158 Chapter 7 investigating the intricate connection between adherence to HBE recommendations and recovery from LBP calls for innovative research approaches. An initial step could involve gathering data on adherence and clinical outcomes during every treatment session and throughout the follow-up period, allowing comprehensive longitudinal analysis. Technological advances and innovations such as the TRAK© telerehabilitation tool (43) might lead to novel platforms to prescribe and support HBE and facilitate the measurement of adherence and clinical outcomes on a larger scale. By also integrating qualitative methods to explore patient motivations and beliefs, a more holistic understanding of adherence can be achieved. Emerging new insights might then contribute to the development of effective strategies for enhancing adherence in patients with LBP. The last explanation is that the number of patients in some groups used in the regression models was relatively small, which reduces precision and might be the reason for the wide 95% confidence intervals (95% CIs). This is especially apparent for the models testing the relationship between adherence and recovery. Only 28.5% of participants considered themselves to have recovered from LBP after 3 months, which equates to 4 (21.1%) participants who recovered from the “declining adherence” trajectory class. The “increasing adherence” class had the highest percentage of recovered participants (33.8%) and had the largest effect (OR 0.48), with a wide 95% CI ranging from 0.13 to 1.72, indicating that a lack of precision might be the cause of the nonsignificant difference. This variability suggests an underlying trend that recovery is associated with the trajectory of the patient’s adherence class, although this finding was not statistically significant in this study. Therefore, while the current results do not establish a definitive statistical association, they do hint at a potential relationship that warrants further investigation in future studies with more participants to achieve narrower confidence intervals and more definitive conclusions. This study has several important strengths. The data for this study were collected as part of a prospective, multicenter cluster randomized controlled trial, and the included patients reflected the characteristics of patients with LBP typically treated in primary care physical therapy practices in the Netherlands (19,44). Therefore, the results from this study can be generalized to the population of patients with LBP in the Netherlands. Another strength is the use of multiple imputation to handle missing data. With 52% of the participants having at least one missing data point, performing complete case analyses would have severely limited the statistical power and reduced the robustness of the findings. There are some limitations to the current study. First, although the EXAS provides data on adherence to HBE recommendations for every treatment session separately, the other outcomes in the study were assessed only at the start and after three months. This design limits the possibilities for repeated measures analysis, resulting in less precise
RkJQdWJsaXNoZXIy MTk4NDMw