Prognostic factors of (non-) adherence to home-based exercise therapy in patients with chronic diseases: a systematic review and meta-analysis

Abstract

Abstract Introduction: Patients with a chronic disease may have an increased risk of non-adherence to prescribed home-based exercise therapy. We performed a systematic review with the aim to identify and grade the quality of variables associated with (non-)adherence to home-based exercise therapy in patients with chronic diseases. Methods: Cohort studies, cross-sectional studies and the experimental arm of randomized trials were identified using a search strategy applied to PubMed, Embase, PsychINFO and CINAHL from inception until August 1th 2022. We included studies with participants ³ 18 years with a chronic disease as an indication for home-based exercise therapy and providing data (quantitative and qualitative) on prognostic factors of (non)adherence to home-based exercise. Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool for observational studies, the Quality Assessment Tool for Observational Cohort and Cross- sectional studies of the National Institutes of Health (NIH) for cross-sectional studies and the Critical Appraisal Skills Program (CASP) qualitative checklist for the qualitative studies. Prognostic factors of adherence were identified and graded for quality using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework for predictor studies. We performed a meta-analysis and best evidence synthesis of the obtained information. Results: A total of 68 studies (11 qualitative and 57 quantitative) were included. Within patient-related factors moderate- and high-quality evidence suggested that more self-efficacy, exercise history, motivation and perceived behavioral control predicted higher adherence. Within social-economic factors moderate-quality evidence suggested more education and physical health to be predictive of higher adherence and within condition-related factors moderate- and low-quality evidence suggested that less comorbidities, depression and fatigue predicted higher adherence. For the domains therapy-related and health-system factors there was not enough information to determine the quality evidence of the prognostic factors. Conclusion: These findings might aid the development of future home-based exercise programs as well as the identification of individuals who may require extra support to benefit from prescribed home-based exercise therapy. Registration: The protocol of this systematic review is registered in PROSPERO with registration number CRD42021277003.