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Published in: BMC Musculoskeletal Disorders 1/2010

Open Access 01-12-2010 | Research article

Indicators of adherence to physiotherapy attendance among Saudi female patients with mechanical low back pain: a clinical audit

Author: Einas Al-Eisa

Published in: BMC Musculoskeletal Disorders | Issue 1/2010

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Abstract

Background

Among current musculoskeletal interventions used to treat low back pain (LBP), physiotherapy exercise has the highest evidence of effectiveness in avoiding recurrence and chronic disability. However, effectiveness of physiotherapy is thought to be directly related to the patients' adherence to physiotherapy. Since adherence is reported to be directly influenced by socio-cultural factors, this study was conducted to investigate factors related to patients' adherence in a group of Saudi female patients with LBP.

Methods

A retrospective chart review was conducted on female LBP patients referred to the department of physiotherapy at a local tertiary hospital over a 12 month period. A total of 98 charts were reviewed. Two physiotherapists specialized in musculoskeletal rehabilitation collected information from the medical files. Data were classified in three categories: patients' personal demographics, patients' medical condition and history, and type of physiotherapy administered. Contingency tables and chi-square test were computed to test for differences in proportions. Spearman rank correlation coefficient was calculated to examine relationships among variables.

Results

Subjects who attended their scheduled appointments were classified as adherent (40%), and those who failed to attend 2 consecutive scheduled appointments and got discharged were classified as non-adherent (60%). Factors that significantly correlated with adherence included: age (r = 0.7, p < 0.05), initial pain intensity (r = 0.5, p < 0.05), and subjective report of improvement (r = 0.7, p < 0.01). Adherence did not correlate with the type of LBP, patient occupation, experience or nationality of the physiotherapist.

