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Table 4 Research implications for improving patient engagement

From: Identifying the factors affecting ‘patient engagement’ in exercise rehabilitation

COM-B Recommendations for clinical decision-making/clinical trial designs
Capability Include patient education—to inform the patient of the relevance of the exercise and how it will benefit them, also to ensure that they understand their condition and are not ‘in denial’
If the patient is required to complete sessions unsupervised, ensure that the patient has a clear guide of how to undertake their exercise sessions. This may include digital or hardcopy descriptions of their exercises, including factors such as duration, sets, repetitions and frequency of sessions. Where possible video clips that lead the patient through the session may be useful
Dispel fears of the risk of injury and/or adverse events when participating in the prescribed exercise
Identify the modes of exercise that the patient will undertake and if possible avoid those that they dislike
Opportunity Ensure that the exercise sessions are affordable and accessible
Ensure that the patient has time to undertake the exercise, including and travel time to locations
Prescribe a program for which compliance will not be diminished by other priorities such as work, family and other commitments
Where possible engage support structures and networks, such as friends and family
Motivation Foster a positive relationship between the patient, their exercise prescribing clinician, and other health professionals they are working with
Use motivational strategies, such as motivational interviews and goal setting
If setting goals, ensure that they are desired, realistic and attainable for that patient, to reduce the risk of demotivation
Work in partnership with the patient in the design of their program and goal setting to enhance their autonomous motivation, and program ownership
Review the program design and associated goals regularly, not only in the context of the exercises that they are functionally capable of, but also in the context of their evolving Capabilities, Opportunities, and Motivations