Skip to main content
SpringerLink
Log in

Factors influencing adherence among older people with osteoarthritis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

This study aims to identify potential factors that could affect adherence and influence the implementation of an evidence-based structured walking program, among older adults diagnosed with knee osteoarthritis. A total of 69 participants with mild to moderate osteoarthritis of the knee fulfilled an online survey on potential factors that could affect their adherence to an evidence-based structured walking program. Adherence with regard to the influencing factors was explored using a logistic regression model. Results tend to show higher odds of adhering to the evidence-based walking program if the participants were supervised (more than 2.9 times as high), supported by family/friends (more than 3.7 times as high), and not influenced by emotional involvement (more than 11 times as high). The odds of adhering were 3.6 times lower for participants who indicated a change in their medication intake and 3.1 times lower for individuals who considered themselves as less physically active (95 % confidence interval (CI)). Our exploratory findings identified and defined potential adherence factors that could guide health professionals in their practice to better identify positive influences and obstacles to treatment adherence, which would lead to the adoption of a more patient-centered approach. A large-scale study is required to clearly delineate the key factors that would influence adherence. We addressed a new knowledge gap by identifying the main strategies to promote the long-term adherence of community-based walking program.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Klippel JH, Stone JH, Crofford LJ, et al. (2008) Juvenile idiopathic arthritis. In: Primer on the rheumatic diseases (Eds.), Chapter 7, 13th edn. Springer (CB Lindsley), Arthritis Foundation, USA, pp 166–167

  2. Loew L, Brosseau L, Wells GA, Tugwell P, Kenny GP, Reid R, Maetzel A, Huijbregts M, McCullough C, De Angelis G, Coyle D, Panel Ottawa (2012) Ottawa Panel evidence-based clinical practice guidelines for walking programs in the treatment of osteoarthritis. Arch Phys Med Rehabil 69:1269–1284

    Article  Google Scholar 

  3. Dunlop DD, Song J, Semanik PA, Chang RW, Sharma L, Bathon JM, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK, Mysiw WJ, Newitt NC, Hootman JM (2011) Hochberg measurement in the osteoarthritis initiative: are guidelines being met? Arthritis Rheum 63(11):3372–3383

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bombardier C, Hawker G, Mosher D (2011) The impact of arthritis in Canada: today and over the next 30 years. Arthritis Alliance of Canada: 1–52

  5. Messier SP (2009) Obesity and osteoarthritis: disease genesis and nonpharmacologic weight management. Med Clin North Am 93(1):145–159

    Article  PubMed  Google Scholar 

  6. Jordan JL, Holden MA, Mason EEJ, Foster NE (2010) Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev 1(CD005956):1–60

    Google Scholar 

  7. Hoogeboom TJ, Oosting E, Vriezekolk JE, Veenhof C, Siemonsma PC, de Bie RA, van den Ende CH, van Meeteren NL (2012) Therapeutic validity and effectiveness of preoperative exercise on functional recovery after joint replacement: a systematic review and meta-analysis. PLoS ONE 7(5):1–13

    Article  Google Scholar 

  8. Rosella LC, Fitzpatrick T, Wodchis WP, Calzavara A, Manson H, Goel V (2014) High-cost health care users in Ontario, Canada: demographic, socio-economic, and health status characteristics. BMC Health Serv Res 14:532–538

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lunsky Y, Balogh RS, Cobigo V, Isaac B, Lin E, Ouellette-Kuntz HM (2014) Primary care of adults with developmental disabilities in Ontario. Healthcare Q 17(3):11–13

    Article  Google Scholar 

  10. Poitras S, Rossignol M, Avouac J, Cedraschi C, Nordin M, Rousseaux C, Rozenberg S, Savarieau B, Thoumie P, Valat JP, Vignon E, Hilliguin P (2010) Management recommendations for knee osteoarthritis: how usable are they? Joint Bone Spine 77(5):458–465

    Article  PubMed  Google Scholar 

  11. Slovenic D’Angelo M, Reid RD (2007) A model for exercise behavior change regulation in patients with heart disease. J Sport Exerc Psychol 29:208–224

    Article  Google Scholar 

  12. Rothman AJ, Baldwin AS, Hertel AW (2004) Self-regulation and behavior change: disentangling behavioral initiation and behavioral maintenance. In: Baumeister R, Vohs K (eds) Handbook of self-regulation: research, theory, and applications. Guilford Press, New York, USA, pp 130–148

