157 Exploring the association between exercise adherence and recovery of low back pain DISCUSSION This study is among the first to explore the relationship between adherence to HBE recommendations and changes in clinical outcomes in patients with LBP. The results indicate that, both before and after adjusting for confounders, there are no significant associations between adherence to HBE recommendations and clinical outcome changes in LBP patients. Similarly, there is no evident association between LBP recovery and adherence. Although comparable literature focusing specifically on LBP patients is lacking, a similar study has examined the relationship between adherence to an HBE program and clinical outcomes in patients with knee osteoarthritis (38). A significant distinction from our study is the cross-sectional design used in the study. Nevertheless, the findings in patients with knee osteoarthritis are very similar to the findings of the current study. Although difficult to generalize, these findings suggest that there is no apparent association between adherence to exercise recommendations and changes in pain or disability or recovery from LBP. Nevertheless, prior to confirming a lack of association between adherence and clinical outcomes, it is important to consider potential factors or underlying reasons that might account for these nonsignificant results. The first is that the construct of adherence to HBE recommendations is much more complex than previously thought. Existing research on predictors of adherence to HBE or other forms of exercise in patients with LBP reveals that patient factors, treatment-related factors, therapist factors, environmental factors, and social factors can influence adherence (3,4,6,7,11,13,39–42). Further complicating the construct of adherence is that the influence of these factors on adherence behavior can differ significantly among patients. For example, reduced pain and disability from LBP as a result of HBE may encourage one patient to remain adherent, while another might discontinue exercising, believing it is unnecessary as their pain and limitations decrease. In contrast, increased pain may prompt one patient to cease exercising while stimulating another to exercise more. Unfortunately, because the outcomes were not measured during every physiotherapy session, this remains hypothetical. However, this could explain the large standard deviations of the mean EXAS scores for the different groups in the current study. Furthermore, although the regression models were adjusted for a number of factors (e.g., age, body mass index, education level, pain catastrophizing, self-efficacy, self-management), many factors could not be adjusted for. A second explanation is that although adherence to frequency, intensity, and quality of performance recommendations are important indicators of adherence, the EXAS might not be optimal for their measurement. Despite improvements in existing measures of adherence, the accuracy of the EXAS score is limited by patient reporting bias (e.g., recall or patient honesty) and reporting errors by the physiotherapist. It appears that properly 7
RkJQdWJsaXNoZXIy MTk4NDMw