Adherence to treatment: development and testing of the Fiala treatment adherence model with transcutaneous electrical nerve stimulation for acute postoperative pain after total knee replacement as an exemplar
Date of Degree
Access restricted until 01/31/2021
PhD (Doctor of Philosophy)
Rakel, Barbara A.
First Committee Member
Second Committee Member
Third Committee Member
Clark, M. Kathleen
Fourth Committee Member
Adherence is a complex concept, with multiple definitions, over 200 possible predictors, and inconsistent measurement. This has had a detrimental impact on producing interventions to promote treatment adherence. Promoting and maintaining treatment adherence can decrease the likelihood of poor health outcomes and decrease healthcare costs for patients. This study created a conceptual model that was utilized in a secondary analysis to determine if patient factors (Income, Depression, Perceived Threat of Illness Severity, Social Support, and Treatment Beliefs) in the model predict adherence to Transcutaneous Electrical Nerve Stimulation (TENS) when used for pain control post-Total Knee Replacement (TKR). The sample included 97 patients who were randomized to TENS treatment. A higher level of Perceived Threat of Illness Severity, measured with the Pain Catastrophizing Scale, was significantly related to a Moderate level of Adherence (60-79%) versus Non-Adherence (0-59%) (OR= .260, 95% CI= .073-.992, p= .037). The other patient factors of income, depression, social support and treatment beliefs did not significantly predict adherence. This finding is clinically important, as clinicians can assess how patients are interpreting or perceiving actual (or potential) threats of illness severity, then provide education and support to help patients adhere to treatment. The effect of Daily Pain [measured with an 11-point Numeric Rating Scale (0-10)] on Daily Adherence was also investigated in this study. Daily Pain and Daily Adherence did not show a significant association in this sample. This could be attributed to the fact that Daily Adherence was maintained consistently around 70% throughout the 2-week period.
Adherence, Non-pharmacological, Pain, Transcutaneous Electrical Nerve Stimulation
xiii, 163 pages
Includes bibliographical references (pages 112-152).
Copyright © 2018 Catherine Anne Fiala
Fiala, Catherine Anne. "Adherence to treatment: development and testing of the Fiala treatment adherence model with transcutaneous electrical nerve stimulation for acute postoperative pain after total knee replacement as an exemplar." PhD (Doctor of Philosophy) thesis, University of Iowa, 2018.
Available for download on Sunday, January 31, 2021