Trajectories of Adherence to Home-Based Exercise Recommendations Among People With Low Back Pain: A Longitudinal Analysis

Abstract

Objective This study aimed to examine the presence of distinct trajectories of adherence to home-based exercise recommendations among people with low back pain. This study also aimed to identify differences in baseline characteristics among groups. Methods This study was a secondary analysis of a prospective, multicenter cluster randomized controlled trial investigating the cost-effectiveness of a stratified blended physical therapist intervention compared to usual care physical therapy in patients with low back pain. The intervention group received usual care with integrated support via a smartphone app. A total of 208 patients were recruited from 58 primary care physical therapist practices. Baseline data included patient characteristics, physical functioning, pain intensity, physical activity, fear avoidance, pain catastrophizing, self-efficacy, self-management ability, and health-related quality of life. The Exercise Adherence Scale (score range = 0 to 100) was used to measure adherence during each treatment session. Latent class growth analysis was used to estimate trajectories of adherence. Results Adherence data was available from 173 out of 208 patients (83%). Data was collected during an average of 5.1 (SD = 2.5) treatment sessions, with total treatment duration of 51 (SD = 41.7) days. Three trajectory classes were identified: "declining adherence" (12%), "stable adherence" (45%), and "increasing adherence" (43%). No differences in baseline characteristic were found between groups. Conclusions Three adherence trajectories to exercise recommendations were identified in patients with low back pain. However, baseline characteristics cannot identify a patient's trajectory group. Impact Despite the presence of distinct trajectories of adherence in patients with low back pain, physical therapists should not attempt to place a patient in a trajectory group at the start of treatment. Instead, adherence should be closely monitored as treatment progresses and supported when required as part of an ongoing process.