![]() ![]() The current study has two aims (i.e., objectives). Other evidence suggests that recommending self-directed-exercises may be common practice among some general practitioners, as some already undertake specific training in musculoskeletal medicine. Cottrell et al.’s review of general practitioners’ attitudes, beliefs, and behaviors regarding exercise for chronic knee pain concluded that self-directed-exercises are under-recommended. While the above information demonstrates patient demand and organizational support for self-directed-exercises, it is unknown whether general practitioners routinely recommend self-directed-exercises to patients affected by musculoskeletal problems. The Cochrane reviews on exercise in knee and hip osteoarthritis and meta-analyses of exercises for tendinopathy and back pain find no significantly harmful outcomes. Fear that self-directed-exercises are harmful is largely unwarranted. ![]() In addition, self-directed-exercises fit well in the NHS Five-Year Forward View “to support people to manage their own health”. NICE states that self-directed-exercises can reduce patients’ pain and disability in a cost-effective manner. The NICE guidelines also recommend a “structured exercise program” for the early treatment of non-specific lower back pain. This advice is echoed by the European League Against Rheumatism. For example, the National Institute for Health and Care Excellence (NICE) guidelines identify “strengthening exercise and aerobic fitness training” as central to the treatment of osteoarthritis. This finding emphasizes that many patients are already motivated to take up self-directed-exercises.Ĭlinical guidelines advocate that general practitioners recommend self-directed-exercises to patients suffering from musculoskeletal problems, but such guidelines are often not clear as to when recommendations should be issued and what they should contain. Surprisingly, O’Reily et al.’s study found that 24 patients were preforming self-directed-exercises before they were contacted by the research team. Among the four studies was O’Reilly et al.’s that sought to help new patients take up self-directed-exercises. A 2015 Cochrane review suggests that the beneficial effects of exercises extend to knee osteoarthritis, and four studies in this review looked specifically at self-directed-exercises. ![]() For example a YouTube video demonstrating the “Taylor Twist” exercise for tennis elbow (twisting the wrists as a bar is shifted from a horizontal to vertical position) has over 400,000 views as of June 2018. There is notable demand for these online resources. A number of other exercises for tennis elbow exist along with online resources to help patients use them. For example, eccentric exercises (lengthening muscles under strain) benefit patients affected by tennis elbow more than conservative management after 6 weeks and more than corticosteroid injections after 52 weeks. Self-directed-exercises can improve the wellbeing of patients affected by musculoskeletal problems and many patients are happy to use them. The present study aims first to establish whether general practitioners already recommend self-directed-exercises and second to describe the barriers and facilitators general practitioners experience to making such recommendations. ![]() Some of this demand and cost could be alleviated if general practitioners recommended that patients use self-directed-exercises. Regarding finances, the NHS spends approximately £5.4 billion on musculoskeletal problems annually, making them the fourth largest disease group in terms of spending. Regarding demand, musculoskeletal problems bring approximately 100,000 people to general practices every day, accounting for about one-third of consultations. Musculoskeletal problems substantially impact the demand for and the finances of the United Kingdom’s National Health Service (NHS). Musculoskeletal conditions are characterized by damage or disorder to joints or other tissues causing pain or discomfort. ![]()
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