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What Adherence Measures Should Be Used in Trials of Home-Based Rehabilitation Interventions? A Systematic Review of the Validity, Reliability, and Acceptability of Measures

Frost, R.; Levati, S.; McClurg, D.; Brady, M.; Williams, B.


R. Frost

S. Levati

D. McClurg

M. Brady

B. Williams


To systematically review methods for measuring adherence used in home-based rehabilitation trials and to evaluate their validity, reliability, and acceptability.
Data Sources
In phase 1 we searched the CENTRAL database, NHS Economic Evaluation Database, and Health Technology Assessment Database (January 2000 to April 2013) to identify adherence measures used in randomized controlled trials of allied health professional home-based rehabilitation interventions. In phase 2 we searched the databases of MEDLINE, Embase, CINAHL, Allied and Complementary Medicine Database, PsycINFO, CENTRAL, ProQuest Nursing and Allied Health, and Web of Science (inception to April 2015) for measurement property assessments for each measure.
Study Selection
Studies assessing the validity, reliability, or acceptability of adherence measures.
Data Extraction
Two reviewers independently extracted data on participant and measure characteristics, measurement properties evaluated, evaluation methods, and outcome statistics and assessed study quality using the COnsensus-based Standards for the selection of health Measurement INstruments checklist.
Data Synthesis
In phase 1 we included 8 adherence measures (56 trials). In phase 2, from the 222 measurement property assessments identified in 109 studies, 22 high-quality measurement property assessments were narratively synthesized. Low-quality studies were used as supporting data. StepWatch Activity Monitor validly and acceptably measured short-term step count adherence. The Problematic Experiences of Therapy Scale validly and reliably assessed adherence to vestibular rehabilitation exercises. Adherence diaries had moderately high validity and acceptability across limited populations. The Borg 6 to 20 scale, Bassett and Prapavessis scale, and Yamax CW series had insufficient validity. Low-quality evidence supported use of the Joint Protection Behaviour Assessment. Polar A1 series heart monitors were considered acceptable by 1 study.
Current rehabilitation adherence measures are limited. Some possess promising validity and acceptability for certain parameters of adherence, situations, and populations and should be used in these situations. Rigorous evaluation of adherence measures in a broader range of populations is needed.


Frost, R., Levati, S., McClurg, D., Brady, M., & Williams, B. (2017). What Adherence Measures Should Be Used in Trials of Home-Based Rehabilitation Interventions? A Systematic Review of the Validity, Reliability, and Acceptability of Measures. Archives of Physical Medicine and Rehabilitation, 98(6), 1241-1256.e45

Journal Article Type Article
Acceptance Date Oct 1, 2016
Online Publication Date Oct 1, 2016
Publication Date Jun 1, 2017
Deposit Date Oct 17, 2017
Journal Archives of Physical Medicine and Rehabilitation
Print ISSN 0003-9993
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 98
Issue 6
Pages 1241-1256.e45
Keywords Patient compliance, rehabilitation, reproducibility of results,
Public URL

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