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Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: a systematic review and meta-analysis
  1. Philippa J A Nicolson1,
  2. Kim L Bennell1,
  3. Fiona L Dobson1,
  4. Ans Van Ginckel1,
  5. Melanie A Holden2,
  6. Rana S Hinman1
  1. 1Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
  2. 2Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
  1. Correspondence to Professor Rana Hinman, Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, Level 7 Alan Gilbert Building, The University of Melbourne, Melbourne, VIC 3010, Australia; ranash{at}


Objective To evaluate whether interventions aimed at increasing adherence to therapeutic exercise increase adherence greater than a contextually equivalent control among older adults with chronic low back pain and/or hip/knee osteoarthritis.

Design A systematic review and meta-analysis.

Data sources Five databases (MEDLINE (PubMed), CINAHL, SportDISCUS (EBSCO), Embase (Ovid) and Cochrane Library) were searched until 1 August 2016.

Eligibility criteria for selecting studies Randomised controlled trials that isolated the effects of interventions aiming to improve adherence to therapeutic exercise among adults ≥45 years of age with chronic low back pain and/or hip/knee osteoarthritis were included.

Results Of 3899 studies identified, nine studies (1045 participants) were eligible. Four studies, evaluating strategies that aimed to increase motivation or using behavioural graded exercise, reported significantly better exercise adherence (d=0.26–1.23). In contrast, behavioural counselling, action coping plans and/or audio/video exercise cues did not improve adherence significantly. Meta-analysis using a random effects model with the two studies evaluating booster sessions with a physiotherapist for people with osteoarthritis revealed a small to medium significant pooled effect in favour of booster sessions (standardised mean difference (SMD) 0.39, 95% CI 0.05 to 0.72, z=2.26, p=0.02, I2=35%).

Conclusions Meta-analysis provides moderate-quality evidence that booster sessions with a physiotherapist assisted people with hip/knee osteoarthritis to better adhere to therapeutic exercise. Individual high-quality trials supported the use of motivational strategies in people with chronic low back pain and behavioural graded exercise in people with osteoarthritis to improve adherence to exercise.

  • Osteoarthritis
  • Exercise
  • Lower back
  • Intervention
  • Meta-analysis

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  • Contributors All authors were involved in study concept and design. PJAN and FLD performed the literature search. PJAN, AVG and MHA screened articles for eligibility. PJAN, AVG and FLD evaluated the quality of included articles. PJAN wrote the first draft of this article. All authors revised the paper and provided scientific input. All authors approved the final manuscript. RSH is the guarantor (the contributor who accepts full responsibility for the finished article, had access to all data and controlled the decision to publish).

  • Funding PJAN is supported by a PhD stipend from the Medibank Health Research Fund. KLB is supported by an NHMRC Principal Research Fellowship (#1058440). RSH is supported by an Australian Research Council Future Fellowship (FT130100175). AVG is supported by an NHMRC programme grant (#061887). MAH is supported by the National Institute for Health Research (NIHR) School for Primary Care Research.

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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