Development of an optimized framework for delivery of and adherence to exercise-based care for persons with subacromial pain syndrome

Background
Subacromial pain syndrome (SAPS) is a common musculoskeletal condition compromising physical function. Exercise-based care is first-line treatment, but adherence is compromised. This calls for action to optimize the context for clinical pathways to enhance adherence.

Purpose
To prioritize and define necessary changes (targets, behaviors, and actions) in the contextual framework and systematically evaluate proposed solutions.

Materials and methods
An ethnographic field study employing participatory design to propose actions to facilitate adherence to recommendations. Data were collected in co-design workshops and participant observations. Twelve physiotherapists and medical doctors were recruited as an expert panel to define targets and behaviors and propose actions in workshop 1, and to critically evaluate proposed actions in workshop 2 using the APEASE evaluation criteria and behavior change theories.

Results
Targets to enhance adherence to recommendations were: (1) Improved patient motivation for exercise-based treatment, (2) Changing patient beliefs about treatment effects, (3) Changing patient expectations about treatment pathways, and (4) Decreasing complications in cross-sectoral communication. Eight behaviors and corresponding actions to change behaviors were positively evaluated.

Conclusion
We identified actions to promote specific behaviors and achieve prioritized targets. The proposed contextual changes may enhance adherence with recommendations and promote optimization of care for people with SAPS.