A self-efficacy-enhancing intervention for Chinese patients after total hip arthroplasty: study protocol for a randomized controlled trial with 6-month follow-up

Background Total hip arthroplasty (THA) is a common and effective surgical method for advanced hip arthritis. Rehabilitation exercises are important to improve joint function after THA and are usually conducted in a home-based program. Poor patient adherence limits improvements in pain and function, affecting quality of life. The increasing use of THA in the aging Chinese population underscores the need to develop strategies that maximize functional outcomes. The purpose of this pilot study is to develop and assess the feasibility of a self-efficacy-enhancing intervention (SEEI) to improve exercise adherence in patients undergoing THA. Methods This single-blinded, parallel, randomized control trial will recruit 150 patients after THA and randomly assign them to an intervention or control group using computer-generated block randomization. The control group will receive usual care using evidence-based guidelines. The intervention group will receive the 6-month SEEI comprising personalized exercise guidance and self-efficacy education delivered using one face-to-face education session and four telephone consultations, supplemented by written materials. Participants are encouraged to build confidence in their own abilities, set rehabilitation goals, and self-monitor their physical exercise. Results Assessments will be conducted at baseline and 1, 3, and 6 months postsurgery. The outcome indicators are exercise adherence, physical function, anxiety and depression, self-efficacy of rehabilitation, joint function, and quality of life. Conclusions This study will test a theory-based intervention program to improve self-efficacy in rehabilitation, which may significantly impact out-of-hospital rehabilitation. The results will provide evidence to inform the postoperative recovery of patients undergoing THA or similar procedures. Trial registration Chinese Clinical Trials Registry, ChiCTR2000029422, registered on 31 January 2020

Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus

ObjectiveTo develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies.MethodWe conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK.ResultsIn round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains—(1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4.ConclusionWe developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders’ experiences and the cost-effectiveness of implementing these strategies.

Short-Term Effects of Strengthening Exercises of the Lower Limb Rehabilitation Protocol on Pain, Stiffness, Physical Function, and Body Mass Index among Knee Osteoarthritis Participants Who Were Overweight or Obese: A Clinical Trial

Background. Osteoarthritis (OA) of the knee is defined as a progressive disease of the synovial joints and is characterized by wear and tear of the cartilage and underlying bone. This study aimed to determine the short-term effects of the lower limb rehabilitation protocol (LLRP) on pain, stiffness, physical function, and body mass index (BMI) among knee OA participants who were overweight or obese. Methodology. A single-blinded randomized controlled trial of one-month duration was conducted at Rehmatul-Lil-Alameen Postgraduate Institute, Lahore, Pakistan. Fifty overweight or obese participants with knee OA were randomly divided into two groups by a computer-generated number. Participants in the rehabilitation protocol group (RPG) were provided with leaflets explaining the strengthening exercises of the LLRP and instruction of daily care (IDC), while the participants in the control group (CG) were provided with leaflets explaining the IDC only for a duration of four weeks. The primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness, and physical function. The secondary outcome measures were BMI, exercise adherence, and patients’ satisfaction assessed by using the numeric rating scale ranging from 0 to 10. The paired-sample t-test was used to analyze the differences within groups from baseline to posttest evaluations. The analysis of variance 2 × 2 factor was used to analyze the differences in BMI, knee pain, stiffness, and physical function between the groups. Results. Participants in the RPG and CG reported a statistically significant reduction in knee pain and stiffness ( p ≤ 0.05 ) within the group. The reduction in the scores of knee pain was higher in participants in the RPG than that in participants in the CG ( p = 0.001 ). Additionally, participants in the RPG reported greater satisfaction ( p = 0.001 ) and higher self-reported exercise adherence ( p = 0.010 ) and coordinator-reported exercise adherence ( p = 0.046 ) than the participants in the CG. Conclusion. Short-term effects of the LLRP appear to reduce knee pain and stiffness only, but not physical function and BMI.

Motivation Levels and Goals for the Practice of Physical Exercise in Five Different Modalities: A Correspondence Analysis

The identification of the practitioner’s profile regarding their motivation level for physical exercise engagement could be a behavioral strategy to increase exercise adherence. The present study investigates the associations between motivation levels, modalities practiced, and goals concerning the practice of physical exercise among physical exercise practitioners. A total of 100 physical exercise practitioners, of which 67 were women, took part in this study. The participants were engaged in extreme fitness program, strength training, fight training, Pilates, and functional training. Motivation level (BREQ-3) and expectations regarding regular physical exercise (IMPRAF-54) were assessed. A multiple correspondence analysis demonstrates preferential relationships between descriptive and non-inferential variables. Strength training and fight training practitioners seek these modalities with the goals of “Health” and “Aesthetics,” demonstrating low autonomy in relation to the behavior for the practice of physical exercise. Extreme conditioning program and functional training practitioners have as goal “Pleasure,” demonstrating medium and high levels of autonomy for such practice and Pilates practitioners have the goal of “Stress Control.” To promote and encourage the regular practice of physical exercise, this strategy could be used to take actions that increase the public’s intention to start or continue in a physical exercise program.

Measures of Engagement with mHealth Interventions in Patients with Heart Failure: A Scoping Review (Preprint)

BACKGROUND The computing and communication features of mobile devices are increasingly leveraged in mHealth interventions to provide comprehensive and tailored support that may have positive outcomes in patients with heart failure (HF). However, examination of mHealth intervention effectiveness has provided mixed findings. Considering that patient engagement is a prerequisite for the effectiveness of interventions, understanding how patients engage with mHealth interventions, and the effects of patient engagement on HF outcomes may explain the mixed findings. OBJECTIVE Our aim was to synthesize current evidence on measures of patient engagement with mHealth interventions, and the effects of engagement on HF outcomes METHODS A comprehensive search of the literature was conducted in 7 databases for relevant studies published in the English Language from 2009 to September 2021. Descriptive characteristics of studies were reported. Content analysis was conducted to identify themes that described patient engagement with mHealth in the qualitative studies included in the review. RESULTS We synthesized 32 studies that operationalized engagement with mHealth interventions in 4771 patients with HF (67.9% male), ranging from a sample of 7 to 1571, with a median of 53.3 patients. Patient engagement with mHealth interventions was measured only quantitatively based on system usage data (71.8%, 23/32), only qualitatively based on data from semi-structured interviews and focus groups (6.3%, 2/32), and by a combination of both quantitative and qualitative data (21.9%, 7/32). System usage data were evaluated using 6 metrics of engagement: (1) number of physiological parameters transmitted (63.3%, 19/30); (2) number of HF questionnaires completed (6.7%, 2/30); (3) numbers of logins (13.3%, 4/30); (4) number of short message service (SMS) responses (3.3%, 1/30); (5) time spent (16.7%, 5/30); (6) number of features accessed/screen viewed (9.5%, 4/30). There was a lack of consistency in how system usage metrics were reported across the studies. Eighty percent of the studies reported only the descriptive characteristics of the system usage data. Emotional, cognitive, and behavioral domains of patient engagement were identified in qualitative studies. Patient engagement levels ranged from 45% to 100% and decreased over time. The effects of engagement on HF knowledge, self-care, exercise adherence, and HF hospitalizations were inconclusive. CONCLUSIONS The operational definitions of patient engagement with mHealth interventions are underreported and lack consistency. The application of inferential analytical methods to engagement data is extremely limited. More research focused on developing optimal and standardized measures of patient engagement that may be applied across different study designs is warranted.