Factors affecting adherence to Alfredson’s eccentric training programme in patients with chronic mid-portion Achilles tendinopathy
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Objectives: To explore, from the participants perspective, what factors affected adherence to Alfredson's eccentric training programme when prescribed it for chronic mid-portion Achilles tendinopathy. Design: A qualitative design, with descriptive phenomenological approach, using semi-structured interviews. Setting: Participants were interviewed in a private room in their local community hospital. Participants: Five participants with a clinical diagnosis of chronic mid-portion Achilles tendinopathy who had been prescribed the full Alfredson eccentric exercise program. Results: Through thematic analysis 3 main themes of factors that affected adherence were developed: beliefs about the condition, belief in the rehabilitation program, and motivation and support. Specifically, negative beliefs about the condition and fear of rupture limited adherence but could be addressed by the physiotherapist if good communication was present. A lack of belief in the efficacy of the program also reduced adherence, mediated in part by a lack of rationale for the program. The severity of the impact of the condition also effected adherence, if normal activities were significantly limited then motivation and adherence were high. Lack of early improvement reduced adherence as this produced a negative outlook due to the duration of the program. Follow-up appointments provided support and motivation, while difficulty fitting the exercises into the daily routine was a major barrier. 3 Conclusions: Specific factors affected adherence to Alfredson's eccentric training programme in patients who had been prescribed it for chronic mid-portion Achilles tendinopathy. Some of these can be addressed when prescribing the program and may enhance adherence. Recommendations for prescribing this program in future include: proactively addressing the fear of rupture; highlighting the positive prognosis of the condition and efficacy of the program; explaining the rationale for the programme; offering follow-up appointments; and helping patients fit the program into their routine.
- Masters Degrees (Sport) 
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