Mechanisms influencing adult adherence to physiotherapist-delivered rehabilitation for Achilles tendinopathy: a longitudinal qualitative study.

Abstract

Purpose: Achilles tendinopathy rehabilitation can be complex to deliver. Outcomes are variable, with low adherence a likely contributory factor. We aimed to identify the mechanisms influencing adult adherence behaviour to physiotherapist-delivered rehabilitation for Achilles tendinopathy.

Method: We applied interpretative descriptive design, utilising semi-structured interviews of 30 adults with Achilles tendinopathy who were interviewed at six-timepoints across 52-weeks. Data were analysed using Framework Analysis.

Results: We identified twelve mechanisms influencing adherence behaviour and grouped these into four themes: Tendinopathy paradigm consisted of "meaning-making of load and pain", "comprehension of new knowledge" and "operationalising knowledge." Self-management skills consisted of "internal self-management capability", "external life-rhythm management" and "managing physical capability." Therapeutic relationship consisted of "pre-scheduled regular check-ins", "personal and professional connection", and "coaching support." Focus on outcome consisted of "motivation to maintain functional ability with progressing age", "framing success" and, "it's a trial."Three delivery profiles were identified guiding clinicians in the application of the mechanisms to optimise adherence.

Conclusion: Identification of mechanisms influencing adult adherence behaviour to physiotherapist-delivered rehabilitation for Achilles tendinopathy and delivery profiles to support implementation may optimise adherence, with the potential to improve outcomes.