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Title: Non-adherence to prescribed home exercise in chronic low back pain
Author: Newman-Beinart, Naomi Angela
ISNI:       0000 0004 5991 3365
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2016
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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.
Supervisor: Weinman, John Alfred ; Godfrey, Emma Louise ; Norton, Sam Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available