Barrieren und Förderfaktoren der eigenständigen Durchführung von Übungen

Zusammenfassung

Hintergrund: Chronische Kreuzschmerzen (Chronic low back Pain, CLBP) ist ein häufig vorkommendes und kostenintensives Krankheitsbild. Die Betroffenen sind oft stark in ihrer körperlichen Aktivität eingeschränkt. Leitlinien empfehlen, den Schwerpunkt der Physiotherapie auf aktive Maßnahmen zu legen. Die Adhärenz zur eigenständigen Übungstherapie beeinflusst den Therapieerfolg jedoch maßgeblich. In der Literatur finden sich Adhärenz-Raten von 30 – 72 %.

Ziel: Das Ziel der vorliegenden Arbeit war das Identifizieren von Barrieren und Förderfaktoren hinsichtlich der Durchführung von Eigenübungen bei Patienten mit CLBP nach einer interdisziplinären Schmerztherapie.

Methode: 10 Patienten mit CLBP nach einer interdisziplinären, biopsychosozialen Schmerztherapie wurden zur Umsetzung ihrer Übungen befragt. Die Auswertung der Interviews erfolgte mit der inhaltlich strukturierenden qualitativen Inhaltsanalyse.

Ergebnisse: Aus Sicht der Patienten waren die höchsten Barrieren geringe Motivation (Abgeschlagenheit nach der Arbeit, mangelnder sozialer Support, Schmerzen beim Üben), Zeitmangel durch Arbeit und Freizeitaktivitäten, Unsicherheit bei der Übungsdurchführung sowie Druck durch den Trainingsplan. Die stärksten Förderfaktoren umfassten Steigerung der Motivation (durch ambulante Physiotherapie, sozialen Support, individuelle Ziele und positive Effekte durch Übungen bzw. Verschlechterung der Situation ohne Übungen), die Edukation und die Übungszettel. Die Art der Übung konnte sowohl eine Barriere als auch einen Förderfaktor darstellen. Die Barrieren und Förderfaktoren der Übungsdurchführung decken sich weitestgehend mit den Ergebnissen der internationalen Literatur. Für eine theoretische Sättigung hätte die Probandenanzahl erhöht werden müssen.

Schlussfolgerung: Die Patientenperspektive verdeutlicht die Komplexität des Phänomens Adhärenz. Physiotherapeuten können die Informationen nutzen, um Barrieren der Patienten gegenüber Übungen zu identifizieren, Förderfaktoren gezielt einzusetzen und durch ihre Arbeitsweise die Adhärenz zu verbessern. Dabei sollte insbesondere die Patientenedukation eine zentrale Rolle einnehmen.

Abstract

Background: Chronic Low Back Pain (CLBP) is a common and cost-intensive clinical pattern. The physical activity of the affected patients is often severely restricted. Guidelines recommend the physiotherapeutic focus on active interventions. However, non-adherence to self-managed home exercise has a negative influence on therapy success. Literature reports adherence rates of 30 – 72 %.

Objective: The aim of this study was to identify both the barriers and supporting factors concerning the performance of self-managed exercise in patients with CLBP following interdisciplinary pain therapy.

Method: Ten patients with CLBP after interdisciplinary biopsychosocial pain therapy were interviewed regarding their exercise implementation. The interviews were evaluated using a qualitatively structured content analysis.

Results: From the patients’ perspective the main barriers were poor motivation (fatigue after work, lack of social support, pain during exercise), lack of time due to work and leisure activities, uncertainty during exercise and stress due to the training schedule. Main supporting factors included growing motivation (by physical therapy, social support, individual goals, positive effects of exercises or deterioration without exercises), education and exercise sheets. The exercise type could serve both as barrier and supporting factor. Barriers and supporting factors widely correspond with the results of international literature. A higher sample size is required to achieve theoretical saturation. Therapy recommendations related to specific barriers were given.

Conclusions: The patient’s view illustrates the complexity of the adherence phenomenon. Physiotherapists can use this information to identify patient’s barriers to exercise, to implement facilitators and to improve adherence by their working method. Particularly patient education should be included in practice.

Schlüsselwörter

chronische Kreuzschmerzen - Übungen - Barrieren - Förderfaktoren

Key words

chronic low back pain - exercise - barriers - facilitators

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