Home exercise programs (HEPs) are cost-effective and efficacious treatments for musculoskeletal pain conditions. Although HEPs are an important part of the continuum of care, non-adherence limits their effectiveness.
OBJECTIVE:
The objective of this study was to examine adherence and specific barriers to clinician-prescribed HEPs in adults with musculoskeletal pain.
METHODS:
A cross-sectional study was conducted with a total of 300 patients presenting to an outpatient pain clinic in an academic medical center. Participants’ self-reported information, including HEP completion frequency and barriers, was collected through a survey.
RESULTS:
The participants’ mean age was 54.1 15.8 years (females 133 (65.5%)). Of 203 participants, 99 (48.8%) adhered to HEP, 56 (27.6%) partially adhered, and 48 (23.6%) did not adhere. One hundred eighty-seven (92.1%) participants reported receiving adequate instructions, and 175 (86.2%) reported receiving instructional materials. Age and “sufficient instructions” were found to be significant determinants of adherence ( 0.05), while gender and handouts were not ( 0.05). Pain in more than one body part was significantly ( 0.05) associated with motivational barriers for non-adherence.
CONCLUSION:
Age and participants’ perception of sufficient instructions were significant factors for non-adherence. These results emphasize the importance of therapist-provided instructions to overcome barriers to adherence.
JamesSLAbateDAbateKHAbaySMAbbafatiCAbbasiN, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018 Nov; 392(10159): 1789-858.
2.
WoolfADPflegerB. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003; 81(9): 646-56.
3.
CareyTSFreburgerJKHolmesGMCastelLDarterJAgansR, et al. A long way to go: practice patterns and evidence in chronic low back pain care. Spine. 2009 Apr 1; 34(7): 718-24.
4.
IvanovaJIBirnbaumHGSchillerMKantorEJohnstoneBMSwindleRW. Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care. Spine J Off J North Am Spine Soc. 2011 Jul; 11(7): 622-32.
5.
CostaFAlvesOLAnaniaCDZileliMFornariM. Decompressive surgery for lumbar spinal stenosis: WFNS spine committee recommendations. World Neurosurg X. 2020 Jul; 7: 100076.
6.
GugliottaMda CostaBRDabisETheilerRJüniPReichenbachS, et al. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open. 2016 Dec 21; 6(12): e012938.
7.
BabatundeOOJordanJLVan der WindtDAHillJCFosterNEProtheroeJ. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PloS One. 2017; 12(6): e0178621.
8.
KernsRDBurgessDJColemanBCCookCEFarrokhiSFritzJM, et al. Self-management of chronic pain: Psychologically guided core competencies for providers. Pain Med Malden Mass. 2022 Oct 29; 23(11): 1815-9.
9.
BurgerMAfricaCDroomerKNormanAPheiffeCGerickeA, et al. Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: A systematic review and meta-analysis. South Afr J Physiother. 2016; 72(1): 318.
10.
HopewellSKeeneDJMarianIRDritsakiMHeinePCuretonL, et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial. Lancet Lond Engl. 2021 Jul 31; 398(10298): 416-28.
11.
ChesterRDaniellHBeldersonPWongCKinsellaPMcLeanS, et al. Behaviour Change Techniques to promote self-management and home exercise adherence for people attending physiotherapy with musculoskeletal conditions: A scoping review and mapping exercise. Musculoskelet Sci Pract. 2023 May 29; 66: 102776.
12.
AzevedoDCFerreiraPHDe Oliveira SantosHOliveiraDRLeite De SouzaJVPena CostaLO. Association between patient independence in performing an exercise program and adherence to home exercise program in people with chronic low back pain. Musculoskelet Sci Pract. 2021 Feb; 51: 102285.
13.
KanavakiAMRushtonAEfstathiouNAlrushudAKlockeRAbhishekA, et al. Barriers and facilitators of physical activity in knee and hip osteoarthritis: a systematic review of qualitative evidence. BMJ Open. 2017 Dec 26; 7(12): e017042.
14.
PichaKJHowellDM. A model to increase rehabilitation adherence to home exercise programmes in patients with varying levels of self-efficacy. Musculoskeletal Care. 2018 Mar; 16(1): 233-7.
15.
JackKMcLeanSMMoffettJKGardinerE. Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. Man Ther. 2010 Jun; 15(3): 220-8.
16.
WebbJBakerAPalmerTHallAAhlquistADarlowJ, et al. The barriers and facilitators to physical activity in people with a musculoskeletal condition: A rapid review of reviews using the COM-B model to support intervention development. Public Health Pract Oxf Engl. 2022 Jun; 3: 100250.
