Elements of exercise prescription in Randomised controlled trials of musculoskeletal rehabilitation in a one-on-one setting. A scoping review

Abstract

Background: Randomised controlled trials (RCTs) are used by clinicians to inform evidence-based practice including when providing exercise programs. They should sufficiently report exercise interventions to permit accurate replication and incorporation into clinical practice.

Objectives: The aim of this scoping review was to describe the elements used within the exercise prescription process for musculoskeletal rehabilitation in a one-on-one setting reported in RCTs including their methods and prescription in intervention or control groups.

Methods: The databases CINHAL, COCHRANE, EMBASE, MEDLINE and PUBMED were searched using a predefined strategy. Articles were reviewed according to detailed inclusion/exclusion criteria which included whether they were RCTs prescribing exercises for musculoskeletal rehabilitation in a one-on-one setting published within the last 5 years. For studies retained following screening, data extracted included year of publication, musculoskeletal condition and interventions studied. A pre-determined checklist ascertained the elements of the exercise prescription process reported in each study. Data obtained were analysed descriptively and summarised.

Results: After screening, 153 studies were retained for data extraction. The two most reported items included 'specific dosages provided' (75%, n = 115), and 'observe the patient performing the exercises' (71%. n = 108). Over half of studies reported basing their exercise intervention on existing evidence-based protocols (61%, n = 93). Elements considering biomechanical principles were the most 'unclear'. Most of the checklist items received an 'unclear' score due to inadequate descriptions of interventions.

Conclusion: Many RCTs under report the development and prescription of exercise interventions, limiting replication of findings in clinical practice. A comprehensive framework is needed to ensure exercise prescription is adequately reported.

Keywords: Clinical trials as topic; Exercise therapy; Musculoskeletal disease; Physical therapy; Physical therapy modalities; Rehabilitation exercise.