Remco Arensman

185 Summary important results, including the development of the EXAS which showed good validity and reliability for adherence measurement, the acceptance and value of the smartphone app by patients for supporting HBE, and the identification of distinct adherence trajectories among patients. Surprisingly, no significant association was found between adherence trajectories and improvements in physical functioning or pain intensity, challenging previous assumptions about the straightforward relationship between exercise adherence and recovery from LBP. The stratified blended physiotherapy intervention, while not outperforming traditional physiotherapy in improving physical function, was effective in reducing fear-avoidance beliefs and enhancing self-reported adherence, particularly in patients with high risk for persistent LBP. Despite the rigorous design, the study acknowledged the complexity of properly measuring adherence and the potential for varied interpretations of adherence data. Further refinement of the EXAS and specialized research designs combining quantitative data collection with qualitative methods are recommended as the next steps. The findings have significant implications for clinical practice, suggesting a need for personalized, technology-supported interventions to enhance adherence. The research underscores the important role of physiotherapists in motivating and supporting patients through tailored treatments. Future research should focus on personalized treatment incorporation technological advances such as gamification and Artificial Intelligence to ensure that patients receive the care that is best for them. 9

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