the belief that one is capable of performing in a certain manner to attain certain goals, patient activation, i.e. Interindividual variability in adherence to medical treatment/therapy has been shown to be related to various personal characteristics including patients’ convictions in relation to their and others’ responsibility for their health and illness, self-efficacy, i.e.
If the exercises that patients are instructed to perform are aimed at addressing specific functional deficits, have a sound underlying physiological rationale and demonstrate a dose–response relationship, then it could be expected that patients who adhere well to the prescribed exercise programme would fare better in terms of their final outcome.
Conceivably, one factor influencing individual success with such programmes may be the adherence of the patient to the treatment, where adherence implies active voluntary involvement in the planning and implementation of the treatment and is defined as the extent to which the patient undertakes the clinic-based and home-based prescribed components of the physiotherapy programme. The reasons for the widely varying individual response to treatment are largely unknown few studies have been able to identify predictors of a positive outcome. However, a recent meta-analysis of the results of exercise therapy trials reveals that even this gold standard treatment does not elicit a positive response in all patients, and the group mean changes in pain and disability, although statistically significant, are clinically only modest. According to current evidence-based clinical guidelines, exercise therapy (of any type) is one of the few recommended treatments for non-specific cLBP. Whether the “adherence–outcome” interaction was mediated by improvements in function related to the specific exercises, or by a more “global” effect of the programme, remains to be examined.Ĭhronic low back pain (cLBP) is a complex and poorly understood problem and its management represents a major challenge to our health-care systems. Hence, more effort should be invested in finding ways to improve patients’ motivation to take responsibility for the success of their own therapy, perhaps by increasing exercise self-efficacy. The benefits of rehabilitation depended to a large extent on the patient’s exercise behaviour outside of the formal physiotherapy sessions. Adherence to home exercises showed a moderate, positive correlation with the reduction in average pain (Rho = 0.54, P = 0.003) and disability (Rho = 0.38, P = 0.036) higher MAI scores were associated with greater reductions in average pain (Rho = 0.48, P = 0.008) and a (n.s.) tendency for greater reductions in disability (Rho = 0.32, P = 0.07) Neither attendance at therapy nor SIRAS were significantly related to any of the outcomes. Pain intensity and self-rated disability decreased significantly after therapy (each P < 0.01). The only psychological/beliefs variable showing a unique significant association with MAI was exercise self-efficacy (Rho = 0.36, P = 0.045). Overall, adherence to therapy was very good (average MAI score, 85% median (IQR), 89 (15)%). Psychological disturbance, fear-avoidance beliefs, catastrophising, exercise self-efficacy and health locus of control were measured by questionnaire disability in everyday activities was scored with the Roland–Morris disability scale and back pain intensity with a 0–10 graphic rating scale. The average of these three measures formed a multidimensional adherence index (MAI). Adherence to the 9-week programme was documented as: percent attendance at therapy, percent adherence to daily home exercises (patient diary) and percent commitment to rehabilitation (Sports Injury Rehabilitation Adherence Scale (SIRAS)). A total of 32/37 patients with cLBP completed the study (mean age, 44.0 (SD = 12.3) years 11/32 (34%) male). This prospective study examined factors associated with adherence and the relationship between adherence and outcome after a programme of physiotherapeutic spine stabilisation exercises. Exercise rehabilitation is one of the few evidence-based treatments for chronic non-specific low back pain (cLBP), but individual success is notoriously variable and may depend on the patient’s adherence to the prescribed exercise regime.
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