Conclusion

This study reveals an alarming level of non-adherence to physiotherapy among patients with LBP. It remains unclear as to what level of adherence is required to achieve beneficial effect of treatment. It is quite evident however, that early withdrawal from treatment would not allow the therapeutic benefits of the treatment to be realized. Future research should be directed toward developing strategies to improve adherence.
Literature
1.
go back to reference Loney PL, Stratford PW: The prevalence of low back pain in adults: a methodological review of the literature. Physical Therapy. 1999, 79: 384-396.PubMed Loney PL, Stratford PW: The prevalence of low back pain in adults: a methodological review of the literature. Physical Therapy. 1999, 79: 384-396.PubMed
2.
go back to reference Walker BF, Muller R, Grant WD: Low back pain in Australian adults: prevalence and associated disability. J Mnipulative Physiol Ther. 2004, 27: 238-244. 10.1016/j.jmpt.2004.02.002.CrossRef Walker BF, Muller R, Grant WD: Low back pain in Australian adults: prevalence and associated disability. J Mnipulative Physiol Ther. 2004, 27: 238-244. 10.1016/j.jmpt.2004.02.002.CrossRef
3.
go back to reference Oleske DM, Lavender SA, Andersson GBJ, Morissey MJ: Risk factors for recurrent episodes of work-related back pain in an industrial population. Spine. 2006, 31: 789-798. 10.1097/01.brs.0000207017.30490.28.CrossRefPubMed Oleske DM, Lavender SA, Andersson GBJ, Morissey MJ: Risk factors for recurrent episodes of work-related back pain in an industrial population. Spine. 2006, 31: 789-798. 10.1097/01.brs.0000207017.30490.28.CrossRefPubMed
4.
go back to reference Frymoyer JW: Predicting disability from low back pain. Clin Orthop Relat Res. 1992, 279: 101-109.PubMed Frymoyer JW: Predicting disability from low back pain. Clin Orthop Relat Res. 1992, 279: 101-109.PubMed
5.
go back to reference Waddell G: The Back Pain Revolution. 1998, Edinburgh: Churchill Livingstone Waddell G: The Back Pain Revolution. 1998, Edinburgh: Churchill Livingstone
6.
go back to reference Maniadakis N, Gray A: The economic burden of back pain in the UK. Pain. 2000, 84: 95-103. 10.1016/S0304-3959(99)00187-6.CrossRefPubMed Maniadakis N, Gray A: The economic burden of back pain in the UK. Pain. 2000, 84: 95-103. 10.1016/S0304-3959(99)00187-6.CrossRefPubMed
7.
go back to reference Abalkhail BA, Bahnassy AA, Ghabrah TM: Low back pain among Saudi school workers in Jeddah. Saudi Medical J. 1998, 19: 491-495. Abalkhail BA, Bahnassy AA, Ghabrah TM: Low back pain among Saudi school workers in Jeddah. Saudi Medical J. 1998, 19: 491-495.
8.
go back to reference Anthony Woolf, Bruce Pfleger: Burden of major musculoskeletal conditions. Bulletin of the World Health Organization. 2003, 81: 646-656. Anthony Woolf, Bruce Pfleger: Burden of major musculoskeletal conditions. Bulletin of the World Health Organization. 2003, 81: 646-656.
9.
go back to reference Pincus T, Vogel S, Breen A, Foster N, Underwood M: Persistent back pain-why do physical therapy clinicians continue treatment? A mixed methods study of chiropractors, osteopaths and physiotherapists. Euro J Pain. 2006, 10: 67-76. 10.1016/j.ejpain.2005.01.008.CrossRef Pincus T, Vogel S, Breen A, Foster N, Underwood M: Persistent back pain-why do physical therapy clinicians continue treatment? A mixed methods study of chiropractors, osteopaths and physiotherapists. Euro J Pain. 2006, 10: 67-76. 10.1016/j.ejpain.2005.01.008.CrossRef
10.
go back to reference Callaghan M: Evaluation of a back rehabilitation group for chronic low back pain in an out-patient setting. Physiotherapy. 1994, 80: 677-680. 10.1016/S0031-9406(10)60930-3.CrossRef Callaghan M: Evaluation of a back rehabilitation group for chronic low back pain in an out-patient setting. Physiotherapy. 1994, 80: 677-680. 10.1016/S0031-9406(10)60930-3.CrossRef
11.
go back to reference Foster NE, Thompson KA, Baxter GD, Allen JM: Management of nonspecific low back pain by physiotherapists in Britain and Ireland: a descriptive questionnaire of current clinical practice. Spine. 1999, 24: 1332-1342. 10.1097/00007632-199907010-00011.CrossRefPubMed Foster NE, Thompson KA, Baxter GD, Allen JM: Management of nonspecific low back pain by physiotherapists in Britain and Ireland: a descriptive questionnaire of current clinical practice. Spine. 1999, 24: 1332-1342. 10.1097/00007632-199907010-00011.CrossRefPubMed
12.
go back to reference Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected rehabilitation Interventions for Low Back Pain. Phys Ther. 2001, 81: 1641-1674. Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected rehabilitation Interventions for Low Back Pain. Phys Ther. 2001, 81: 1641-1674.