    Google Scholar 

  13. WHO (2003) Adherence to long-term therapies—evidence for action. Noncommunicable diseases and mental health adherence to long term therapies project. Report. Report World Health Organization, Geneva, Switzerland

  14. Sirur R, Richardson J, Wishart L, Hanna S (2009) The role of theory in increasing adherence to prescribed practice. Physiother Can 61:68–77

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bandura A (1986) Social foundations of thought and action: a social cognitive theory. Prentice Hall, Englewood Cliffs

    Google Scholar 

  16. Aronson JK (2007) Compliance, concordance, adherence. Br J Clin Pharmacol 63(4):383–384

    Article  PubMed  PubMed Central  Google Scholar 

  17. Miranda J (2009) An exploration of participants’ treatment preferences in a partial RCT. CJNR 41(1):276–290

    PubMed  Google Scholar 

  18. Tilbrook H (2008) Patients’ preferences within randomised trials: systematic review and patient level of meta-analysis. BMJ 337(a1864):1–8

    Google Scholar 

  19. Waynes G, Klippel JH (2010) A National Public Health Agenda for Osteoarthritis. Centers for Disease Control and Prevention and the Arthritis 1–62

  20. Stoneking L, Denninghoff K, Deluca L, Keim SM, Munger B (2011) Sepsis bundles and compliance with clinical guidelines. J Intensive Care Med 26(3):172–182

    Article  PubMed  Google Scholar 

  21. Loew L, Kenny GP, Durand-Bush N, Poitras S, Wells GA, Brosseau L (2014) The implementation of an effective aerobic walking program based on Ottawa panel guidelines for older individuals with mild to moderate osteoarthritis: a participant exercise preference pilot randomized clinical protocol design. Br J Med Med Res 4(18):3491–3511

    Article  Google Scholar 

  22. King AC, Kiernan M (1997) Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making. Health Psychol 16(4):380–389

    Article  CAS  PubMed  Google Scholar 

  23. Westby MA (2001) A health professional’s guide to exercise prescription for people with arthritis: a review of aerobic fitness activities. Arthritis Care Res 45(6):501–511

    Article  CAS  Google Scholar 

  24. Tran CS, Kong Y, Gupta A (2013) Long-term exercise adherence after completion of the diabetes aerobic and resistance exercise (DARE) trial. Can J Diabetes 37(S4):S50–S51

    Article  Google Scholar 

  25. Damush TM, Perkins SM, Mikesky AE (2005) Motivational factors influencing older adults diagnosed with knee osteoarthritis to join and maintain an exercise program. J Aging Phys Act 13:45–60

    Article  Google Scholar 

  26. McAuley E, Jerome GJ, Marquez DX, Elavsky S, Blissmer B (2003) Exercise self-efficacy in older adults: social, affective, and behavioural influences. Ann Behav Med 25(1):1–7

    Article  PubMed  Google Scholar 

  27. Shih M, Hootman JM, Kruger J, Helmick CG (2006) Physical activity in men and women with arthritis. Am J Prev Med 30(5):385–393

    Article  PubMed  Google Scholar 

  28. Weijters B, Cabooter E, Schillewaert N (2010) The effect of rating scale format on response styles: the number of response categories and response category labels. Int J Res Mark 27(3):236–247

    Article  Google Scholar 

  29. Hosmer DW, Lemeshow S, Sturdivant RX (2013) Applied logistic regression. John Wiley and Sons, 3rd edn

  30. Stiggelbout M, Hopman-Rock M, Tak E, Lechner L, van Mechelen W (2005) Dropout from exercise programs for seniors: a prospective cohort study. J Aging Phys Act 13:409–421

    Article  Google Scholar 

  31. Preference Collaborative Review Group (2008) Patients’ preferences within randomised trials: systematic review and patient level meta-analysis. Br Med J 337:1–8

    Article  Google Scholar 

  32. Crandall S, Howlett S, Keysor SJ (2013) Exercise adherence interventions for adults with chronic musculoskeletal pain. Phys Ther 93(1):17–21

    Article  PubMed  Google Scholar 

  33. Hendry M, Williams NH, Markland D, Wilkinson C, Maddison P (2006) Why should we exercise when our knees hurt? A qualitative study of primary care patients with osteoarthritis of the knee. Fam Pract 23:558–567

