The added value of therapist communication on the effect of physical therapy treatment in older adults; a systematic review and meta-analysis

Objective
Lower physical activity levels in older adults are associated with increased co-morbidities and disability. Physical therapists have a critical role in facilitating increases in physical activity. The communication they use may impact their effectiveness. 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. Communication was classified with the Behavior Change Taxonomy(BCT). Effect sizes were pooled using Cochrane’s Review-Manager. Strength of the evidence was analyzed using GRADE’s criteria.

Results
Twelve studies were identified. Overall, communication techniques revealed an immediate and long-term effect(ES:0.19;0.24) on self-reported physical activity measures but not on performance-based, with moderate to high strength of evidence. Divided in BCT-categories, only ‘Generalisation of target behavior’, defined as communication aimed to help patients generalise an exercise from one situation to another at home), had a positive effect on self-reported activity(ES:0.34), with low strength of evidence.

Conclusion
Adding a communication technique to physical therapy is effective on self-reported physical activity measures but not on performance-based measures.

Practice implications
Add communication to exercise when treatment aims at perceived, but not performed, physical activity.