Understanding barriers to adherence to home exercise programs in patients with musculoskeletal neck pain.

BACKGROUND: Home exercise program (HEP) prescription is commonplace in physical therapy (PT). Adherence to HEPs is generally poor, with non-adherence as high as 70%. Poor adherence may negatively impact outcomes. OBJECTIVES: To (i) qualitatively assess patients' thoughts and beliefs regarding HEP performance and (ii) quantitatively define the relationship between adherence to HEPs and functional outcomes and identify variables that impact adherence. DESIGN: Mixed-methods. METHOD: Part 1 involved semi-structured interviews with patients attending PT for neck pain. Responses were assessed using thematic analysis. Part 2 involved a retrospective chart review of patients seen in outpatient PT for neck pain. Between-group (adherent and non-adherent) differences in functional scores were analyzed using a linear mixed model. Sex, age, and functional score data was entered into a regression model to explore their ability to predict adherence. RESULTS: 25 participants were interviewed. Qualitative analysis revealed the following themes associated with adherence to a HEP: (i) prior PT, (ii) observability of outcomes, (iii) expectations of PT, and (iv) experience of pain. Retrospective data from 187 patients was analyzed. Functional scores at discharge were significantly higher (p = 0.03, mean difference = 12.4) in the adherent group. Age (OR = 0.98; 95% CI = 0.93-1.02), male sex (OR = 1.23; 95% CI = 0.22-6.91), and functional scores at intake (OR = 0.99; 95% CI = 0.92-1.07) were not significant predictors of non-adherence. CONCLUSIONS: Individual patient experiences such as delayed improvement in symptoms and/or experience of pain associated with HEP performance may contribute to poor adherence to HEPs. Adherence to a HEP was associated with superior functional outcomes compared to non-adherence. Age, sex, and functional scores were not predictors of non-adherence.

Home Exercise Programs Are Infrequently Prescribed in Trials of Supervised Exercise for Individuals With Low Back Pain: A Scoping Review of 292 Randomized Controlled Trials.

OBJECTIVES: To (1) determine how often home exercise programs (HEPs) are prescribed in supervised exercise trials for low back pain (LBP) and (2) describe characteristics of the HEP programs (design, purpose, dose, and adherence). DESIGN: Scoping review. LITERATURE SEARCH: PubMed, CINAHL, and Ovid MEDLINE were searched from January 1, 2010, to August 17, 2021. STUDY SELECTION CRITERIA: Randomized controlled trials that included adults with LBP who received exercise interventions. DATA SYNTHESIS: The presence or absence of a prescribed HEP and any details of the HEP including design, dose, and adherence were extracted and summarized. RESULTS: Of 2689 potentially relevant trials, 292 were eligible for inclusion. Ninety-four trials (32%) included a HEP. The most commonly prescribed home exercises were core stability, trunk strengthening, and motor control exercises. There was great variation in the frequency and duration with which HEPs were prescribed. Adherence to HEPs was measured in fewer than half of the trials, and the methods for measuring adherence were inconsistent. Adherence to HEPs ranged from 29% to 82% in the 21 trials that reported adherence. CONCLUSION: Home exercise programs are not regularly prescribed in supervised exercise trials for LBP. There was considerable variation in prescribing HEPs and monitoring exercise adherence in trials of exercise-based treatments for adults with LBP. There is no consistent method used to measure participants' adherence to HEPs, and adherence percentages vary widely. J Orthop Sports Phys Ther 2023;53(3):120-142. Epub: 16 January 2023. doi:10.2519/jospt.2023.11448.