151 Exploring the association between exercise adherence and recovery of low back pain months. Recovery from LBP was reported by the patient after three months. After three months, patients were asked about recurrent pain, and patients who reported being free from LBP for at least four consecutive weeks were considered to have recovered. All other patients were considered to have not recovered. Exposures The exposure of interest was adherence to HBE recommendations and was assessed by the physical therapist using the Exercise Adherence Scale (EXAS) during every physical therapy treatment session (18). The EXAS measures adherence to frequency, intensity, and quality of performance recommendations. First, the physical therapist instructed the patient in the performance of the exercises for at home and recorded the recommended frequency and intensity. At the start of the following treatment session, the patient reported adherence to the HBE recommendations, and the physical therapist rated the quality of performance of the exercises by the patient on a 5-point Likert scale (poor, moderate, reasonable, good, excellent) (18). For each exercise, adherence was then calculated by expressing patient-reported adherence as a percentage of physiotherapist recommendations for frequency and intensity, and the resulting percentage was modified by the quality of performance rating (18). The mean score for all exercises was calculated and resulted in an EXAS score for every treatment session following the first session where exercises were recommended. The EXAS score ranges from 100 (perfect adherence to HBE recommendations) to 0 (no adherence to HBE recommendations). After the last treatment session, the therapist recorded the number of treatment sessions. To obtain the overall mean EXAS score, all EXAS scores for the individual treatment sessions were averaged. Trajectory classes of adherence in the cohort of patients in this study were established in a prior study by utilizing EXAS scores from individual treatment sessions (10). Three distinct adherence classes were identified: “declining adherence” (12% of participants), “stable adherence” (45% of participants), and “increasing adherence” (43% of participants). The trajectory classes served as a metric for changes in adherence over time. Potential confounders Patient characteristics (age, sex, height, weight, BMI, education level, and duration of LBP prior to the start of treatment) and factors known to be related to adherence (fear avoidance, pain catastrophizing, central sensitization, self-efficacy, self-management ability, and health-related quality of life) were recorded at the start of treatment. Fear avoidance beliefs were measured using the Fear-Avoidance Beliefs Questionnaire (FABQ) (29). The FABQ score ranges from 0 to 96, with a higher score indicating stronger fear and avoidance beliefs regarding the effects of physical activity on LBP. 7
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