Behavioral treatment of adherence to therapeutic exercise by children with hemophilia.
Behavioral treatment of adherence to therapeutic exercise by ten children (aged 8 to 15) with hemophilia was investigated during a one-year period. During a one-week baseline phase, adherence to exercise performance was 55%. A 12-session behavioral physical therapy program was then implemented emphasizing individualized instruction in progressive strengthening exercises with weights. Endurance activities such as stationary bicycling and swimming, as well as noncontact sports (which provide optimal musculoskeletal conditioning without potentiating a joint or muscle bleed), were also included. Within a contingency contract format, designated points were given for adherence and exchanged for reinforcers. Adherence parameters included the percentage of prescribed therapeutic exercises performed, the percentages of exercise record forms returned, and the percentage of sessions attended. During the treatment phase, therapeutic adherence averaged 94% across the three parameters. Adherence declined during the follow-up phases from 84% to 66% across these parameters, as explicit reinforcement decreased.
Greenan-Fowler
E
E
Orthopaedic Hospital, University of Southern California, Los Angeles 90007.
Powell
C
C
Varni
J W
JW
D000293:Adolescent; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D005069:Evaluation Studies as Topic; D005081:Exercise Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000628:therapy*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D013997:Time Factors