Patient adherence to physiotherapist prescribed self-management strategies: a critical review

Aims: To examine the published literature on patient adherence to physiotherapist prescribed self-management strategies in order to describe: changes in the proportion of publications over time; methodological quality of non-intervention and intervention-based studies; types of measures used to assess patient adherence and the reported accuracy of those measures. Methods: A comprehensive search of eight electronic databases was conducted, covering the period from January 1995 to November 2014. Data were extracted and coded for the number and proportion of articles that were: i) non data-based; ii) data-based, no new data (reviews); iii) data-based, new data. The methodological quality of non-intervention and intervention publications was assessed using the Effective Public Health Practice Project Quality Assessment Tool, and data were extracted regarding the type and accuracy of adherence measures reported in these publications. Results: A total of 80 relevant papers were identified. Of these, 49 non-intervention and intervention quantitative study designs underwent methodological assessment, with only 14 studies (29%) assessed as being of at least moderate quality. Fifty-three different measures of patient adherence were recorded from the 49 included studies, with only 5 of the 49 included studies (10%) reporting statistical evidence to support accuracy of the adherence measures applied. Conclusions: The results indicate that despite a trend towards intervention-based studies and reviews over the last 20 years, the methodological quality of studies on patient adherence could be improved. Accurate and standardised measures of patient adherence are needed for any future research involving patient adherence to physiotherapist prescribed self-management strategies.