17.
HillKDHunterSWBatchelorFACavalheriVBurtonE. Individualized home-based exercise programs for older people to reduce falls and improve physical performance: A systematic review and meta-analysis. Maturitas. 2015 Sep; 82(1): 72-84.
18.
BlanqueroJCortés-VegaMDRodríguez-Sánchez-LaulhéPCorrales-SerraBPGómez-PatricioEDíaz-MatasN, et al. Feedback-guided exercises performed on a tablet touchscreen improve return to work, function, strength and healthcare usage more than an exercise program prescribed on paper for people with wrist, hand or finger injuries: a randomised trial. J Physiother. 2020 Oct; 66(4): 236-42.
19.
AnwerSAlghadirABrisméeJM. Effect of home exercise program in patients with knee osteoarthritis: A systematic review and meta-analysis. J Geriatr Phys Ther 2001. 2016; 39(1): 38-48.
20.
SimekEMMcPhateLHainesTP. Adherence to and efficacy of home exercise programs to prevent falls: a systematic review and meta-analysis of the impact of exercise program characteristics. Prev Med. 2012 Oct; 55(4): 262-75.
21.
PistersMFVeenhofCSchellevisFGTwiskJWRDekkerJDe BakkerDH. Exercise adherence improving long-term patient outcome in patients with osteoarthritis of the hip and/or knee. Arthritis Care Res. 2010 Aug; 62(8): 1087-94.
22.
BaileyDLHoldenMAFosterNEQuickeJGHaywoodKLBishopA. Defining adherence to therapeutic exercise for musculoskeletal pain: a systematic review. Br J Sports Med. 2020 Mar; 54(6): 326-31.
23.
SabatéE, World Health Organization, editors. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization. 2003; 198.
24.
MannionAFHelblingDPulkovskiNSprottH. Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2009 Dec; 18(12): 1881-91.
25.
MarksRAllegranteJP. Chronic osteoarthritis and adherence to exercise: a review of the literature. J Aging Phys Act. 2005 Oct; 13(4): 434-60.
26.
SimekEMMcPhateLHainesTP. Adherence to and efficacy of home exercise programs to prevent falls: A systematic review and meta-analysis of the impact of exercise program characteristics. Prev Med. 2012 Oct; 55(4): 262-75.
27.
BuntingJWWithersTMHeneghanNRGreavesCJ. Digital interventions for promoting exercise adherence in chronic musculoskeletal pain: a systematic review and meta-analysis. Physiotherapy. 2021 Jun; 111: 23-30.
28.
PeekKSanson-FisherRMackenzieLCareyM. Interventions to aid patient adherence to physiotherapist prescribed self-management strategies: a systematic review. Physiotherapy. 2016 Jun; 102(2): 127-35.
29.
MeadeLBBearneLMSweeneyLHAlageelSHGodfreyEL. Behaviour change techniques associated with adherence to prescribed exercise in patients with persistent musculoskeletal pain: Systematic review. Br J Health Psychol. 2019 Feb; 24(1): 10-30.
30.
JordanJLHoldenMAMasonEEFosterNE. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Musculoskeletal Group, editor. Cochrane Database Syst Rev [Internet]. 2010 Jan 20; [cited 2023 Jun 15]. Available from: doi: 10.1002/14651858.CD005956.pub2.
31.
FriedrichMGittlerGArendasyMFriedrichKM. Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain. Spine. 2005 May 1; 30(9): 995-1000.
32.
CoppackRJKristensenJKarageorghisCI. Use of a goal setting intervention to increase adherence to low back pain rehabilitation: a randomized controlled trial. Clin Rehabil. 2012 Nov; 26(11): 1032-42.
33.
PetersonGELandén LudvigssonMHO’LearySPDederingÅMWallmanTJönssonMIN, et al. The effect of 3 different exercise approaches on neck muscle endurance, kinesiophobia, exercise compliance, and patient satisfaction in chronic whiplash. J Manipulative Physiol Ther. 2015 Sep; 38(7): 465-476.e4.
34.
EiseleASchaggDKrämerLVBengelJGöhnerW. Behaviour change techniques applied in interventions to enhance physical activity adherence in patients with chronic musculoskeletal conditions: A systematic review and meta-analysis. Patient Educ Couns. 2019 Jan; 102(1): 25-36.
35.
MeadeLBBearneLMGodfreyEL. “It’s important to buy in to the new lifestyle”: barriers and facilitators of exercise adherence in a population with persistent musculoskeletal pain. Disabil Rehabil. 2021 Feb; 43(4): 468-78.
36.
