title: Measurement tools for adherence to non-pharmacologic self-management treatment for chronic musculoskeletal conditions: a systematic review.
abstract: OBJECTIVE
  To identify measures of adherence to nonpharmacologic self-management treatments for chronic musculoskeletal (MSK) populations; and to report on the measurement properties of identified measures.
  
  
  METHODS
  Five databases were searched for all study types that included a chronic MSK population, unsupervised intervention, and measure of adherence.
  
  
  METHODS
  Two independent researchers reviewed all titles for inclusion using the following criteria: adult (>18y) participants with a chronic MSK condition; intervention, including an unsupervised self-management component; and measure of adherence to the unsupervised self-management component.
  
  
  METHODS
  Descriptive data regarding populations, unsupervised components, and measures of unsupervised adherence (items, response options) were collected from each study by 1 researcher and checked by a second for accuracy.
  
  
  RESULTS
  No named or referenced adherence measurement tools were found, but a total of 47 self-invented measures were identified. No measure was used in more than a single study. Methods could be grouped into the following: home diaries (n=31), multi-item questionnaires (n=11), and single-item questionnaires (n=7). All measures varied in type of information requested and scoring method. The lack of established tools precluded quality assessment of the measurement properties using COnsensus-based Standards for the selection of health Measurement INstruments methodology.
  
  
  CONCLUSIONS
  Despite the importance of adherence to self-management interventions, measurement appears to be conducted on an ad hoc basis. It is clear that there is no consistency among adherence measurement tools and that the construct is ill-defined. This study alerts the research community to the gap in measuring adherence to self-care in a rigorous and reproducible manner. Therefore, we need to address this gap by using credible methods (eg, COnsensus-based Standards for the selection of health Measurement INstruments guidelines) to develop and evaluate an appropriate measure of adherence for self-management.
authors.affiliation: School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland. Electronic address: amandahall@george.org.au.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Hall
authors.affiliation: Musculoskeletal Division, George Institute for Global Health, Sydney, NSW, Australia; EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kamper
authors.affiliation: School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.
authors.forename: Marian
authors.initials: M
authors.lastname: Hernon
authors.affiliation: School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland; Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
authors.forename: Katie
authors.initials: K
authors.lastname: Hughes
authors.affiliation: Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
authors.forename: Gráinne
authors.initials: G
authors.lastname: Kelly
authors.affiliation: Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Lonsdale
authors.affiliation: Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Hurley
authors.affiliation: EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Raymond
authors.initials: R
authors.lastname: Ostelo
mesh_terms: D002908:Chronic Disease; D006801:Humans; D009140:Musculoskeletal Diseases / Q000628:therapy*; D010349:Patient Compliance; D012648:Self Care
keywords: Musculoskeletal diseases; Patient compliance; Rehabilitation; Self care