Arensman R1,2, Koppenaal T1,3, Veenhof C1,4, Pisters M1,2,3
1University Medical Center Utrecht, Rehabilitation, Physiotherapy Science & Sport, Utrecht, Netherlands, 2Center for Physiotherapy Research and Innovation in Primary Care, Utrecht, Netherlands, 3Fontys University of Applied Sciences, Department of Health, Innovations & Technology, Eindhoven, Netherlands, 4HU University of Applied Sciences Utrecht, Research Group Innovation of Human Movement Care, Utrecht, Netherlands
Background: Low back pain is a major health problem with a global prevalence of over 500 million in 2015. Research has shown that exercise therapy is effective in reducing pain intensity and disability in patients with LBP, but often requires the patients to adhere to a home-based exercise program. As a result, the effectiveness of the interventions often depends on the patient´s adherence to the exercise recommendations from the physiotherapist. Therefore, an instrument to measure patient adherence to home-based exercise recommendations is needed to asses the impact of adherence on the effectiveness of interventions for patients with aspecific low back pain.
Purpose: To develop an instrument to measure adherence to recommended home-based exercises and to evaluate construct validity and test-retest reliability in individuals with aspecific low back pain.
Methods: Following a review of the literature a first draft of the instrument was created. Items were added by the researchers based on relevance and clinical experience. Face validity was checked by an expert panel and after the inclusion of the suggestions from the expert panel, the instrument was pilot tested in clinical practice. Following the results from the pilot test the final version of the instrument was produced. The developed instrument, the Utrecht Home-based Exercise Adherence Questionnaire (UHAQ) consists of two parts, in which frequency, intensity and quality of exercise adherence are measured.
The validity was investigated in 28 patiënts with aspecific LBP. Validity was determined by investigating convergent validity between exercise adherence, and perceived barriers and motivation. The association between exercise adherence, and pain and disability was determined to test divergent validity. Reliability was investigated for the quality score of the instrument in fifty healthy subjects and was determined by calculating the weighed Cohen's Kappa for test-retest reliability using 200 observations.
Results: Convergent validity correlations for “Time to exercise” and “Motivation” were rho = 0.47 (p = 0.013) and rho = 0.48 (p = 0.011) respectively.
For divergent validity, correlations of rho = 0.243 (p = 0.22) for “Pain” and r = 0.047 (p = 0.82) for “Disability” were found.
Test-retest reliability was Kqw = 0.87 (95% CI 0.825-0.921).
Conclusion(s): A new instrument to measure adherence to home-based exercise recommendations was developed, showing moderate validity in patients with aspecific low back pain. Test-retest reliability is high making the UHAQ suitable for use in research and daily practice.
Implications: The UHAQ provides clinicians and researchers with a new way to gain insight into patient adherence to home-based exercise recommendations. This enables tailoring of home-based exercise recommendations to the needs of the patient, increasing treatment effectiveness.
Keywords: exercise adherence, low back pain
Funding acknowledgements: The study was completed without external funding.
Purpose: To develop an instrument to measure adherence to recommended home-based exercises and to evaluate construct validity and test-retest reliability in individuals with aspecific low back pain.
Methods: Following a review of the literature a first draft of the instrument was created. Items were added by the researchers based on relevance and clinical experience. Face validity was checked by an expert panel and after the inclusion of the suggestions from the expert panel, the instrument was pilot tested in clinical practice. Following the results from the pilot test the final version of the instrument was produced. The developed instrument, the Utrecht Home-based Exercise Adherence Questionnaire (UHAQ) consists of two parts, in which frequency, intensity and quality of exercise adherence are measured.
The validity was investigated in 28 patiënts with aspecific LBP. Validity was determined by investigating convergent validity between exercise adherence, and perceived barriers and motivation. The association between exercise adherence, and pain and disability was determined to test divergent validity. Reliability was investigated for the quality score of the instrument in fifty healthy subjects and was determined by calculating the weighed Cohen's Kappa for test-retest reliability using 200 observations.
Results: Convergent validity correlations for “Time to exercise” and “Motivation” were rho = 0.47 (p = 0.013) and rho = 0.48 (p = 0.011) respectively.
For divergent validity, correlations of rho = 0.243 (p = 0.22) for “Pain” and r = 0.047 (p = 0.82) for “Disability” were found.
Test-retest reliability was Kqw = 0.87 (95% CI 0.825-0.921).
Conclusion(s): A new instrument to measure adherence to home-based exercise recommendations was developed, showing moderate validity in patients with aspecific low back pain. Test-retest reliability is high making the UHAQ suitable for use in research and daily practice.
Implications: The UHAQ provides clinicians and researchers with a new way to gain insight into patient adherence to home-based exercise recommendations. This enables tailoring of home-based exercise recommendations to the needs of the patient, increasing treatment effectiveness.
Keywords: exercise adherence, low back pain
Funding acknowledgements: The study was completed without external funding.
Topic: Outcome measurement; Musculoskeletal: spine
Ethics approval required: No
Institution: University Medical Centre Utrecht
Ethics committee: The Medical Ethics Committee of the University Medical Centre Utrecht
Reason not required: The Medical Ethics Committee of the University Medical Centre Utrecht ruled that the study did not fall under the Dutch Medical Research (Human Subjects) Act and therefore required no ethical approval.
All authors, affiliations and abstracts have been published as submitted.
