Mechanisms influencing adult adherence to physiotherapist-delivered rehabilitation for Achilles tendinopathy: a longitudinal qualitative study

Achilles tendinopathy rehabilitation can be complex to deliver. Outcomes are variable, with low adherence a likely contributory factor. We aimed to identify the mechanisms influencing adult adherence behaviour to physiotherapist-delivered rehabilitation for Achilles tendinopathy. We applied interpretative descriptive design, utilising semi-structured interviews of 30 adults with Achilles tendinopathy who were interviewed at six-timepoints across 52-weeks. Data were analysed using Framework Analysis. We identified twelve mechanisms influencing adherence behaviour and grouped these into four themes: <i>Tendinopathy paradigm</i> consisted of “meaning-making of load and pain”, “comprehension of new knowledge” and “operationalising knowledge.” <i>Self-management skills</i> consisted of “internal self-management capability”, “external life-rhythm management” and “managing physical capability.” <i>Therapeutic relationship</i> consisted of “pre-scheduled regular check-ins”, “personal and professional connection”, and “coaching support.” <i>Focus on outcome</i> consisted of “motivation to maintain functional ability with progressing age”, “framing success” and, “it’s a trial.” Three delivery profiles were identified guiding clinicians in the application of the mechanisms to optimise adherence. Identification of mechanisms influencing adult adherence behaviour to physiotherapist-delivered rehabilitation for Achilles tendinopathy and delivery profiles to support implementation may optimise adherence, with the potential to improve outcomes.