The primary result of this study yielded a non-compliance to physiotherapy questionnaire adjusted to an inpatient setting. A literature review yielded the synthesis of appropriate items for the survey, an evaluation by subject matter and questionnaire experts resulted in the refinement of the individual elements and a pretesting method ensured the quality assessment of the survey. When adding the results of this study to the noncompliance questionnaire provided by “correlates of exercise compliance in physical therapy” () a comprehensive evaluation of the patient´s motivation to not adhere to physical therapy in a hospital setting can be evaluated.
The literature search yielded thirteen questions dealing with a variety of aspects of physiotherapy. The physician specific aspects were discussed in one paper (22) while other studies focused on the environmental aspects affecting the patient´s compliance (23) (24). Intrinsic patient related factors are discussed in “the correlates of exercise compliance to physiotherapy”. Deeper psychological aspects affecting patient compliance are out of the scope of this questionnaire and the resulting RCT will exclude patients with psychological disorders that might affect compliance. This aspect, however, is not very well researched and should be considered as a topic for future RCTs dealing with early postoperative rehabilitation. Suggested elements for this type of research can be taken over from studies dealing with non-compliance to pharmaceutical therapy (27)
The results of the expert review lead to the revision and the adjustment of individual elements. Items were adjusted to imply the patient´s specific situation. QAS items 4 (Vague/Unclear), 7 (undefined/vague term), 15 (Undefined Period), 20 (Complex estimation), 22 (Undefined Term) and 23 (Vague Term) were used to evaluate survey questions and responses. This lead to the adjustments presented in the results of stage 2. Since the patient´s comprehension of the question is key in the evaluation process (28), terms like “postoperative” and “prosthesis” were simplified to “after surgery” and “artificial joint”, respectively. The implementation of precise elements was also tackled leading to the modification of the terms “early postoperative” and “PT exercises” to the first days after your operation” and to “your prescribed PT exercises”, respectively. German grammatical errors were corrected by the questionnaire expert.
Pretesting on a patient population revealed no comprehension related issues. Patients primarily used the “Suggestions and Comments” part of the questionnaire to express their views on compliance. The empathy physicians expressed towards the patient´s situation, the motivation physicians provide to patients in taking ownership with regard to rehabilitative measure, the presentation of a realistic image concerning the early postoperative period and the communication of a specific rehabilitative plan all play a substantiative role that affect patient´s adherence to their exercises. Familial support seemed to play the biggest role with regards to compliance with rehabilitative measures. The result of this analysis, however, are not representative for a wide patient population with varying disorders since the evaluation only took place in the confined space of the wards of the orthopaedics and traumatology department and mostly included in-hospital patients treated with reconstruction of the joints.
Finally, the importance of having an active lifestyle and the compliance to physical therapy cannot be understated. New measures to increase the adherence of patients to physiotherapy, specifically, and to an active lifestyle, more generally, have to be found. At the center of Orthopaedics and Trauma Surgery of the University Clinic of Brandenburg, new methods, such as the utilization of a mobile physiotherapeutic reminder application and the use of knee motion sensors are currently under investigation.
Limitations of this study include the pretesting done on patients in German. The use of this questionnaire in English speaking countries would require the re-evaluation of step 3 using a patient population.