    Article  Google Scholar 

  34. Hutton I, Gamble G, McLean G, Butcher H, Gow P, Dalbeth N (2010) What is associated with being active in arthritis? Analysis from the obstacles to action study. Intern Med J 40(7):512–520

    Article  CAS  PubMed  Google Scholar 

  35. Ehrlich-Jones L, Lee J, Semanik P, Cox C, Dunlop D, Chang RW (2011) Relationship between beliefs, motivation, and worries about physical activity and physical activity participation in persons with rheumatoid arthritis. Arthritis Care Res 63(12):1700–1705

    Article  Google Scholar 

  36. Hurkmans EJ, Maes S, de Gucht V, Knittle K, Peeters AJ, Ronday HK, Vlieland TP (2010) Motivation as a determinant of physical activity in patients with rheumatoid arthritis. Arthritis Care Res 62(3):371–377

    Article  CAS  Google Scholar 

  37. Jones M, Jolly K, Raftery J, Lip GY, Greenfield S, BRUM Steering Committee (2007) ‘DNA’ may not mean ‘did not participate’: a qualitative study of reasons for non-adherence at home- and centre-based cardiac rehabilitation. Fam Pract 24(4):343–357

    Article  PubMed  Google Scholar 

  38. Kehn M, Kroll T (2009) Staying physically active after spinal cord injury: a qualitative exploration of barriers and facilitators to exercise participation. BMC Public Health 9:168

    Article  PubMed  PubMed Central  Google Scholar 

  39. Lee J, Dunlop D, Ehrlich-Jones L, Semanik P, Song J, Manheim L, Chang RW (2012) Public health impact of risk factors for physical inactivity in adults with rheumatoid arthritis. Arthritis Care Res 64(4):488–493

    Article  Google Scholar 

  40. O’Hea EL, Wood KB, Brantley PJ (2003) The transtheoretical model: gender differences across 3 health behaviors. Am J Health Behav 27(6):645–656

    Article  PubMed  Google Scholar 

  41. Rich E, Lipson D, Libersky J, Peikes DN, Parchman M (2012) Organizing care for complex patients in the patient-centered medical home. Ann Fam Med 10(1):60–62

    Article  PubMed Central  Google Scholar 

Download references

Acknowledgments

We are thankful to the Chair of the thesis examination committee Dr. Mary Egan (Epidemiologist), study participants, research staff (Amélie Gravelle, Valérie Langlois, Lisa Lévesque, Isabel Théberge, Ana Lakic, Prinon Rahman, David Li, Christine Smith, Spencer Yam), members of the Pacesetters Walking Club, Marion D.-Russell from the Arthritis Society, and Billings Bridge Shopping Centre staff. The proposed study was supported by the Arthritis Health Professions Association (AHPA) and The Arthritis Research Foundation Movement and Mobility. It was awarded the 2012 Arthritis Research Foundation Movement and Mobility Award. Other funds that were obtained include the following: scholarships from the Fonds de recherche en santé du Québec (FRSQ), University of Ottawa Research Chair, Knowledge Translation Canada, in collaboration with the Canadian Institutes of Health Research (CIHR), Ontario Physiotherapy Association (OPA), Government of Ontario, and the University of Ottawa.

Author information

Authors and Affiliations

  1. School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada

    Laurianne Loew, Lucie Brosseau, Stéphane Poitras & Gino De Angelis

  2. School of Human Kinetics, Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada

    Glen P. Kenny & Natalie Durand-Bush

  3. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Glen P. Kenny

  4. Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    George A. Wells

Authors
  1. Laurianne Loew
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lucie Brosseau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Glen P. Kenny
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Natalie Durand-Bush
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stéphane Poitras
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gino De Angelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. George A. Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laurianne Loew.

Ethics declarations

This proposed study was in accordance with ethical standards for human research and was approved by the Research Ethics Board from the University of Ottawa (H01-07-08C).

Disclosures

None.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 23 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Loew, L., Brosseau, L., Kenny, G.P. et al. Factors influencing adherence among older people with osteoarthritis. Clin Rheumatol 35, 2283–2291 (2016). https://doi.org/10.1007/s10067-015-3141-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-015-3141-5

Keywords

Search

Navigation