Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee

R Campbell, M Evans, M Tucker, B Quilty, P Dieppe, JL Donovan

Research output: Contribution to journalArticle (Academic Journal)peer-review

252 Citations (Scopus)

Abstract

STUDY OBJECTIVESTo understand reasons for compliance and non-compliance with a home based exercise regimen by patients with osteoarthritis of the knee. DESIGNA 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. SETTINGPatients were interviewed at home. The study was nested within a pragmatic randomised controlled trial. PARTICIPANTSTwenty 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 RESULTSInitial 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. CONCLUSIONSNon-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 non-compliance 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.
Translated title of the contributionWhy don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee
Original languageEnglish
Pages (from-to)132 - 138
Number of pages7
JournalJournal of Epidemiology and Community Health
Volume55
DOIs
Publication statusPublished - Sep 2001

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