For other patients, actively involving partners in the rehabilitation process to encourage and motivate the patient may help (Fekete et al., 2006). Envisaging a greater number of barriers to participating

in exercise predicted non-adherence with treatment (Sluijs et al., 1993 and Alexandre et al., 2002). Barriers included transportation problems, child care needs, work schedules, lack of time, family dependents, financial constraints, convenience and forgetting. Physiotherapists need to be aware of difficulties that patients foresee in relation to adhering with a proposed treatment plan and act collaboratively Baf-A1 with their patients to design treatment plans which are customised to the patient’s life circumstances (Turk and Rudy, 1991). The addition of coping plans may help patients to overcome difficulties that may arise and allow them

to maintain the treatment programme (Gohner and Schlicht, 2006 and Ziegelmann et al., 2006). There was limited evidence for many barriers and a lack of research into other potential predictors, e.g. socioeconomic status and the barriers introduced by health selleck products professionals or health organisations. Adherence has been identified as a priority in physiotherapy research (Taylor et al., 2004) therefore further high quality research is required in order to investigate the predictive validity of these barriers within musculoskeletal settings. Poor attendance at clinic appointments is an objective measure with quantifiable cost implications to the health service. The extent to which patients actually carry out a programme of exercises recommended by a physiotherapist is an important research question which is methodologically

more difficult to answer. These two different aspects of adherence may be related to different barriers and may require different IMP dehydrogenase strategies to overcome them, therefore these different aspects of adherence may be better addressed individually. This review identified 20 studies investigating barriers which predicted non-adherence with musculoskeletal treatment. Strong evidence was found that low levels of physical activity at baseline or in previous weeks, low in-treatment adherence with exercise, low self-efficacy, depression, anxiety, helplessness, poor social support or activity, greater perceived number of barriers to exercise and increased pain levels during exercise are all barriers to treatment adherence. Identification of these barriers during patient assessments may be important in order to adopt appropriate management strategies which help to counteract their effects and improve treatment outcome.