128 Chapter 6 performance recommendations for HBE (16). The EXAS allows for the measurement of adherence during the treatment process, providing more detailed information on the patient’s self- reported adherence. With the large number of both patient- and therapist-related factors influencing patient adherence, it is likely that adherence varies significantly between individuals and over time. Furthermore, the trajectory of adherence over time during the treatment period is likely to vary among patients with LBP. Although, to date, no studies have examined the presence of common trajectories of adherence to HBE recommendations in patients with LBP, evidence for distinct trajectories of adherence has been found in patients with osteoarthritis of the knee and/or hip, and in older adults with cognitive impairment rehabilitating at home after hip fractures (17,18). Although both the nature of rehabilitation and the health of the patients are not comparable to those of patients with LBP, these studies showed that trajectories of adherence are present in different groups of patients. Each distinct trajectory has different clinical implications, and early identification of group membership of a patient can assist clinicians to determine which patients benefit from interventions designed to boost adherence and at what timepoint during treatment. Furthermore, identification of factors associated with the trajectory of adherence of patients with LBP can assist in the development of interventions to boost patient adherence. Therefore, investigating the unique trajectories of adherence to HBE recommendations from a physical therapist in patients with LBP has the potential to increase the effectiveness of interventions for this patient group. Therefore, the aim of this study was to investigate the presence and proportion of groups of patients with distinct trajectories of adherence to HBE recommendations among people with LBP and to identify differences in baseline characteristics between groups. METHODS Study design This study was a secondary analysis of a prospective, multicenter cluster randomized controlled trial investigating the cost-effectiveness of a stratified blended physical therapist intervention compared to usual care in patients with LBP. The detailed study protocol of the parent trial has been published previously (19). The Guidelines for Reporting on Latent Trajectory Studies checklist was used to aid in the reporting of this study (20). One hundred and twenty-two physical therapists (median 12; interquartile range 19.5 years of experience) from 58 primary care physical therapist practices in the Netherlands
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