13.
go back to reference Mikhail C, Korner-Bitensky N, Rossignol M, Dumas JP: : Physical therapists' use of interventions with high evidence of effectiveness in the management of a hypothetical typical patient with acute low back pain. Phys Ther. 2005, 85: 1151-1167.PubMed Mikhail C, Korner-Bitensky N, Rossignol M, Dumas JP: : Physical therapists' use of interventions with high evidence of effectiveness in the management of a hypothetical typical patient with acute low back pain. Phys Ther. 2005, 85: 1151-1167.PubMed
14.
go back to reference Middleton A: Chronic low back pain: patient compliance with physiotherapy advice and exercise, perceived barriers and motivation. Physical Therapy Reviews. 2004, 9: 153-160. 10.1179/108331904225006312.CrossRef Middleton A: Chronic low back pain: patient compliance with physiotherapy advice and exercise, perceived barriers and motivation. Physical Therapy Reviews. 2004, 9: 153-160. 10.1179/108331904225006312.CrossRef
15.
go back to reference Sluijs EM, Kok GJ, van der Zee J: Correlates of exercise compliance in physical therapy. Phys Ther. 1993, 73: 771-786.PubMed Sluijs EM, Kok GJ, van der Zee J: Correlates of exercise compliance in physical therapy. Phys Ther. 1993, 73: 771-786.PubMed
16.
go back to reference World Health Organization: Adherence to long term therapies: evidence for action. 2003, Geneva, Switzerland, 3-4. World Health Organization: Adherence to long term therapies: evidence for action. 2003, Geneva, Switzerland, 3-4.
17.
go back to reference Kroll T, Barlow JH, Shaw K: Treatment adherence in juvenile rheumatoid arthritis--a review. Scan J Rheumatol. 1999, 28: 10-18. Kroll T, Barlow JH, Shaw K: Treatment adherence in juvenile rheumatoid arthritis--a review. Scan J Rheumatol. 1999, 28: 10-18.
18.
go back to reference Alexandre NMC, Nordin M, Hiebert R, Campello M: Predictors of compliance with short-term treatment among patients with back pain. Rev Panam Salud Publica. 2002, 12 (2): 86-94. 10.1590/S1020-49892002000800003.CrossRefPubMed Alexandre NMC, Nordin M, Hiebert R, Campello M: Predictors of compliance with short-term treatment among patients with back pain. Rev Panam Salud Publica. 2002, 12 (2): 86-94. 10.1590/S1020-49892002000800003.CrossRefPubMed
19.
go back to reference Di Fabio RP, Mackey G, Holte JB: Disability and functional status in patients with low back pain receiving workers' compensation: a descriptive study with implications for the efficacy physical therapy. Phys Ther. 1995, 75: 180-193.PubMed Di Fabio RP, Mackey G, Holte JB: Disability and functional status in patients with low back pain receiving workers' compensation: a descriptive study with implications for the efficacy physical therapy. Phys Ther. 1995, 75: 180-193.PubMed
20.
go back to reference Kyngäs H, Duffy ME, Kroll T: Conceptual analysis of compliance. J Clin Nurs. 2000, 9: 5-12. 10.1046/j.1365-2702.2000.00309.x.CrossRefPubMed Kyngäs H, Duffy ME, Kroll T: Conceptual analysis of compliance. J Clin Nurs. 2000, 9: 5-12. 10.1046/j.1365-2702.2000.00309.x.CrossRefPubMed
21.
go back to reference Agras WS: Understanding compliance with the medical regimen: the scope of the problem and a theoretical perspective. Arthritis Care Res. 1989, 2 (3): S2-7. 10.1002/anr.1790020308.CrossRefPubMed Agras WS: Understanding compliance with the medical regimen: the scope of the problem and a theoretical perspective. Arthritis Care Res. 1989, 2 (3): S2-7. 10.1002/anr.1790020308.CrossRefPubMed
22.
go back to reference Turk DC, Rudy TE: Neglected topics in the treatment of chronic pain patients--relapse, noncompliance, and adherence enhancement. Pain. 1991, 44 (1): 5-28. 10.1016/0304-3959(91)90142-K.CrossRefPubMed Turk DC, Rudy TE: Neglected topics in the treatment of chronic pain patients--relapse, noncompliance, and adherence enhancement. Pain. 1991, 44 (1): 5-28. 10.1016/0304-3959(91)90142-K.CrossRefPubMed
23.
go back to reference Bassett SF: The assessment of patient adherence to physiotherapy rehabilitation. N Z Journal of Physiotherapy. 2003, 31: 60-66. Bassett SF: The assessment of patient adherence to physiotherapy rehabilitation. N Z Journal of Physiotherapy. 2003, 31: 60-66.
24.
go back to reference Brewer BW, Van Raalte JL, Cornelius AE, Petitpas AJ, Sklar JH, Pohlman MH, Krushell RJ, Ditmar TD: Psychological factors, rehabilitation adherence, and rehabilitation outcome after anterior cruciate ligament reconstruction. Rehabilitation Psychology. 2000, 45: 20-37. 10.1037/0090-5550.45.1.20.CrossRef Brewer BW, Van Raalte JL, Cornelius AE, Petitpas AJ, Sklar JH, Pohlman MH, Krushell RJ, Ditmar TD: Psychological factors, rehabilitation adherence, and rehabilitation outcome after anterior cruciate ligament reconstruction. Rehabilitation Psychology. 2000, 45: 20-37. 10.1037/0090-5550.45.1.20.CrossRef
