TRAJECTORIES OF ADHERENCE TO HOME-BASED EXERCISE RECOMMENDATIONS AMONG PEOPLE WITH LOW BACK PAIN

R. Arensman^1,2, M. Heymans³, C. Kloek^1,4, R. Ostelo^5,6, C. Veenhof^1,2,4, T. Koppenaal^1,2,7, M. Pisters^1,2,7

¹Julius Health Care Centers, Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, Netherlands, ²University Medical Center Utrecht, Utrecht University, Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center, Utrecht, Netherlands, ³Amsterdam Public Health Research Institute, Department of Data Science and Bio-statistics, Amsterdam, Netherlands, ⁴HU University of Applied Sciences, Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, Utrecht, Netherlands, ⁵VU University Amsterdam, Amsterdam Movement Sciences research institute Amsterdam, Department of Health Sciences, Faculty of Science, Amsterdam, Netherlands, ⁶Amsterdam University Medical Centre, Location VUmc, Department of Epidemiology and Data Science, Amsterdam, Netherlands, ⁷Fontys University of Applied Sciences, Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Eindhoven, Netherlands

Background: The impact of low back pain (LBP) on society and healthcare, and its related cost are well established. Exercise in the clinic or at home has become part of the core recommendations for the treatment of LBP in many clinical guidelines, but the effectiveness of exercise depends largely on patient adherence, which is generally low. Adherence is a complex and multifactorial construct, making it difficult to measure. However, with the development of the Exercise Adherence Scale (EXAS), measurement of adherence during the treatment process is now possible and provides more detailed information on the patient’s self-reported adherence. Although adherence varies between patients, it is likely that trajectories of adherence with different clinical implications are present in patients with low back pain.

Purpose: The purpose of this study was to investigate the presence and proportion of groups of patients with distinct trajectories of adherence to home-based exercise recommendations among people with low back pain and to identify differences in baseline characteristics between groups.

Methods: This study was imbedded in a prospective, multicentre cluster randomised controlled trial investigating the cost-effectiveness of a stratified blended physiotherapy intervention in patients with LBP. Patients were recruited from primary care physiotherapy practices. Baseline characteristics consisted of patient characteristics, physical functioning, pain intensity, physical activity, fear avoidance, pain catastrophizing, self-efficacy, self-management ability, and health related quality of life. Adherence was measured using the EXAS during each treatment session by the physiotherapist. The EXAS measures adherence to frequency, intensity, and quality of performance by the patient.

Results: Data from 173 patients was available for analysis and was collected during 5.1 (SD 2.5) treatment sessions and total treatment duration was 51 (SD 41.7) days. Three distinct trajectory classes were identified. Approximately 12% of participants belonged to the “declining adherence” class, 45% to the “stable adherence” class, and 43% to the “increasing adherence” class. No differences were found between the three patient groups based on baseline characteristics.

Conclusions: Three different trajectories of adherence to exercise recommendations were identified in patients with LBP. No differences in baseline characteristics were found between the three trajectory groups. Future research should incorporate the patient-therapist interaction, the patient’s social environment, and patient characteristics when studying patient adherence to better understand how patient adherence can be supported during physiotherapy treatment.

Implications: Physiotherapists should be aware that different trajectories of adherence to home-based exercise recommendations exist in patients with LBP. To optimize treatment effectiveness, adherence should be closely monitored during treatment and supported when required as part of an ongoing process.

Funding acknowledgements: This study was co-funded by the Taskforce for Applied Research SIA (RAAK.PRO02.063), part of the Dutch Research Council (NWO).

Keywords:
Low back pain
Adherence
Home-based exercise

Topics:
Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: University Medical Center Utrecht

Committee: Medical Research Ethics Committee

Ethics number: ISRCTN 94074203