The effects of mode of exercise instruction on compliance with a home exercise program in older adults with osteoarthritis
Introduction
This study examined the effects of mode of home exercise instruction on correctness of exercise performance and home exercise adherence in elderly people with osteoarthritis of the knees and/or hips. Therapeutic exercises need to address individual needs and to be performed correctly, consistently and with appropriate intensity to optimise therapy outcomes [1], [2], [3]. Modes of home exercise instruction evaluated in the literature include face-to-face verbal instructions [3], [4], illustrated brochures [4], [5], audiotapes [6] and videotapes [7], [8]. In people with conditions such as back pain and knee arthroplasty, these have been shown to influence the accuracy of exercise performance [3], [7] as well as adherence to prescribed exercises [4], [5], [7]. Adherence can be defined as the level of compliance with a prescribed exercise program [9].
The effectiveness of written instructions can be compromised by memory problems in older people [10], [11] and poor readability of handouts [12], [13] due to small fonts, complicated words and sentence construction, and poor layout. Written information can be adapted to improve comprehension by using a narrative style of writing [14] or by including illustrations [15], [16]. Most studies that have previously examined the outcomes of written exercise instructions omitted to report the levels of education or literacy in the sample, as well as the level of reading skills needed to understand the written text [17]. In addition, memory was not assessed in studies of older adults who relied on verbal instructions [3], [18]. Some of the older participants could have performed poorly due to problems with recall, particularly when they had to remember a number of exercises. Face-to-face verbal instructions and supervision during the instruction procedure together with an illustrated brochure written at a junior school educational level have been argued to enhance comprehension, correctness of exercise performance and home exercise adherence in older people [19]. It is possible that audiotapes could further assist the comprehension of exercise information, although this has not yet been demonstrated in controlled research. Videotaped instructions have been shown to produce similar [20] or even better outcomes [7], [8] than other forms of exercise instruction, although these studies lacked control and statistical power.
The aim of this investigation was to explore whether correctness of exercise performance and compliance with a home exercise program was influenced by the mode of exercise instruction (brochure; brochure and audiotape; brochure and videotape). Elderly people with osteoarthritis of knees or hips were recruited because this condition has been found to benefit from exercise [21]. Based on findings of a systematic review of the literature [19], evidence is accumulating that provision of an audiotape or videotape together with a brochure could improve correctness of exercise performance to a greater extent than providing elderly people with an instructional brochure alone.
Section snippets
Participants
A total of 115 participants (41 males and 74 females) with osteoarthritis of the knees and/or hips were recruited by 18 physiotherapists from 18 physiotherapy clinics in rural Victoria, Australia. The sources included orthopedic waiting lists for knee or hip joint replacement, physician's referrals with a diagnosis of osteoarthritis of knees and/or hips, and arthritis support groups. Members of the latter group were eligible to participate in the study when they self-reported osteoarthritis of
Results
Ten males and 15 females failed to complete the study. Reasons for this included joint replacement (n = 3), increased hip and knee pain (n = 5), work commitments (n = 3), depression (n = 2), belief that the exercise program was not helpful to relieve symptoms (n = 3), family circumstances (n = 1), angina (n = 1), diabetes (n = 1), colon problems (n = 2), lower back pain (n = 2), neck pain (n = 1), or fear related to an old fractured vertebra (n = 1). The results are based on 90 participants (30 per group) that
Discussion
The prediction that brochures together with videotaped instructions would be more effective than brochures alone or brochures combined with audiotapes was not supported by the results. Emphasis was placed on providing all participants with the opportunity to use the allocated modes of instruction at home. The brochures required grade four reading skills. Participants who received a videotape or an audiotape were also given a brochure that could be used when away from home. However, the addition
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