Physiotherapists' experiences and views of older peoples' exercise adherence with respect to falls prevention in Singapore: a qualitative study.

ABSTRACT

PURPOSE: To seek physiotherapists' perspectives on patient adherence to exercise prescription for falls prevention/risk reduction in the Singapore setting. METHOD: Three focus groups with physiotherapists (n = 16) were conducted. An inductive thematic analysis was performed to identify main themes by four independent researchers. RESULTS: Three main themes emerged "it's about the patient," "delivery of the programme," and "carer/family support and facilitation." Physiotherapists believed that adherence was all about the patients' mindset and motivation, and they had to tailor interventions to optimise adherence to cater for patients as distinct characters, with different health/cultural beliefs and ability to prioritise time. Furthermore, physiotherapists reported better patient adherence when therapy goals referred to maintaining function rather than reducing falls. Families/carers can act as facilitators while providing practical and/emotional support further enhanced exercise adherence. CONCLUSIONS: Awareness of the perspectives of physiotherapists in identifying and addressing patients' adherence to exercise may better equip researchers and healthcare providers in developing culturally relevant interventions that promote exercise adherence in Singapore. Certainly, adherence varies widely among patients receiving the same treatment. Analysis of predictive factors of non-adherence will assist to tailor intervention.Implications for rehabilitationPhysiotherapists believe the use of individualised approaches that adapt to patients and their health beliefs are critical for exercise adherence in older people in Singapore to prevent falls and falls risk.Adherence to exercise is multi-factorial physiotherapists need to include attention to education, building rapport and facilitating practical and emotional family/carer support.Non-adherence is not merely a patient problem but is influenced by both clinicians and the healthcare system in Singapore/Southeast Asia.