130 Chapter 6 to prescribed HBE showed a statistically significant difference between the intervention and control groups. To account for the possible effect of the intervention on adherence during physical therapist treatment, treatment group allocation was included as a baseline characteristic for data analyses. Outcomes All outcomes were measured at baseline only, except for adherence to HBE recommendations. Adherence to HBE recommendations was measured using the EXAS during patients’ visits at the clinic and recorded on a case report form by the physical therapist (16). During the first treatment session, the exercises and recommended frequency and intensity were recorded, and at the start of the following treatment session, the patient reported adherence to the recommendations. The physical therapist recorded patient-reported adherence using the EXAS and rated the quality of performance of the exercises on a 5-point scale (poor, moderate, reasonable, good, excellent). Adherence was then calculated as a percentage, and the resulting percentage was modified by the quality of performance rating. The EXAS score was then obtained by calculating the mean modified adherence percentage for all exercises, resulting in an EXAS score for every treatment session after the first session. The EXAS score ranges from 100 (perfect adherence) to 0 (no adherence). After the last treatment session, the therapist recorded the total number of treatment sessions. For the comparison between groups with distinct trajectories of adherence, patients completed questionnaires on patient characteristics, physical functioning, pain intensity, fear avoidance, pain catastrophizing, self-efficacy, self- management ability, and healthrelated quality of life at the start of the study. Physical functioning was measured using the Oswestry Disability Index (ODI), version 2.1a (26,27). The score on the ODI ranges from 0 to 100 with a higher score indicating increased functional disability. The ODI is part of the “Core Outcome Set” for research involving patients with nonspecific LBP (28). Pain intensity was measured with an 11-point Numeric Pain Rating Scale for the average pain intensity in the past 7 days or since the onset of the pain if pain duration was less than 7 days (27,29). Pain scores range from 0 to 10 (0 = no pain; 10 = worst pain imaginable). Fear avoidance beliefs were assessed using the Fear- Avoidance Beliefs Questionnaire (FABQ) (30). The FABQ score ranges from 0 to 96, and a higher score indicates stronger fear and avoidance beliefs regarding how physical activity affects LBP.
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