Aiding patient adherence to physiotherapist-prescribed self-management strategies: An evidence-based behavioural model.



Introduction: Physiotherapist-prescribed self-management strategies can play an important role in the overall treatment plan for many patients. However, patient non-adherence to self-management is recognised as a significant barrier to the integrity of a prescribed treatment plan. The translation of best evidence into clinical practice is integral to the continued development of physiotherapy. This study presents a six-step behavioural model (known as 'cycle of adherence nudging' uCAN) based on current evidence on how to best aid, or ‘nudge’ patient adherence to physiotherapist-prescribed self-management strategies. Methods: A literature search was undertaken to locate best practice evidence when prescribing self-management strategies to patients leading to the development of a behavioural model by a panel of experienced health professionals and health behaviour researchers. Results: Research findings indicate that patient adherence to physiotherapist-prescribed self-management strategy can be aided by considering six important steps during the prescribing process. These include: selecting the appropriate self-management strategy based on best-evidence and patient preference; identifying barriers and enablers to adherence; individualizing the strategy to the patient; providing tailored patient information; building patient skills and confidence; and confirming patient understanding. Conclusion: Patient adherence has been shown to be directly related to patient outcome; therefore, it is important that physiotherapists translate high-quality adherence aiding research into routine clinical practice. Key words: Behaviour Change; Health-related behaviours; Knowledge Translation Key messages 1. Frameworks or practice models are important resources to promote the uptake of evidence into physiotherapy practice. 2. Current research suggests that patient adherence to physiotherapist-prescribed strategies can be aided or nudged by considering six important steps during the prescribing process which include: selecting the appropriate strategy based on best-evidence and patient preference; identifying barriers and enablers to adherence; individualizing the strategy to the patient; providing tailored patient information; building patient skills and confidence; and confirming patient understanding. 3. It is important that physiotherapists translate high-quality adherence aiding research into routine clinical practice in order to improve patient outcomes.


Kerry Peek

Priority Research Centre for Health Behaviour, University of Newcastle, Australia

Kerry Peek graduated as a physiotherapist in 1997. Since then she has worked in both hospital and private practice settings in Australia and the UK. After completing a Masters in Clinical Science (evidence-based practice) in 2014, Kerry commenced her PhD on 'Patient adherence to physiotherapist-prescribed self-management strategies' at the University of Newcastle, NSW. Her thesis by publication is written and will be submitted in May 2017.