;Donovan, JL
研究目的：了解膝关节骨关节炎患者遵守和不遵守家庭锻炼方案的原因，设计：一项定性研究，嵌套在一项随机对照试验中，检查物理治疗在减轻膝关节骨关节炎疼痛和增加活动性方面的有效性。在干预组，参与者进行了一系列简单的练习，并使用胶带重新定位膝盖骨。对干预组的一部分参与者进行了深入访谈，使用开放式问题，以主题时间表为指导，鼓励患者描述他们的经历，并反思他们为什么遵守或不遵守物理治疗。对访谈进行了录音、全文转录，并根据不断比较的方法进行了专题分析。一个模型解释了影响依从性的因素。这项研究是嵌套在一个务实的随机对照试验。患者-20名参与者在干预组的随机试验进行了采访后，他们已经完成了物理治疗计划的三个月。一年后，八人再次接受采访。主要结果-最初的依从性很高，因为忠诚的物理治疗师。支持持续依从性的推理更为复杂，涉及在日常生活中适应锻炼的意愿和能力、症状的严重程度、对关节炎和合并症的态度以及既往骨关节炎经历。一个必要的先决条件，继续遵守的看法，物理治疗是有效的改善不愉快的symptoms. Conclusions，不遵守物理治疗，药物治疗，是常见的。从病人的角度来看，是否服从的决定是理性的，但往往不能由治疗师或研究人员预测。最后，这项研究表明，卫生专业人员需要了解不遵守的原因，如果他们要提供支持性治疗和试验者应包括定性研究试验中的依从性水平可能会影响干预的有效性。
Study objectives-To understand reasons for compliance and non-compliance with a home based exercise regimen by patients with osteoarthritis of the knee.Design-A qualitative study, nested within a randomised controlled trial, examining the effectiveness of physiotherapy in reducing pain and increasing mobility in knee osteoarthritis. In the intervention arm, participants undertook a series of simple exercises and repositioning of the kneecap using tape. In depth interviews were conducted with a subset of participants in the intervention arm using open ended questions, guided by a topic schedule, to encourage patients to describe their experiences and reflect on why they did or did not comply with the physiotherapy. Interviews were audiotaped, fully transcribed and analysed thematically according to the method of constant comparison. A model explaining factors influencing compliance was developed.Setting-Patients were interviewed at home. The study was nested within a pragmatic randomised controlled trial.Participants-Twenty participants in the intervention arm of the randomised trial were interviewed three months after they had completed the physiotherapy programme. Eight were interviewed again one year later.Main results-Initial compliance was high because of loyalty to the physiotherapist. Reasoning underpinning continued compliance was more complex, involving willingness and ability to accommodate exercises within everyday life, the perceived severity of symptoms, attitudes towards arthritis and comorbidity and previous experiences of osteoarthritis. A necessary precondition for continued compliance was the perception that the physiotherapy was effective in ameliorating unpleasant symptoms.Conclusions-Non-compliance with physiotherapy, as with drug therapies, is common. From the patient's perspective, decisions about whether or not to comply are rational but often cannot be predicted by therapists or researchers. Ultimately, this study suggests that health professionals need to understand reasons for noncompliance if they are to provide supportive care and trialists should include qualitative research within trials whenever levels of compliance may have an impact on the effectiveness of the intervention.