25.
go back to reference Di Fabio RP, Mackey G, Hole JB: Physical therapy outcomes for patients receiving workers' compensation following treatment for herniated lumbar disc and mechanical low back pain syndrome. J Orthop Sports Phys Ther. 1996, 23: 180-187.CrossRefPubMed Di Fabio RP, Mackey G, Hole JB: Physical therapy outcomes for patients receiving workers' compensation following treatment for herniated lumbar disc and mechanical low back pain syndrome. J Orthop Sports Phys Ther. 1996, 23: 180-187.CrossRefPubMed
26.
go back to reference White JL, Ransdell LB, Vener J, Flohr JA: Factors related to physical activity adherence in women: Review and suggestions for future research. Women Health. 2005, 41: 123-148. 10.1300/J013v41n04_07.CrossRefPubMed White JL, Ransdell LB, Vener J, Flohr JA: Factors related to physical activity adherence in women: Review and suggestions for future research. Women Health. 2005, 41: 123-148. 10.1300/J013v41n04_07.CrossRefPubMed
27.
go back to reference Kolt GS, McEvoy JF: Adherence to rehabilitation in patients with low back pain. Man Ther. 2003, 8: 110-116. 10.1016/S1356-689X(02)00156-X.CrossRefPubMed Kolt GS, McEvoy JF: Adherence to rehabilitation in patients with low back pain. Man Ther. 2003, 8: 110-116. 10.1016/S1356-689X(02)00156-X.CrossRefPubMed
28.
go back to reference Spetch LA, Kolt GS: : Adherence to sport injury rehabilitation: implications for sports medicine providers and researchers. Physical Therapy in Sport. 2001, 2: 80-90. 10.1054/ptsp.2001.0062.CrossRef Spetch LA, Kolt GS: : Adherence to sport injury rehabilitation: implications for sports medicine providers and researchers. Physical Therapy in Sport. 2001, 2: 80-90. 10.1054/ptsp.2001.0062.CrossRef
29.
go back to reference Ludwing EG, Adams SD: Patient cooperation in a rehabilitation center: assumption of the client role. J Health Soc Behav. 1968, 9: 328-336. 10.2307/2948541.CrossRef Ludwing EG, Adams SD: Patient cooperation in a rehabilitation center: assumption of the client role. J Health Soc Behav. 1968, 9: 328-336. 10.2307/2948541.CrossRef
30.
go back to reference Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I: Combined exercise and motivation program: Effect on the compliance and level of disability of patients with chronic low back pain: A randomized controlled trial. Arch Phys Med Rehabil. 1998, 79: 475-487. 10.1016/S0003-9993(98)90059-4.CrossRefPubMed Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I: Combined exercise and motivation program: Effect on the compliance and level of disability of patients with chronic low back pain: A randomized controlled trial. Arch Phys Med Rehabil. 1998, 79: 475-487. 10.1016/S0003-9993(98)90059-4.CrossRefPubMed
31.
go back to reference Hansen FR, Bendix T, Skov P, Jensen CV, Kristensen JH, Krohn L: et al., Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low-back pain. Spine. 1993, 18: 98-108. 10.1097/00007632-199301000-00015.CrossRefPubMed Hansen FR, Bendix T, Skov P, Jensen CV, Kristensen JH, Krohn L: et al., Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low-back pain. Spine. 1993, 18: 98-108. 10.1097/00007632-199301000-00015.CrossRefPubMed
32.
go back to reference Stankovic R, Johnell O: Conservative treatment of acute low back pain: a prospective randomized trial. Spine. 1990, 15: 120-123. 10.1097/00007632-199002000-00014.CrossRefPubMed Stankovic R, Johnell O: Conservative treatment of acute low back pain: a prospective randomized trial. Spine. 1990, 15: 120-123. 10.1097/00007632-199002000-00014.CrossRefPubMed
33.
go back to reference Belza B, Topolski T, Kinne S, Patrick DL, Ramsey SD: Does adherence make a difference? Results from a community-based aquatic exercise program. Nurs Res. 2002, 51: 285-29. 10.1097/00006199-200209000-00003.CrossRefPubMed Belza B, Topolski T, Kinne S, Patrick DL, Ramsey SD: Does adherence make a difference? Results from a community-based aquatic exercise program. Nurs Res. 2002, 51: 285-29. 10.1097/00006199-200209000-00003.CrossRefPubMed
34.
go back to reference Verbeek J, Sengers MJ, Riemens L, Haafkens J: Patients expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine. 2004, 29: 2309-2318. 10.1097/01.brs.0000142007.38256.7f.CrossRefPubMed Verbeek J, Sengers MJ, Riemens L, Haafkens J: Patients expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine. 2004, 29: 2309-2318. 10.1097/01.brs.0000142007.38256.7f.CrossRefPubMed
35.
go back to reference Hayden JA, van Tulder MW, Tomlinson G: Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005, 142: 776-785.CrossRefPubMed Hayden JA, van Tulder MW, Tomlinson G: Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005, 142: 776-785.CrossRefPubMed
