Rotator cuff related shoulder pain. Describing home exercise adherence and the use of behavior change interventions to promote home exercise adherence: a systematic review of randomized controlled trials

Background: A home exercise program (HEP) is integral in the management of rotator cuff related shoulder pain (RCRSP). There are many methods of measuring HEP adherence and many possible interventions to promote HEP adherence. Understanding the adherence rates to HEP and the strategies used to promote HEP adherence is important in order to interpret the existing evidence for the use of HEP in the management of RCRSP. Objectives: To report and synthesize home exercise adherence and strategies to promote home exercise adherence in order to understand the limitations of the current evidence base and make recommendations for clinical practice and future research investigating HEPs in the management of RCRSP. Methods: An electronic search of EMBASE, MEDLINE, PubMed, CINAHL, AMED, and CENTRAL was undertaken. Methodological quality was assessed using the Cochrane RoB 2.0, and BC techniques were coded in accordance with the BC technique taxonomy (version 1). Results: Seventeen RCTs were retrieved. Forty-seven percent described a formal method of measuring HEP adherence and 29% described adherence rates. The included studies described between three and seventeen BC techniques and the mean number of BC techniques per study was 5.8. Twelve percent of the studies described offering patients an explanation of how the exercise program might help their symptoms resolve. Conclusions: Poor reporting of adherence and the underutilisation of BC interventions to promote HEP adherence was prevalent. Recommendations for clinicians and researchers include more widespread use and definitive reporting of BC techniques to promote adherence, and the use of objective, patient self-reported, and clinician-assessed measures of adherence when prescribing HEPs.