Background Exercise is recommended for managing older adults with osteoarthritis (OA) related knee pain. However, the majority of older adults with OA do not meet physical activity recommendations. It remains unclear how exercise is best delivered to optimise patient outcomes. In the BEEP trial (ISRCTN93634563), participants were randomised to Usual Physiotherapy Care (UPC), Individually Tailored Exercise (ITE), or Targeted Exercise Adherence (TEA).
Objectives To investigate (1) Acceptability of interventions to trial participants (2) Impact of interventions on exercise and general physical activity behaviour and (3) Explanations for long term change in exercise behaviour to help contextualise the results of the trial.
Methods Face to face interviews with participants receiving each intervention (n=30 on completion of treatment, n=22 12-18 months later). Analysis included (1) open coding (using constant comparison) of transcripts to investigate experiences of interventions, views on exercise and barriers and facilitators to exercise (2) deductive coding to predetermined codes of individualisation, supervision and progression (BEEP intervention characteristics) (3) within-case and cross-case longitudinal analysis focusing on change.
Results Different levels of supervision, progression and individualisation emerged (matching intervention protocols). Overall higher levels were seen in narratives of those in TEA and ITE. Therapeutic relationships were present in narratives of those who reported positive experiences of interventions (regardless of intervention). A wide range of barriers or facilitators to BEEP interventions existed. Prominent factors that facilitated adherence at 12-18 months were patient related (e.g. being naturally active, feeling benefits, change in knowledge or retained knowledge about the role of exercise for pain). Change in knowledge was linked to patient and physiotherapy characteristics and a therapeutic alliance. Patient factors (existence of pain or other physical conditions, being pain free, exercise self-efficacy, lack of motivation), time and place, weather, lack of supervision and monitoring remained as barriers to exercise. New barriers at 12-18 months were financial, lack of family support, and conflicting advice causing uncertainty. More regular reviews or treatment sessions for a longer time period and different modes of delivery were suggested as improvements to BEEP interventions.
Conclusions Interview participants experienced different levels of supervision, individualisation and progression. Similar barriers and facilitators to exercise and physical activity existed for all three interventions and barriers remained at follow-up. The findings contextualise the clinical results of the trial and highlight on-going support and therapeutic alliance as targets for future trials of exercise in older adults with knee OA.
Acknowledgements Independent research funded by National Institute for Health Research (NIHR) through its Programme Grants for Applied Research Programme (RP-PG-0407-10386) and the Arthritis Research UK Centre in Primary Care grant (18139). NF supported by NIHR Research Professorship (NIHR-RP-011-015). CJ part supported by NIHR CLAHRC WM. MH part supported by NIHR School for Primary Care Research. Views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Disclosure of Interest None declared