159 Exploring the association between exercise adherence and recovery of low back pain regression models. However, measuring all outcomes at every treatment session leads to considerable additional administrative burden on patients, therapists, and researchers. Short and high-quality measurement instruments, such as those from the PatientReported Outcomes Measurement Information System (PROMIS®), might help mitigate those downsides (45). A second limitation is that data on patient adherence were collected by physical therapists. Although all participating physical therapists were trained for data collection, adherence data from 21 patients were lost and could not be used in the analyses. However, given the current results, it is unlikely that without lost data, the analyses would have produced different results. Ultimately, while increasing adherence may seem to be an easy solution to improve treatment effects, the results from the current study, along with the complexity of the construct of adherence and its measurement, suggest a more intricate relationship that warrants further investigation. CONCLUSIONS This study explored the association between adherence to HBE recommendations and changes in clinical outcomes for patients with LBP. Contrary to expectations, no association was found between adherence measures and changes in clinical outcomes. These findings suggest that the relationship between adherence to HBE recommendations and treatment outcomes may be more complex than initially assumed. Further research using detailed longitudinal data combined with qualitative methods to investigate patient motivation and beliefs may lead to a deeper understanding of the relationship between adherence and clinical outcomes in patients with LBP. Abbreviations LBP: Low Back Pain; HBE: Home-based Exercise; ODI: Oswestry Disability Index; NPRS: Numeric Pain Rating Scale; EXAS: Exercise Adherence Scale; FABQ: Fear-Avoidance Beliefs Questionnaire; PCS: Pain Catastrophizing Scale; CSI: Central Sensitization Inventory; GSE Scale: General Self-Efficacy Scale; PAM: Patient Activation Measure; IQR: Interquartile range; SD: Standard Deviation; 95%-CI: 95% confidence interval. DECLARATIONS Ethics approval and consent to participate This study was reviewed and approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, the Netherlands (ISRCTN 94074203), for all 7
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