title: Individual and intervention-related factors associated with adherence to home exercise in chronic low back pain: a systematic review.
abstract: BACKGROUND
  Exercise has been shown to reduce pain and increase function in patients with chronic low back pain. However up to 70% of patients do not engage in prescribed home exercise. Physiotherapists need to understand more about the complex factors influencing patients' adherence to prescribed home exercise to tailor their exercise interventions more effectively and support patients to self-manage.
  
  
  OBJECTIVE
  This review identifies factors associated with adherence to health care practitioner-prescribed home exercise in adults with chronic low back pain.
  
  
  METHODS
  Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used for the reporting of this review.
  
  
  METHODS
  We explored literature in which the authors studied adherence to home exercise in adults with CLBP.
  
  
  METHODS
  Adherence to home exercise was the primary outcome. Additional outcome measures were recorded in the data extraction table.
  
  
  METHODS
  The following databases were searched: Embase, PsychINFO, MEDLINE, PEDro, and the Cochrane Central Register of Controlled Trials. Data were independently extracted and assessed for methodologic quality by two reviewers.
  
  
  RESULTS
  Eleven randomized controlled trials, including 1,088 participants, met the inclusion criteria. Moderate evidence was found for one individual patient subfactor and three intervention-related subfactors associated with increased adherence to home exercise. These subfactors were greater health locus of control, supervision, participation in an exercise program, and participation in a general behavior change program incorporating motivational strategies.
  
  
  CONCLUSIONS
  This is the first systematic review investigating adherence to prescribed home exercise in a chronic low back pain population. It is difficult to draw firm conclusions because the research lacks detailed descriptions of intervention content. The use of a taxonomy of behavior change techniques has been suggested to overcome this key problem. This review has highlighted the lack of standardized measures of adherence to prescribed home exercise. The development of a validated measure of adherence should be a priority because this will provide a better understanding of the multitude of factors that may influence adherence to home exercise.
authors.affiliation: Division of Health and Social Care Research, School of Medicine, King's College London, 7th Floor Capital House, 42 Weston St, London SE1 3QD, UK. Electronic address: naomi.beinart@kcl.ac.uk.
authors.forename: Naomi A
authors.initials: NA
authors.lastname: Beinart
authors.forename: Claire E
authors.initials: CE
authors.lastname: Goodchild
authors.forename: John A
authors.initials: JA
authors.lastname: Weinman
authors.forename: Salma
authors.initials: S
authors.lastname: Ayis
authors.forename: Emma L
authors.initials: EL
authors.lastname: Godfrey
mesh_terms: D005081:Exercise Therapy / Q000379:methods / Q000523:psychology*; D006801:Humans; D017116:Low Back Pain / Q000523:psychology* / Q000534:rehabilitation*; D010349:Patient Compliance / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic
keywords: Adherence; Chronic low back pain; Exercise; Physical therapy; Review