Individual and intervention-related factors associated with adherence to home exercise in chronic low back pain

Exercise has been shown to decrease pain and improve function in individuals suffering from chronic low back pain. However as many as 70% of patients do not perform prescribed home exercises. Physiotherapists need to understand more about the complex factors influencing patients’ adherence to prescribed home exercise to personalize their exercise interventions more effectively and support patients to self-manage. In this review, the authors identify factors associated with adherence to health care practitioner-prescribed home exercise in adults with chronic low back pain. They used Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for the reporting of this review. They examined literature in which the authors studied adherence to home exercise in adults with CLBP. Adherence to home exercise was their primary outcome; they recorded additional outcome measures in the data extraction table. The authors searched the following databases: Embase, PsychINFO, MEDLINE, PEDro, and the Cochrane Central Register of Controlled Trials. Data were independently extracted and assessed for methodologic quality by two reviewers. Eleven randomized controlled trials, including 1,088 participants, met the inclusion criteria. Moderate evidence was found for one individual patient subfactor and three intervention-related subfactors associated with increased adherence to home exercise. These subfactors were greater health locus of control, supervision, participation in an exercise program, and participation in a general behavior change program incorporating motivational strategies.

 

This is the first systematic review examining adherence to prescribed home exercise in a chronic low back pain population. It was difficult for the authors to arrive at solid conclusions due to the research’s lack of detailed descriptions of intervention content. The use of a taxonomy of behavior change techniques has been suggested to overcome this key problem. They concluded that this review pointed out the lack of standardized measures of adherence to prescribed home exercise and that the development of a validated measure of adherence should be a priority as this will provide a better understanding of the multitude of factors that could affect participation in home exercise.

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