title: Challenges to early prevention and intervention: personal experiences with adherence.
abstract: OBJECTIVE
  To describe potential adherence-related difficulties encountered in the implementation of a secondary prevention, early intervention study with acute low back pain patients. An additional goal is to provide recommendations, based on the authors' experience, on how best to overcome these potential obstacles for future research.
  
  
  METHODS
  The study used a predictive algorithm, identified through previous research, to identify which patients presenting with acute low back pain were at risk for developing chronic problems. These subjects were then treated prophylactically with an interdisciplinary intervention. Specific difficulties initially encountered during the pilot stage of implementation of this intervention included securing adequate physician referrals to the study and helping patients to progress through treatment in the most efficient manner.
  
  
  CONCLUSIONS
  Potential difficulties are discussed in the contextual framework of treatment adherence and factors affecting it, including the impact of personality factors, satisfaction, comprehension, side effects, financial issues, length of treatment, type of regimen, social issues, patient beliefs, and biologic factors. It is hoped that the present authors' experience will enable future investigators to anticipate these common problems, and structure their research endeavors accordingly.
authors.affiliation: University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-8898, USA. carla.pulliam@utsouthwestern.edu
authors.forename: Carla
authors.initials: C
authors.lastname: Pulliam
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gatchel
authors.forename: Richard C
authors.initials: RC
authors.lastname: Robinson
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001294:Attitude to Health; D002908:Chronic Disease; D006801:Humans; D007902:Length of Stay; D017116:Low Back Pain / Q000191:economics / Q000517:prevention & control* / Q000523:psychology* / Q000534:rehabilitation; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010352:Patient Dropouts / Q000523:psychology; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010865:Pilot Projects; D012944:Social Support; D016896:Treatment Outcome