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Motivational sessions help patients better adhere

Long-lasting low back pain and arthritis of the hip and knee are the most common painful conditions for older adults

Osteoarthritis is a condition in which protective cartilage surrounding joints deteriorates over the course of time, which causes pain and disability. It is most common in the hips and knees, and along with chronic (long-lasting) low back pain, these conditions represent the most common causes of pain in older adults. In addition, the number of individuals affected by chronic low back pain or hip or knee osteoarthritis is expected to rise in the future, which makes it extremely important to promote treatments that are effective for these patients. Exercise programs that include strengthening, flexibility, balance and aerobic exercises are commonly recommended for older adults with these conditions, and studies have shown that it reduces pain levels and improves function; however, one of the biggest problems with these programs is getting patients to continue doing the exercises is the long term. This is called adherence, which is essentially the degree that a patient follows the recommendations given to them by the physical therapist. Since adherence is frequently not as great as it should be in older patients, strategies are needed to encourage them to stick with their exercises and improve overall adherence. With this in mind, a powerful pair of studies called a systematic review and meta-analysis was conducted to determine which strategies were effective for improving adherence to exercise programs in older adults with chronic low back pain or hip or knee osteoarthritis.

Five major medical databases searched for appropriate studies

Investigators searched through five major medical databases for studies that evaluated strategies to improve the adherence to exercise programs in people 45 years or older with low back pain for more than three months or hip or knee osteoarthritis. They only accepted randomized-controlled trials (RCTs), which are high-quality studies that are considered the gold standard for determining if a treatment is effective or not. This search led to 73 studies being screened, and of these, nine were approved and accepted for the review. All studies were analyzed and their findings were compared to one another, and investigators then assessed their quality with a rating to determine how reliable their results were.

Adding booster sessions and motivating patients to exercise improves their adherence

After completing the study, investigators found evidence of moderate quality that when physical therapists add booster sessions to exercise programs for osteoarthritis, adherence to the program may improve. Booster sessions are usually very similar to the original treatment sessions for patients, but they are given at regular intervals in the future to help patients stay on track. In addition, high-quality evidence was found showing that strategies aimed at increasing patients' motivation may improve their adherence to exercise programs for chronic low back pain. Finally, there was high-quality evidence that an approach focusing on gradually increasing the intensity of exercises over time and encouraging healthy behaviors may also improve exercise adherence for patients with osteoarthritis. These findings show that there are several effective strategies that can be used to improve the adherence of older adults with chronic low back pain or hip or knee osteoarthritis. Adding booster sessions over time, as well as motivating patients to stick with their exercises and encouraging positive behaviors have all been found to help accomplish this goal, and these strategies should, therefore, be incorporated into treatment programs for older adults. At the same time, patients should understand the importance of adherence to exercise and make every effort to continue their programs in the long term in order to reap the greatest possible benefits.
-As reported in the May '17 issue of the British Journal of Sports Medicine

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