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Patient and Healthcare Team Adherence in Orthopaedics: A Systematic Review to Initiate Optimized Definitions, Metrics, and Implementation Strategies

Kylee Rucinski

Patient adherence in orthopaedics is critical to successful outcomes, but is limited by lack of standardized definitions and terminology, validated measurement tools, and consideration of physician and healthcare team roles and impact. This review was done to comprehensively evaluate and synthesize the peer-reviewed literature surrounding adherence in orthopaedics to ascertain the related terminology, identify common methods for measuring adherence, delineate risk factors for non-adherence, and determine optimal strategies for improving adherence. A systematic literature search was performed of the PubMed and Ovid/Medline databases. Eligible studies included discussion of adherence/compliance in relation to orthopaedic patient and healthcare team populations. One hundred and thirty-one studies meeting criteria were identified. Analysis revealed a lack of standardization in terminology, lack of validated measures, and has fostered widely disparate results regarding the importance of adherence. Physician and healthcare team adherence is a multi-faceted and critical component for assessing and optimizing patient adherence, yet it is often ignored in orthopaedics. Tactics to prevent and/or address non-adherence in orthopaedics have focused on educating patients, measuring and addressing mental health barriers, utilizing wearables, and creating optimized programs to address risk factors. The results of this systematic review make it clear that adherence is a complex, multi-faceted issue in orthopaedics that has not yet been effectively defined, assessed, and implemented. By working towards consensus for standardized definitions and criteria for determining patient and provider adherence, utilizing mixed methods approaches to develop and validate tools to measure adherence, and implementing best practice protocols that foster individualized plans for achieving adherence, the orthopaedic community can expect to improve outcomes across sub-specialties. To realize this goal, integrated healthcare teams must be committed to establishing a culture of patient and healthcare team adherence, and implement comprehensive strategies focused on assisting patients in reaching their best possible outcome.