Abstract
Background: Adherence to prescribed home exercise for chronic low back pain(CLBP) is poor and this remains an under-researched area. There is no standard
measure of exercise adherence and traditional health behaviour models are
limited in their ability to explain non-adherence. This thesis aims to address
these issues.
Aim: To undertake a review of CLBP literature (Study 1), to develop a new
measure (Study 2) and to investigate the role of psychosocial, clinical and
executive function factors in explaining variation in exercise adherence in CLBP
(Study 3).
Design: Study 1 involved systematically reviewing factors associated with
adherence to prescribed home exercise in CLBP. In Study 2, the Exercise
Adherence Rating Scale (EARS) was developed. Study 3 was a prospective
observational study of exercise adherence in a CLBP sample.
Results: Study 1 found nine trials providing moderate evidence that higher
health locus of control, supervision, participation in an exercise programme and
participation in a behaviour change programme incorporating motivational
strategies were associated with better exercise adherence in CLBP samples. In
Study 2, a 1-factor solution explained 66% of the variance in adherence to
exercise. Internal consistency (α = 0.758) and item-response theory methods
indicated that EARS reliability was acceptable. In Study 3, longer duration of
pain, higher present pain, lower educational level and being female significantly
predicted poor adherence behaviour. Executive functions were not predictive of
adherence behaviour.
Conclusions: Study 1 highlighted a lack of good quality evidence and
standardised measures of adherence. The EARS in Study 2 provided a valid and
reliable assessment of adherence behaviour in a CLBP sample and now
requires further testing. Results of Study 3 suggested factors influencing
adherence to prescribed home exercise in patients with CLBP. The inclusion of
these factors within health behaviour models may provide better explanatory
models of exercise behaviour in CLBP.
| Date of Award | 2016 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Supervisor | Emma Godfrey (Supervisor), John Weinman (Supervisor) & Sam Norton (Supervisor) |