184 Chapter 9 physical functioning, no significant superiority was found for the (cost)effectiveness of e-Exercise LBP. Nonetheless, benefits of e-Exercise LBP were observed in secondary outcomes; it significantly improved patients’ fear-avoidance beliefs and self-reported adherence to HBE. Particularly, among patients with a high-risk for developing persistent LBP, e-Exercise LBP demonstrated statistically significant better outcomes in physical functioning and several secondary measures when compared to the control group. These findings suggest that certain subgroups of patients with LBP benefit more from e-Exercise LBP than others and warrants further investigation. Chapter 6 investigates trajectories of adherence to HBE in patients with LBP and explores if baseline characteristics are related to these trajectories utilizing data from the e-Exercise LBP trial. Adherence was measured using the EXAS (chapter 2) and data were available from 173 participants. Through latent class growth analysis, three adherence trajectories were identified: “declining adherence” (12%), characterized by a decrease in adherence over time; “stable adherence” (45%), where adherence levels remained constant; and “increasing adherence” (43%), showing an increase in adherence over time. Surprisingly, no significant differences in baseline characteristics were observed among these groups, indicating that initial patient characteristics are not related to adherence trajectories. These findings underscore the complexity of adherence behavior in patients with LBP, highlighting that physiotherapists should monitor and support adherence throughout the treatment process rather than attempting to categorize patients into specific adherence groups at the onset of treatment. Chapter 7, explores the associations between adherence to HBE recommendations and changes in clinical outcomes in patients with LBP. Utilizing data from the same participants as described in chapter 6, the analysis also included previously established adherence trajectories (“declining,” “stable,” and “increasing” adherence), representing 12%, 45%, and 43% of the study population, respectively. Despite 28.5% of patients reporting recovery from LBP, analysis revealed no significant correlation between adherence levels and improvements in physical functioning or pain intensity. This absence of an association suggests a complex relationship between adherence to HBE recommendations and LBP recovery, underscoring the necessity for further exploration incorporating both longitudinal data and qualitative research into how adherence to HBE recommendations impacts clinical outcomes. Chapter 8 presents the discussion on the study of adherence to HBE recommendations in patients with LBP as part of the e-Exercise LBP project. The role of physiotherapists in guiding patient adherence, the development and validation of a new adherence measurement instrument, and the exploration of the complex construct of adherence and its impact on treatment outcomes are emphasized. The research shows several
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