Clémence Palazzo1, Evelyne Klinger2, Véronique Dorner3, Abdelmajid Kadri4, Olivier Thierry3, Yasmine Boumenir5, William Martin6, Serge Poiraudeau6, Isabelle Ville7. 1. Service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, AP-HP, Paris, France; U1153, Inserm, université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France; Inserm/CNRS, institut fédératif de recherche handicap, Paris, France. Electronic address: clemence.palazzo@aphp.fr. 2. Équipe innovations numériques santé handicap - ESIEA, 38, rue des Docteurs-Calmette-et-Guérin, 53000 Laval, France; Inserm/CNRS, institut fédératif de recherche handicap, Paris, France. 3. Programme handicaps et sociétés, EHESS, Cermes 3, Campus CNRS, Villejuif, France. 4. LAMPA - P&i, EA 1427, arts et métiers ParisTech, Laval, France. 5. Équipe innovations numériques santé handicap - ESIEA, 38, rue des Docteurs-Calmette-et-Guérin, 53000 Laval, France. 6. Service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, AP-HP, Paris, France; U1153, Inserm, université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France; Inserm/CNRS, institut fédératif de recherche handicap, Paris, France. 7. Programme handicaps et sociétés, EHESS, Cermes 3, Campus CNRS, Villejuif, France; Inserm/CNRS, institut fédératif de recherche handicap, Paris, France.
Abstract
OBJECTIVE: To assess views of patients with chronic low back pain (cLBP) concerning barriers to home-based exercise program adherence and to record expectations regarding new technologies. DESIGN: Qualitative study based on semi-structured interviews. PARTICIPANTS: A heterogeneous sample of 29 patients who performed a home-based exercise program for cLBP learned during supervised physiotherapy sessions in a tertiary care hospital. INTERVENTIONS: Patients were interviewed at home by the same trained interviewer. Interviews combined a funnel-shaped structure and an itinerary method. RESULTS: Barriers to adherence related to the exercise program (number, effectiveness, complexity and burden of exercises), the healthcare journey (breakdown between supervised sessions and home exercise, lack of follow-up and difficulties in contacting care providers), patient representations (illness and exercise perception, despondency, depression and lack of motivation), and the environment (attitudes of others, difficulties in planning exercise practice). Adherence could be enhanced by increasing the attractiveness of exercise programs, improving patient performance (following a model or providing feedback), and the feeling of being supported by care providers and other patients. Regarding new technologies, relatively younger patients favored visual and dynamic support that provided an enjoyable and challenging environment and feedback on their performance. Relatively older patients favored the possibility of being guided when doing exercises. Whatever the tool proposed, patients expected its use to be learned during a supervised session and performance regularly checked by care providers; they expected adherence to be discussed with care providers. CONCLUSIONS: For patients with cLBP, adherence to home-based exercise programs could be facilitated by increasing the attractiveness of the programs, improving patient performance and favoring a feeling of being supported. New technologies meet these challenges and seem attractive to patients but are not a substitute for the human relationship between patients and care providers.
OBJECTIVE: To assess views of patients with chronic low back pain (cLBP) concerning barriers to home-based exercise program adherence and to record expectations regarding new technologies. DESIGN: Qualitative study based on semi-structured interviews. PARTICIPANTS: A heterogeneous sample of 29 patients who performed a home-based exercise program for cLBP learned during supervised physiotherapy sessions in a tertiary care hospital. INTERVENTIONS:Patients were interviewed at home by the same trained interviewer. Interviews combined a funnel-shaped structure and an itinerary method. RESULTS: Barriers to adherence related to the exercise program (number, effectiveness, complexity and burden of exercises), the healthcare journey (breakdown between supervised sessions and home exercise, lack of follow-up and difficulties in contacting care providers), patient representations (illness and exercise perception, despondency, depression and lack of motivation), and the environment (attitudes of others, difficulties in planning exercise practice). Adherence could be enhanced by increasing the attractiveness of exercise programs, improving patient performance (following a model or providing feedback), and the feeling of being supported by care providers and other patients. Regarding new technologies, relatively younger patients favored visual and dynamic support that provided an enjoyable and challenging environment and feedback on their performance. Relatively older patients favored the possibility of being guided when doing exercises. Whatever the tool proposed, patients expected its use to be learned during a supervised session and performance regularly checked by care providers; they expected adherence to be discussed with care providers. CONCLUSIONS: For patients with cLBP, adherence to home-based exercise programs could be facilitated by increasing the attractiveness of the programs, improving patient performance and favoring a feeling of being supported. New technologies meet these challenges and seem attractive to patients but are not a substitute for the human relationship between patients and care providers.
Authors: Janosch A Priebe; Katharina K Haas; Leida F Moreno Sanchez; Karin Schoefmann; Daniel A Utpadel-Fischler; Paul Stockert; Reinhard Thoma; Christine Schiessl; Linda Kerkemeyer; Volker Amelung; Siegfried Jedamzik; Jan Reichmann; Ursula Marschall; Thomas R Toelle Journal: J Pain Res Date: 2020-07-17 Impact factor: 3.133