Recommendations for exercise adherence measures in musculoskeletal settings: a systematic review and consensus meeting

Background: Exercise programmes are frequently advocated for the management of musculoskeletal disorders; however, adherence is an important pre-requisite for their success. The assessment of exercise adherence requires the use of relevant and appropriate measures, but guidance for appropriate assessment does not exist. The aim of this study was to recommend outcome measures of exercise adherence that have clinical and research utility in the musculoskeletal field. Methods: There were two key stages to the research. First, a systematic review of the availability, quality and acceptability of measures used to assess exercise adherence in musculoskeletal disorders; second, a consensus meeting. The systematic review was conducted in two phases and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a robust methodology. Phase one identified all reproducible measures that have been used to assess exercise adherence in a musculoskeletal setting. Phase two identified published and unpublished evidence of the measurement and practical properties of identified measures. Study quality was assessed against the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. A shortlist of measures was produced for consideration during stage two: a meeting of relevant stakeholders (n=14) in the United Kingdom. During this meeting consensus on the most relevant and appropriate measures of exercise adherence for application in research and/or clinical practice settings was sought. Key findings: Our systematic review identified numerous measures which had been used as measures of exercise adherence within musculoskeletal research. Of these 36 were deemed reproducible. However, only six had been evaluated as specific measures of exercise adherence for musculoskeletal research: evidence of essential measurement and practical properties was mostly limited or not available. Assessment of relevance and comprehensiveness was largely absent and there was no evidence of patient involvement during the development of any measure. During the consensus process the stakeholders reached agreement that none of the measures were relevant, appropriate or acceptable for use in musculoskeletal clinical or research settings. Conclusions and recommendations: Numerous exercise adherence measures are currently used within musculoskeletal research. However, many of these measures were not originally developed for this purpose; many approaches are not reproducible; and evidence of essential measurement and practical properties was only identified for a limited number of measures. Moreover, substantial methodological and quality issues were identified in the development and evaluation of the six short-listed measures which reduces confidence in the ability of these measures to reliably and validly evaluate adherence to exercise. Furthermore key stakeholders unanimously agreed that these measures were not fit for purpose. Measures of exercise adherence must be clearly conceptualised. Future development and evaluation should seek to involve patients, clinicians and researchers as active collaborators and use credible methods to develop and evaluate an appropriate measure of exercise adherence

Measures of upper limb function for people with neck pain. A systematic review of measurement and practical properties

There is a strong relationship between neck pain (NP) and upper limb disability (ULD). Optimal management of NP should incorporate upper limb rehabilitation and therefore include the use of an ULD measure in the assessment and management process. Clear guidance regarding the suitability of available measures does not exist. The aim of this study was to identify all available measures of ULD for populations with NP, critically evaluate their measurement properties and finally recommend a list of suitable measures. This two-phase systematic review is reported in accordance with the PRISMA statement. Phase one identified clearly reproducible measures of ULD for patients with NP. Phase two identified evidence of their measurement properties. In total, 11 papers evaluating the measurement properties of five instruments were included in this review. The instruments identified were the DASH questionnaire, the QuickDASH questionnaire, the NULI questionnaire, the SFA and the SAMP test. There was limited positive evidence of validity of the DASH, QuickDASH, NULI, SFA and SAMP. There was limited positive evidence of reliability of the NULI, SFA and SAMP. There was unknown evidence of responsiveness of the DASH and QuickDASH. Although all measures are supported by a limited amount of low quality evidence, the DASH, QuickDASH, NULI questionnaires, and the SAMP test are promising measures, but they require further robust evaluation

Quality and acceptability of measures of exercise adherence in musculoskeletal settings: a systematic review

Objective. To recommend robust and relevant measures of exercise adherence for application in the musculoskeletal field. Method. A systematic review of measures was conducted in two phases. Phase 1 sought to identify all reproducible measures used to assess exercise adherence in a musculoskeletal setting. Phase 2 identified published evidence of measurement and practical properties of identified measures. Eight databases were searched (from inception to February 2016). Study quality was assessed against the Consensus-based Standards for the Selection of Health Measurement Instruments guidelines. Measurement quality was assessed against accepted standards. Results. Phase 1: from 8511 records, 326 full-text articles were reviewed; 45 reproducible measures were identified. Phase 2: from 2977 records, 110 full-text articles were assessed for eligibility; 10 articles provided evidence of measurement/practical properties for just seven measures. Six were exercise adherence-specific measures; one was specific to physical activity but applied as a measure of exercise adherence. Evidence of essential measurement and practical properties was mostly limited or not available. Assessment of relevance and comprehensiveness was largely absent and there was no evidence of patient involvement during the development or evaluation of any measure. Conclusion. The significant methodological and quality issues encountered prevent the clear recommendation of any measure; future applications should be undertaken cautiously until greater clarity of the conceptual underpinning of each measure is provided and acceptable evidence of essential measurement properties is established. Future research should seek to engage collaboratively with relevant stakeholders to ensure that exercise adherence assessment is high quality, relevant and acceptable