36.
go back to reference Proctor TJ, Mayer TG, Theodore B, Gatchel RJ: Failure to complete a functional restoration program for chronic musculoskeletal disorders: a prospective 1-year outcome study. Arch Phys Med Rehabil. 2005, 86: 1509-1515. 10.1016/j.apmr.2005.02.010.CrossRefPubMed Proctor TJ, Mayer TG, Theodore B, Gatchel RJ: Failure to complete a functional restoration program for chronic musculoskeletal disorders: a prospective 1-year outcome study. Arch Phys Med Rehabil. 2005, 86: 1509-1515. 10.1016/j.apmr.2005.02.010.CrossRefPubMed
37.
go back to reference Adams N, Ravey J, Taylor D: Psychological models of chronic pain and implications for practice. Physiotherapy. 1996, 82: 124-129. 10.1016/S0031-9406(05)66967-2.CrossRef Adams N, Ravey J, Taylor D: Psychological models of chronic pain and implications for practice. Physiotherapy. 1996, 82: 124-129. 10.1016/S0031-9406(05)66967-2.CrossRef
38.
go back to reference Cook F, Hassenkamp A: Active rehabilitation for chronic low back pain: the patient's perspective. Physiotherapy. 2000, 86: 61-68. 10.1016/S0031-9406(05)61207-2.CrossRef Cook F, Hassenkamp A: Active rehabilitation for chronic low back pain: the patient's perspective. Physiotherapy. 2000, 86: 61-68. 10.1016/S0031-9406(05)61207-2.CrossRef
39.
go back to reference Cameron C: Patient compliance: recognition of factors involved and suggestions for promoting compliance with therapeutic regimens. J Adv Nurs. 1996, 24: 244-250. 10.1046/j.1365-2648.1996.01993.x.CrossRefPubMed Cameron C: Patient compliance: recognition of factors involved and suggestions for promoting compliance with therapeutic regimens. J Adv Nurs. 1996, 24: 244-250. 10.1046/j.1365-2648.1996.01993.x.CrossRefPubMed
40.
go back to reference Oleske DM, Kwasny MM, Lavender SA, Andersson GBJ: Participation in occupational health longitudinal studies: predictors of missed visits and dropouts. Ann Epidemiol. 2007, 17: 9-18. 10.1016/j.annepidem.2006.07.003.CrossRefPubMed Oleske DM, Kwasny MM, Lavender SA, Andersson GBJ: Participation in occupational health longitudinal studies: predictors of missed visits and dropouts. Ann Epidemiol. 2007, 17: 9-18. 10.1016/j.annepidem.2006.07.003.CrossRefPubMed
41.
go back to reference Lasinger B, Nordholm L, Swik T: Characteristics of low back pain patients who do not complete physiotherapeutic treatment. Scand J Caring Sci. 1994, 8: 63-67.CrossRef Lasinger B, Nordholm L, Swik T: Characteristics of low back pain patients who do not complete physiotherapeutic treatment. Scand J Caring Sci. 1994, 8: 63-67.CrossRef
42.
go back to reference Dean SG, Smith JA, Payne S, Weinman J: Managing time: an interpretative phenomenological analysis of patients' and physiotherapists' perceptions of adherence to therapeutic exercise for low back pain. Disabil Rehabil. 2005, 27: 625-636. 10.1080/0963820500030449.CrossRefPubMed Dean SG, Smith JA, Payne S, Weinman J: Managing time: an interpretative phenomenological analysis of patients' and physiotherapists' perceptions of adherence to therapeutic exercise for low back pain. Disabil Rehabil. 2005, 27: 625-636. 10.1080/0963820500030449.CrossRefPubMed
43.
go back to reference Pulliam C, Gatchel R, Robinson R: Challenges to early prevention and intervention: personal experiences with adherence. Clil J Pain. 2003, 19: 114-120. 10.1097/00002508-200303000-00006.CrossRef Pulliam C, Gatchel R, Robinson R: Challenges to early prevention and intervention: personal experiences with adherence. Clil J Pain. 2003, 19: 114-120. 10.1097/00002508-200303000-00006.CrossRef
44.
go back to reference Rapoff MA, Lindsley CB: Improving adherence to medical regimens for juvenile rheumatoid arthritis. Pediatr Rheumatol J. 2007, 5: 10-10.1186/1546-0096-5-10.CrossRef Rapoff MA, Lindsley CB: Improving adherence to medical regimens for juvenile rheumatoid arthritis. Pediatr Rheumatol J. 2007, 5: 10-10.1186/1546-0096-5-10.CrossRef
45.
go back to reference Engstrom LO, Oberg B: Patient adherence in an individualized rehabilitation programme: a clinical follow-up. Scand J Public Health. 2005, 33: 11-18. 10.1080/14034940410028299.CrossRefPubMed Engstrom LO, Oberg B: Patient adherence in an individualized rehabilitation programme: a clinical follow-up. Scand J Public Health. 2005, 33: 11-18. 10.1080/14034940410028299.CrossRefPubMed
Metadata
Title
Indicators of adherence to physiotherapy attendance among Saudi female patients with mechanical low back pain: a clinical audit
Author
Einas Al-Eisa
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2010
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-11-124

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