4. Discussion
osteoarthritis
OSTEOARTHRITIS
The results of our study show that an individualized group-based exercise and behaviour-change program for adults with osteoarthritis has multifaceted benefits for participants. Our findings add to the body of literature on adults waiting for hip and knee surgery–a population which is often not included in research trials. Our results showed perceived improvements in components of physical health such as strength, and in psychological health, through social support. Structured and well-facilitated sessions were important for ENHANCE participants. Participants also developed a sense of mastery which may be helpful for sustaining new habits in their physical-activity behaviours.Research investigating changes in activity for people on wait lists for joint replacement is challenging, with several recent randomised controlled outcome-focused studies unable to recruit sufficient sample sizes to identify quantitative changes in activity after surgery [Goal setting and social-support elements of our behaviour-change counselling program described in these themes, are linked to physical-activity engagement The data in the current study adds to the previously published literature, where social support is identified as a strong motivator for change and increasing adherence to physical activity. [Attitude to exercise is important. Our data indicate that a change in awareness and increased self-efficacy to exercise was a driver for increasing engagement in physical activity. While evidence on the effectiveness of education alone on improving self-efficacy is inconclusive, [Our program ‘ENHANCE’ combined instructor-led exercises and behaviour-change-counselling techniques whilst coaching participants to use their own exercise booklet to progress from understanding the benefits of exercise, to planning on when, where and how to perform the exercises, through to preparing for setbacks and imagining the benefits of exercising post-surgery. Previous research indicates that support and motivation from healthcare workers are important factors in facilitating exercise participation in people with hip and knee OA [This study has several limitations. These findings are relevant to the context of health care in our country. Furthermore, while the qualitative nature of the study design allowed for in-depth investigation of the perspectives of the participants, the number of participants was small which may limit the transferability of the results.