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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-32751

Mannion, A F; Helbling, D; Pulkovski, N; Sprott, H (2009). Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome. European Spine Journal, 18(12):1881-1891.

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Exercise rehabilitation is one of the few evidence-
based treatments for chronic non-specific low back
pain (cLBP), but individual success is notoriously variable
and may depend on the patient’s adherence to the prescribed
exercise regime. This prospective study examined
factors associated with adherence and the relationship
between adherence and outcome after a programme of
physiotherapeutic spine stabilisation exercises. A total of
32/37 patients with cLBP completed the study (mean age,
44.0 (SD = 12.3) years; 11/32 (34%) male). Adherence to
the 9-week programme was documented as: percent
attendance at therapy, percent adherence to daily home
exercises (patient diary) and percent commitment to rehabilitation(Sports Injury Rehabilitation Adherence Scale
(SIRAS)). The average of these three measures formed a
multidimensional adherence index (MAI). Psychological
disturbance, fear-avoidance beliefs, catastrophising, exercise self-efficacy and health locus of control were measured by questionnaire; disability in everyday activities
was scored with the Roland–Morris disability scale and
back pain intensity with a 0–10 graphic rating scale.
Overall, adherence to therapy was very good (average MAI
score, 85%; median (IQR), 89 (15)%). The only psychological/
beliefs variable showing a unique significant association
with MAI was exercise self-efficacy (Rho = 0.36,
P = 0.045). Pain intensity and self-rated disability
decreased significantly after therapy (each P\0.01).
Adherence to home exercises showed a moderate, positive
correlation with the reduction in average pain (Rho = 0.54,
P = 0.003) and disability (Rho = 0.38, P = 0.036);
higher MAI scores were associated with greater reductions
in average pain (Rho = 0.48, P = 0.008) and a (n.s.)
tendency for greater reductions in disability (Rho = 0.32,
P = 0.07) Neither attendance at therapy nor SIRAS were
significantly related to any of the outcomes. The benefits of rehabilitation depended to a large extent on the patient’s exercise behaviour outside of the formal physiotherapy sessions. Hence, more effort should be invested in finding ways to improve patients’ motivation to take responsibility for the success of their own therapy, perhaps by increasing exercise self-efficacy. Whether the "adherence–outcome" interaction was mediated by improvements in function related to the specific exercises, or by a more "global" effect of the programme, remains to be examined.


19 citations in Web of Science®
23 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Rheumatology Clinic and Institute of Physical Medicine
Dewey Decimal Classification:610 Medicine & health
Deposited On:22 Mar 2010 12:07
Last Modified:05 Apr 2016 14:02
Publisher DOI:10.1007/s00586-009-1093-7
PubMed ID:19609785

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