The added value of therapist communication on the effect of physical therapy treatment in older adults : a meta-analysis

Description

An oral presentation at the World Conference of Physical Therapy in Geneve.

Background
Lower physical activity levels in older adults are associated with increased co-morbidities and disability.1 Physical therapists have a critical role in facilitating increases in physical activity. During physical therapy, consciously delivered communication may impact the effectiveness of treatment. Physical therapists do not have an overview of the strength of evidence of communication techniques during treatment.
Purpose
This study investigates the additional value of therapist’s communication during physical therapy on older adults’ physical activity levels.
Methods
Systematic review and meta-analysis. Clinical trials were identified in PubMed, CINAHL, Embase, PsycINFO, PEDro, Cochrane, up to July 2016. Older adults were at least 60 years old. The intervention group had to comprise exercise plus one or more consciously delivered communication technique. The control group had to comprise exercise corresponding the intervention group. Two reviewers independently assigned the communication techniques used into one of the 16 communication techniques described in the Behavior Change Taxonomy (BCT)2 by reading the aim of the study and extracting the BCT that was the primary focus of the intervention. Two reviewers independently performed quality assessments with the PEDro-scale. Studies were considered to have a low risk of bias when at least six out of ten PEDro-items were scored as being positive. Agreement between reviewers on the main BCT-category per study and the PEDro-scores of included studies were assessed using Krippendorff’s alpha (Kα). Effect sizes were pooled using Cochrane’s Review-Manager. Strength of the evidence was analysed using GRADE’s criteria.
Results
From 10,482 eligible studies, twelve studies were identified. The main BCTs used were Social support (n = 6), Goals and planning (n = 3), and Generalisation of the target behavior (n = 3) that is defined as communication with the goal to help the patient generalise an exercise from one situation to another (at home). Four studies had a high and eight studies a low risk of bias (range PEDro-scores: 3-8). Agreement between reviewers on BCT-categories and PEDro-items was good ( BCT Kα = 0.87; PEDro Kα = 0.82). Overall, communication techniques revealed an immediate effect (ES:0.19), rated as moderate strength of evidence, and long-term effect (ES:0.24), rated as high-quality evidence, on self-reported physical activity measures but not on performance-based measures. Divided in the main BCT-categories, Generalization of target behavior had a positive effect on self-reported behavior (ES:0.34), rated as low-quality strength of evidence. Social Support and Goals and planning revealed no effect.
Conclusion(s)
Adding a consciously delivered communication technique to physical therapy treatment is effective on self-reported but not on performance-based physical activity measures. Future studies might unravel specific effects of more BCTs in physical therapy.
Implications
In physical therapy, it is recommended to add communication to exercise when the treatment aims to increase older adults perceived physical activity level, not necessarily when the treatment goal is aimed to objectively performance of physical activity. Policy makers in various areas (e.g. government, healthcare systems, education) might pay attention to the small additional effects, increase awareness to physical therapists and facilitate funding to further investigate the optimization of effective communication skills.

Period	13 May 2019
Event type	Conference
Location	Geneva, Switzerland
Degree of Recognition	International