10 Chapter 1 INTRODUCTION Physiotherapy is pivotal in managing musculoskeletal (MSK) conditions (1). Central to the management of MSK conditions is the biopsychosocial model, which highlights the complex relations between biological, psychological, and social factors in shaping the health and well-being of individuals with MSK pain (2). To translate the biopsychosocial model to clinical practice, clinical guidelines provide best practice recommendations for the assessment and treatment of MSK conditions, emphasizing the importance of patient education, self-management support, and interventions focused on physical activity and exercise (3). This evidence-based approach promotes active lifestyles and physical activity, offering short and long-term pain relief. It integrates components like manual therapy, patient education, and exercise therapy, typically provided by physiotherapists (3,4). Exercise therapy in MSK conditions Exercise therapy is “the systematic performance or execution of planned physical movements or activities intended to enable the patient or client to remediate or prevent impairments of body functions and structures, enhance activities and participation, reduce risk, optimize overall health, and enhance fitness and well-being“ (5). Exercise therapy is effective in managing musculoskeletal pain, demonstrating medium to large pain reduction effects and functional improvements compared to no exercise or other control (6). However, the effects vary between different MSK conditions, and optimal content and mode of delivery of exercise therapy remains inconclusive (7). Exercise therapy can be recommended as either supervised exercise by a physiotherapist, home-based exercise (HBE), or a combination of both. In supervised exercise, patients perform exercises at the physiotherapist’s clinic, where the therapist provides instruction, guidance, and coaching. To maintain endurance performance, healthy adults should have at least two exercise sessions per week, while maintaining strength requires one session, or two for older individuals (8). For enhanced endurance and strength, an additional exercise session is necessary to achieve the minimum effective dose (9,10). However, supervised exercises three or more times a week can be costly and time-consuming. To address these challenges, HBE supplements in-clinic sessions, allowing patients to continue exercising at home (11). This not only increases treatment dose, but also reduces the financial burden on the healthcare system by decreasing the need for supervised sessions over the course of treatment and it affords patients the flexibility to exercise according to their own schedules. Given these advantages, it is no surprise that many studies investigated the effectiveness of HBE interventions on reducing pain and disability in musculoskeletal conditions (12–17).
RkJQdWJsaXNoZXIy MTk4NDMw