Date Presented 03/27/20
In the emerging field of telerehab, OTs can provide rehabilitation in novel ways, such as by using apps or other technologies. Adherence to home exercise is a critical part of sustaining therapeutic gains, but often home exercise is not completed and function may decline after discharge. We show how an app was used to track home exercises, as well as facilitators of and barriers to use. Such information will be important for practitioners when considering using apps and other technologies.
Primary Author and Speaker: Susan Murphy
Additional Authors and Speakers: Donnamarie Krause
Contributing Authors: Erin Welsh, Angela Lyden, Mary Barber, Maya Sabbagh, Vivek Nagaraja, Erica Bush, Janet Poole, Dinesh Khanna
PURPOSE – Engaging consistently in upper extremity home exercises to increase range of motion and promote hand function is considered a critical part of treatment for individuals with systemic sclerosis (SSc). Little is known about how well people with SSc adhere to these programs. The purpose of this study was to examine adherence to prescribed home exercises delivered via mobile app among participants in an ongoing rehabilitation clinical trial.
DESIGN – Adults with early-disease diffuse cutaneous SSc and upper extremity contractures were recruited from a scleroderma clinic to participate in an ongoing clinical trial (NCT03482219 ) in which participants were randomized into either an 8-week OT intervention plus app or app alone; both groups had outcomes collected at baseline, and at 8 and 18 weeks.
METHOD – Participants completed the Disabilities of Arm Shoulder, and Hand (QuickDASH), NIH Patient Reported Outcomes Measurement Information System (PROMIS) physical function and social participation measures, and objective measures including modified Rodnan skin score, grip and pinch measurements, and Nine-Hole peg test. Home exercises were prescribed twice daily with about 27 sets per session with repeated reps per set and were expected to take about 45 minutes per session to perform. Adherence data was aggregated weekly for each participant by time spent following along with the exercise videos, and percent overall adherence was calculated with total weeks in the study as the denominator. Descriptive statistics, correlations, t-tests, and chi-square tests were used to examine factors potentially related to adherence.
RESULTS – Participants so far have mean +-SD age 55.1 years ± 10.0 consisted of 70% women; 75% Caucasian and 25% African American. There are 11 participants randomized to the OT + App group and 9 in App alone. At 8 weeks, the mean exercise adherence to the 1.5-hour home exercise program was 50% (+ 32%) (the median is .43%, interquartile range (IQR) 61%); overall adherence was 42% (+ 33%); median 31% IQR = 59%). Thirteen of the 20 participants (65%) participated in the home exercises for at least 45 minutes a day, which is the time expected for one daily exercise session. Correlations were moderate to low between overall adherence and demographics, survey, and objective variables (r = -.05 - .25). Participants in the OT + App group, who were female, and had a college degree or less education had greater adherence rates (see Figures 1 – 3).
CONCLUSION – Adherence to the app was relatively low, although slightly higher during the first 8 weeks of the study. However, the time burden of the program is high (1.5 hours per day if completely adherent) which may affect adherence rates. While no factors were significantly associated with higher adherence in this small sample, demographic factors and group assignment show more differences in adherence rates than reported symptoms, disease severity, or physical function. Results suggest that one daily session of exercises may have more acceptability in this sample. Future studies with a larger sample will be done to more fully examine how different factors influence adherence over time.
References
Wright, BJ; Galtieri, NJ; Fell, M. (2014). Non-adherence to prescribed home rehabilitation exercises for musculoskeletal injuries: the role of the patient-practitioner relationship. Journal of Rehab Medicine, 26(2) 153-158. DOI: 10.2340/16501977-1241.
Murphy SL, et al. (2018). Occupational therapy treatment to improve upper extremity function in individuals with early systemic sclerosis: a pilot study. Arthritis Care & Research, 70(11), 1653-1660. DOI: 10.1002/acr.23522
