Adherence to self-directed home-exercises in patients with non-specific low back pain: the relationship with readiness to change

Abstract

ABSTRACT

Aim The aim was to explore the relationship between readiness to change, as described in Transtheoretical model, and adherence to self-directed home-exercises in patients with non-specific low back pain, treated with primary care physiotherapy.

Methods A cohort of patients was prospectively observed during usual treatment in seven primary care practices in the Netherlands. Physiotherapists screened the patients for eligibility and included patients with sub-acute, recurrent or chronic non-specific LBP. Readiness to change was measured with the PSOCQ at baseline and in the second and sixth week. Adherence to prescribed home exercises was measured in second and sixth week with the UHEAQ. Association was explored using Relative Risk.

Results In total 41 of the 87 patients that signed in were included, and 23 patients were followed. At baseline, 8.7%(n=2) of the patients were classified in Contemplation, 73.9% (n=17) in Action and 17.4% (n=4) in Maintenance stage. Adherence to self-directed home-exercises (performance > 60%) was 35.0% (n=7) in the second and sixth week. In comparison with higher stages, patients in Contemplation seemed to have 50-60% higher chance for being non-adherent.

Conclusion The study shows that TTM-based readiness to change was relatively high in the studied primary care population, implying that patients were taking an active role in self-management and behavioral change. Although ‘lower’ readiness to change seems to be associated with higher chance for non-adherence to self-directed home exercises, the number of adherent patients even with high readiness to change remains relatively low.

Clinical Relevance There is no clear need for motivational interventions in primary care NSLBP population. Self-directed home-exercises form an important part of self-management in NSLBP care, and although patients seem open for new behavioral strategies, the majority is non-adherent. Therefore new strategies are needed to improve adherence, and future research on integration of Action and Coping Planning in self-management might offer new possibilities.