Barriers to home-based exercise program adherence with chronic low back pain: Patient expectations regarding new technologies.

OBJECTIVE: To assess views of patients with chronic low back pain (cLBP) concerning barriers to home-based exercise program adherence and to record expectations regarding new technologies. DESIGN: Qualitative study based on semi-structured interviews. PARTICIPANTS: A heterogeneous sample of 29 patients who performed a home-based exercise program for cLBP learned during supervised physiotherapy sessions in a tertiary care hospital. INTERVENTIONS: Patients were interviewed at home by the same trained interviewer. Interviews combined a funnel-shaped structure and an itinerary method. RESULTS: Barriers to adherence related to the exercise program (number, effectiveness, complexity and burden of exercises), the healthcare journey (breakdown between supervised sessions and home exercise, lack of follow-up and difficulties in contacting care providers), patient representations (illness and exercise perception, despondency, depression and lack of motivation), and the environment (attitudes of others, difficulties in planning exercise practice). Adherence could be enhanced by increasing the attractiveness of exercise programs, improving patient performance (following a model or providing feedback), and the feeling of being supported by care providers and other patients. Regarding new technologies, relatively younger patients favored visual and dynamic support that provided an enjoyable and challenging environment and feedback on their performance. Relatively older patients favored the possibility of being guided when doing exercises. Whatever the tool proposed, patients expected its use to be learned during a supervised session and performance regularly checked by care providers; they expected adherence to be discussed with care providers. CONCLUSIONS: For patients with cLBP, adherence to home-based exercise programs could be facilitated by increasing the attractiveness of the programs, improving patient performance and favoring a feeling of being supported. New technologies meet these challenges and seem attractive to patients but are not a substitute for the human relationship between patients and care providers.

Wayfinding through an unfamiliar environment.

Strategies for finding one's way through an unfamiliar environment may be helped by 2D maps, 3D virtual environments, or other navigation aids. The relative effectiveness of aids was investigated. Experiments were conducted in a large, park-like environment. 24 participants (12 men, 12 women; age range = 22-50 years; M=32, SD = 7.4) were divided into three groups of four individuals, who explored a 2D map of a given route prior to navigation, received a silent guided tour by means of an interactive virtual representation, or acquired direct experience of the real route through a silent guided tour. Participants then had to find the same route again on their own. 12 observers were given a "simple" route with only one critical turn, and the other 12 a "complex" route with six critical turns. Compared to three people familiar with the routes, among the naive participants, those who had a direct experience prior to navigation all found their way again on the simple and complex routes. Those who had explored the interactive virtual environment were unable to find their way on the complex route. The relative scale representation in the virtual environment may have given incorrect impressions of relative distances between objects along the itinerary, rendering important landmark information useless.