Using Intervention Mapping in the Systematic Development of a Behaviour Change Intervention to Enhance Exercise Adherence among People with Persistent Musculoskeletal Pain.

Purpose: This article describes the first four steps of the intervention mapping framework used to design a programme aimed at increasing adherence to prescribed exercise by people with persistent musculoskeletal pain. Method: In Step 1, a systematic review and qualitative study was completed to inform Step 2 and the identification of the Health Action Process Approach as an appropriate theoretical framework for establishing two programme objectives: enhancing self-management and providing tailored and accessible exercise instructions. Step 3 encompassed the selection of the programme methods, and the programme is described in Step 4. The resulting programme provides virtually delivered motivational interviewing and an app-based exercise programme to support individuals' adherence to exercise. Results: The resulting intervention was assessed in a proof-of-concept feasibility and acceptability study and was shown to be feasible and acceptable. Refinements to the programme included additional tailoring of the exercise app and modifying the motivational interviewing schedule. Conclusions: Using the intervention mapping approach enabled us to successfully develop an intervention aimed at supporting the development of self-management behaviours and addressing maladaptive beliefs as a means of enhancing individuals' adherence to exercise. Evaluation and implementation of the intervention should now be carried out.

Objectif : décrire les quatre premières étapes du cadre de modélisation d'une intervention, utilisé pour concevoir un programme visant à accroître l'adhésion à une prescription d'exercices chez les personnes souffrant de douleurs musculosquelettiques persistantes. Méthodologie : à la première étape, les chercheurs ont effectué une analyse systématique et une étude qualitative pour étayer la deuxième étape et déterminer le processus d'action en santé dans un cadre théorique approprié qui permettrait de formuler les deux objectifs du programme : améliorer l'autogestion et fournir des directives d'exercices adaptées et accessibles. L'étape trois englobait le choix de la méthodologie du programme, décrite à l'étape quatre. Le programme qui en découle comprend des entrevues motivationnelles virtuelles et un programme d'exercices fondé sur une application pour renforcer l'adhésion à l'exercice. Résultats : l'intervention obtenue, évaluée dans une étude de validation de la faisabilité et de l'acceptabilité, s'est révélée faisable et acceptable. Les améliorations au programme ont inclus de nouvelles adaptations à l'application d'exercices et des modifications au calendrier d'entrevues motivationnelles. Conclusion : grâce à la démarche de modélisation de l'intervention, il a été possible d'élaborer une intervention visant à promouvoir l'acquisition de comportements d'autogestion et à corriger des convictions mésadaptées pour accroître l'adhésion à l'exercice. Il reste maintenant à évaluer et à mettre en œuvre l'intervention.

"It's important to buy in to the new lifestyle": barriers and facilitators of exercise adherence in a population with persistent musculoskeletal pain.

INTRODUCTION: Exercise and physical activity may improve pain and function in people with persistent musculoskeletal pain, but adherence is often low. Understanding the barriers and facilitators of exercise adherence could aid in the development of an intervention to promote exercise adherence. This study explored the factors influencing adherence to prescribed exercise in people with persistent musculoskeletal pain. METHODS: Qualitative semi-structured interviews were conducted with patients with persistent musculoskeletal pain. Registered physiotherapists specializing in the treatment of persistent musculoskeletal pain were recruited to two focus groups. Data was analyzed using framework analysis informed by the Theoretical Domains Framework. FINDINGS: Twenty patient participants (mean age = 44 years, standard deviation = 14) and ten physiotherapists (mean duration registered = 11 years, standard deviation = 5) were included. Four themes were identified: the role of environment, the therapeutic relationship, facilitating engagement with self-management and the influence of pain and negative affect. The Health Action Process Approach was identified as an appropriate model to inform intervention development. CONCLUSIONS: Personal, social, and environmental factors as well as the relationship with the physiotherapist influences exercise adherence. These findings may inform practice and the development of theoretically-informed interventions to enhance exercise adherence in people with persistent musculoskeletal pain.Implications for rehabilitationExercise and physical activity can decrease pain while improving mobility in a population with persistent musculoskeletal pain, but adherence to prescribed programs is low.The physical and social environment, the influence of pain, and negative affect may act as barriers to exercise adherence, while fostering a collaborative therapeutic relationship and facilitating self-management may enhance exercise adherence.The findings from the current study align with the constructs theorized by the Health Action Process Approach to support initiation and maintenance of behavior. This may provide a suitable theoretical framework to support the development of a targeted intervention.Healthcare providers, specifically physiotherapists, may find that facilitating self-management strategies that emphasize coping skills to overcome personal, social and environmental barriers may enhance exercise adherence in their patients.

Behaviour change techniques associated with adherence to prescribed exercise in patients with persistent musculoskeletal pain: Systematic review.

PURPOSE: Exercise (planned, structured, repetitive movement) improves pain and function in people with persistent musculoskeletal pain (PMSK), but adherence is often poor. This systematic review evaluates the evidence from randomized controlled trials (RCTs) on the effectiveness of interventions to improve exercise adherence in people with PMSK and describes the content, context, and theoretical underpinning of behaviour change interventions designed to increase adherence. METHODS: Nine electronic databases were searched from inception dates to August 2017. Studies were included if they were RCTs that included adults with PMSK ≥3 months; ≥one measure of exercise adherence, exercise prescribed to both groups, and employed ≥one behaviour change technique (BCT) in the treatment group. Independent data extraction, theory coding, BCT taxonomy coding, and quality assessment using Cochrane Risk of Bias (RoB) tool was conducted by two reviewers. RESULTS: Eight RCTs (five low, three high RoB) met inclusion criteria. Five trials reported between-group differences in exercise adherence, favouring the treatment group. Three trials reported theoretical underpinning. There was moderate evidence that five BCTs, social support, goal setting, instruction of behaviour, demonstration of behaviour, and practice/rehearsal, improved exercise adherence. Interventions employing ≤seven BCTs, unique to those included in the control group, were most effective at enhancing exercise adherence. CONCLUSIONS: Limited moderate-quality evidence supports using a small number of BCTs to enhance exercise adherence in people with PMSK. Further research should explore the associations and synergies between BCTs and explicitly report how theory was utilized. This may inform recommendations for health care professionals working with this population. Statement of contribution What is already known on this subject? Exercise (i.e., planned, structured, repetitive movements) improves pain and function in people with persistent musculoskeletal pain (PMSK). Many people with PMSK do not adhere to exercises prescribed by a health care professional. Little research has explored how to enhance adherence to prescribed exercise in people with PMSK. What does this study add? Moderate-quality evidence from eight trials suggests behaviour change interventions enhance exercise adherence. Social support, goal setting, demonstration, instruction, and rehearsal were employed in effective interventions. Interventions with ≤7 behaviour change techniques were more effective at improving adherence than those employing >7.