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Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults

  • Review
  • Intervention

Authors


Abstract

Background

Chronic musculoskeletal pain (CMP) is a major health problem, accounting for approximately one-quarter of general practice (GP) consultations in the United Kingdom (UK). Exercise and physical activity is beneficial for the most common types of CMP, such as back and knee pain. However, poor adherence to exercise and physical activity may limit long-term effectiveness.

Objectives

To assess the effects of interventions to improve adherence to exercise and physical activity for people with chronic musculoskeletal pain.

Search methods

We searched the trials registers of relevant Cochrane Review Groups. In addition, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Science Citation Index and Social Science Citation Index and reference lists of articles to October 2007. We consulted experts for unpublished trials.

Selection criteria

Randomised or quasi-randomised trials evaluating interventions that aimed to improve adherence to exercise and physical activity in adults with pain for three months and over in the axial skeleton or large peripheral joints.

Data collection and analysis

Two of the four authors independently assessed the quality of each included trial and extracted data. We contacted study authors for missing information.

Main results

We included 42 trials with 8243 participants, mainly with osteoarthritis and spinal pain. Methods used for improving and measuring adherence in the included trials were inconsistent. Two of the 17 trials that compared different types of exercise showed positive effects, suggesting that the type of exercise is not an important factor in improving exercise adherence. Six trials studied different methods of delivering exercise, such as supervising exercise sessions, refresher sessions and audio or videotapes of the exercises to take home. Of these, five trials found interventions improved exercise adherence. Four trials evaluated specific interventions targeting exercise adherence; three of these showed a positive effect on exercise adherence. In eight trials studying self-management programmes, six improved adherence measures. One trial found graded activity was more effective than usual care for improving exercise adherence. Cognitive behavioural therapy was effective in a trial in people with whiplash-associated disorder, but not in trials of people with other CMP. In the trials that showed a positive effect on adherence, association between clinical outcomes and exercise adherence was conflicting.

Authors' conclusions

Interventions such as supervised or individualised exercise therapy and self-management techniques may enhance exercise adherence. However, high-quality, randomised trials with long-term follow up that explicitly address adherence to exercises and physical activity are needed. A standard validated measure of exercise adherence should be used consistently in future studies.

摘要

提升慢性肌肉骨骼疼痛成人持續保持運動的策略

背景

慢性肌肉骨胳疼痛(CMP)是主要的健康問題,在英國(UK)佔家醫科醫師(GP)醫療諮詢內容的四分之一。運動與生體活動對大多數類型的慢性肌肉骨胳疼痛有益,像是背部與膝蓋疼痛。然而,沒有好好持續保持運動及生體活動,可能使其長期有效性受限。

目的

評估促進慢性肌肉骨胳疼痛者持續運動及生體活動活動介入措施的效果。

搜尋策略

我們搜尋了相關考科藍系統行文獻回顧群體試驗註冊。此外,我們也搜尋了Cochrane Central Register of Controlled Trials、MEDLINE、EMBASE、CINAHL、AMED、PsycINFO、Science Citation Index與Social Science Citation Index,以及自2007年10月為止的文章參考清單。我們也向專家諮詢了尚未發表的試驗。

選擇標準

試驗目的為評估在脊椎骨或大型肢體關節上持續疼痛超過三個月的成人,持續運動及生體活動介入措施之隨機化或準隨機化試驗。

資料收集與分析

四位作者中有兩位獨立評估每一個納入試驗的品質、並進行研究數據萃取。我們與研究作者接洽,以取得缺漏的資訊。

主要結果

我們納入了42個試驗,共有8243位參與者,主要是有骨關節炎與脊骨疼痛。納入中,用於促進與測量持續運動的方法並不一致。17個試驗中,有兩個試驗比較不同運動類型的結果顯示,不論運動的種類都具正面成效,運動種類並不是是否能持續保持運動的重要因素。 六個試驗研究了不同的運動進行方法,像是有人指導的運動課程、複習課程(refresher sessions)課程以及在家的錄音或錄影帶運動方式。在這些當中,有五個試驗發現介入措施有助於促進運動能持續保持。 四個試驗評估了特定的介入措施對於持續運動的成效;其中三個顯示出正面效果。在八個研究自我管理課程的試驗中,六個研究結果顯示能維持持續運動。一個試驗發現,分級的活動比一般活動在提升運動持續保持上更具效果。認知性行為治療對於頸部揮鞭症(whiplash-associated disorder)病人有效,但在其它慢性肌肉骨胳疼痛病人則沒有效果。研究結果中顯示出持續運動具有正面效果的試驗中,臨床結果與持續運動間的相關性互有衝突。

作者結論

指導或個人化運動治療以及自我管理技術的介入措施可能可以促進運動的持續。然而,需要有高品質、隨機化試驗、且長期追蹤的研究。未來的研究中,對於持續運動及測量方法的標準化,也應能標準化。

Plain language summary

Strategies for improving adherence to exercise in adults with chronic musculoskeletal pain

This summary of a Cochrane review presents what we know about the effect of different ways of helping people with chronic musculoskeletal pain to stick to exercise and physical activity. 

The review shows that we are uncertain which strategies will work for improving adherence to exercise in adults because the effects of the strategies were inconsistent from study to study. 

We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects.

What is chronic musculoskeletal pain (CMP) and what are ways to help people stick to exercise?

Chronic musculoskeletal pain is on-going pain in the bones and joints of the body, for example in the back or knees.  It may be the result of a musculoskeletal disease or injury or the cause may not be known.  

Exercise can be any activity that enhances or maintains muscle strength, physical fitness and overall health. People exercise for many different reasons including weight loss and strengthening muscles, and improving their energy.

Sometimes it can be difficult to continue with the exercise program that your doctor, nurse or physiotherapist recommends. One way of helping people stick to exercise is called ‘graded exercise activity’.  This means the exercise is targeted to weaker muscles or painful areas and gets increasingly more challenging.   Other ways included supervising exercise sessions, providing ‘refresher’ sessions to go over the exercise program again, and providing audio or videotapes of the exercises to take home.

 

淺顯易懂的口語結論

提升慢性肌肉骨骼疼痛成人持續保持運動的策略

本篇系統性文獻回顧,提出了我們對於協助慢性肌肉骨骼疼痛病人維持運動及身體活動,不同介入措施的成效。

此審閱顯示我們並不確定哪種策略在提升成人的持續運動上會有效,因為策略的效果因研究而各不相同。

我們對於副作用與併發症都沒有精確的資訊。尤其是少見但嚴重的副作用。

甚麼是慢性肌肉骨骼疼痛(CMP),且協助民眾持續運動的方法為何?

慢性肌肉骨骼疼痛是在身體的骨頭與關節中的持續性疼痛,例如在背部與膝蓋。可能是因為肌肉骨骼疾病或是受傷,又或可能是不明的原因造成的結果。

運動可以是任何能提升或維持肌肉強度、體適能(physical fitness)、以及整體健康的活動。人們因為很多理由而運動,包含有減重與強化肌肉、還有增進體力。

有時候要持續進行您的醫師、護理師或是物理治療師建議的運動課程並不容易。有一種協助民眾堅持運動的方法稱為”分級運動活動”(graded exercise activity) 。這意味著運動的目標放在較虛弱的肌肉或是疼痛的地方,然後逐漸增加挑戰。其他方法包含指導式運動課程、提供”複習課程”(‘refresher’ sessions)再次重溫運動課程、以及提供在家可進行的運動錄音或錄影帶。

 

譯註

翻譯: East Asian Cochrane Alliance
翻譯補助: 台灣衛生福利部/台北醫學大學實證醫學研究中心

Ancillary