ForkanRPumperBSmythNWirkkalaHCiolMAShumway-CookA. Exercise adherence following physical therapy intervention in older adults with impaired balance. Phys Ther. 2006 Mar; 86(3): 401-10.
37.
Medina-MirapeixFEscolar-ReinaPGascón-CánovasJJMontilla-HerradorJJimeno-SerranoFJCollinsSM. Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study. BMC Musculoskelet Disord. 2009 Dec 9; 10: 155.
38.
FarìGFischettiFZonnoAMarraFMaglieABianchiFP, et al. Musculoskeletal pain in gymnasts: A retrospective analysis on a cohort of professional athletes. Int J Environ Res Public Health. 2021 May 20; 18(10): 5460.
39.
FarìGSantagatiDMacchiarolaDRicciVDi PaoloSCaforioL, et al. Musculoskeletal pain related to surfing practice: Which role for sports rehabilitation strategies? A cross-sectional study. J Back Musculoskelet Rehabil. 2022; 35(4): 911-7.
40.
SluijsEMKokGJvan der ZeeJ. Correlates of exercise compliance in physical therapy. Phys Ther. 1993 Nov; 73(11): 771-82; discussion 783–786.
41.
MichieSRichardsonMJohnstonMAbrahamCFrancisJHardemanW, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med Publ Soc Behav Med. 2013 Aug; 46(1): 81-95.
42.
CareyRNConnellLEJohnstonMRothmanAJde BruinMKellyMP, et al. Behavior change techniques and their mechanisms of action: A synthesis of links described in published intervention literature. Ann Behav Med Publ Soc Behav Med. 2019 Jul 17; 53(8): 693-707.
43.
FalossiFAzzolliniVNotarstefanoCRaffaetàG. Adherence to a home physical exercise program in patients with osteoporotic vertebral fractures: A retrospective observational study. J Back Musculoskelet Rehabil. 2022; 35(4): 777-82.
44.
PicorelliAMAPereiraLSMPereiraDSFelícioDSherringtonC. Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review. J Physiother. 2014 Sep; 60(3): 151-6.
45.
NationalCenter for Health Statistics(US). Health, United States, 2016: With Chartbook on Long-term Trends in Health [Internet]. Hyattsville (MD): National Center for Health Statistics (US). 2017; [cited 2023 May 23]. (Health, United States). Available from: http//www.ncbi.nlm.nih.gov/books/NBK453378/.
46.
Medina-MirapeixFLillo-NavarroCMontilla-HerradorJGacto-SánchezMFranco-SierraMÁEscolar-ReinaP. Predictors of parents’ adherence to home exercise programs for children with developmental disabilities, regarding both exercise frequency and duration: a survey design. Eur J Phys Rehabil Med [Internet]. 2017 Aug; [cited 2023 Jun 15]; 53(4). Available from: https//www.minervamedica.it/index2.php?show=R33Y2017N04A0545.
47.
JengCBraunLT. Bandura’s self-efficacy theory: a guide for cardiac rehabilitation nursing practice. J Holist Nurs Off J Am Holist Nurses Assoc. 1994 Dec; 12(4): 425-36.
48.
SchooAMMMorrisMEBuiQM. The effects of mode of exercise instruction on compliance with a home exercise program in older adults with osteoarthritis. Physiotherapy. 2005 Jun; 91(2): 79-86.
49.
YilmazMSahinMAlgunZC. Comparison of effectiveness of the home exercise program and the home exercise program taught by physiotherapist in knee osteoarthritis. J Back Musculoskelet Rehabil. 2019; 32(1): 161-9.
50.
JohnstonVShawWS. Helping workers help themselves: empowering physiotherapy clients to manage musculoskeletal problems at work. Phys Ther Rev. 2013 Oct; 18(5): 373-8.
51.
HallKGrinsteadALewisJSMercerCMooreARidehalghC. Rotator cuff related shoulder pain. Describing home exercise adherence and the use of behavior change interventions to promote home exercise adherence: a systematic review of randomized controlled trials. Phys Ther Rev. 2021 Jul 4; 26(4): 299-322.
52.
FlegalKEKishiyamaSZajdelDHaasMOkenBS. Adherence to yoga and exercise interventions in a 6-month clinical trial. BMC Complement Altern Med. 2007 Nov 9; 7: 37.
53.
CoxKLCyartoEVEllisKAAmesDDesmondPPhalP, et al. A randomized controlled trial of adherence to a 24-month home-based physical activity program and the health benefits for older adults at risk of alzheimer’s disease: The aibl active-study. J Alzheimers Dis JAD. 2019; 70(s1): S187-205.
