149 Exploring the association between exercise adherence and recovery of low back pain INTRODUCTION Exercise therapy is often a primary choice physical therapy treatment for patients with persistent nonspecific low back pain (LBP) (1). It has also been shown to reduce pain and disability in patients with acute LBP (1). Incorporating home-based exercise (HBE) into treatment plans can help alleviate the burden of LBP on the public health system. HBE, often recommended as a combination of strength and other exercises such as relaxation or postural exercises, has been shown to be effective in mitigating pain and disability in patients with LBP (2). However, adherence to exercise recommendations is frequently low, with nonadherence rates reaching up to 70% in patients with LBP, which may substantially reduce the effectiveness of these interventions (3–5). Studying patient adherence is a complex and challenging task because it is influenced by numerous external factors, such as financial constraints and healthcare accessibility, as well as patient-related factors, such as motivation and self-efficacy (6,7). Although external factors are beyond physiotherapist control, patient- and treatment-related factors can be effectively targeted through specific interventions (7). Several factors have been linked to adherence, including physiotherapist guidance, the quantity of prescribed exercises, self-motivation, self-efficacy, past adherence behavior, initial physical or aerobic activity levels, focus during exercise, increased pain during exercise, and significant levels of helplessness, depression, or anxiety (7,8). Additionally, adherence is not a static concept; it can vary over time. Distinct adherence trajectories have been observed in patients with LBP and osteoarthritis, indicating that adherence changes over time and that there are patient subgroups with similar patterns of adherence change (9,10). While there is evidence available identifying factors linked to adherence to HBE in patients with LBP (6,11–13) and interventions aimed at enhancing adherence have been studied (14), the majority of adherence measurement tools either lack comprehensive psychometric testing or are too simplistic (15,16). Only in recent years have researchers developed and more rigorously tested novel measurement instruments, facilitating more detailed and long-term tracking of adherence to HBE recommendations in studies (17,18). In clinical practice, clinicians face the challenge of discerning whether to adjust their HBE recommendations due to ineffectiveness or whether they should provide additional support to their patients to enhance adherence when treatment effects fall short of expectations. Despite identifying different groups of patients with LBP and their distinct adherence trajectories over time as a potential solution, the fundamental assumption that adherence to HBE recommendations correlates with clinical outcomes remains insufficiently explored (10). Consequently, the aim of this study was to explore the associations between adherence to HBE recommendations and changes in clinical outcomes in patients with LBP. 7
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