Adherence and barriers to home exercise program participation in adults with musculoskeletal pain

Research Objectives: Home Exercise Programs (HEPs) are cost-effective and efficacious treatments for musculoskeletal pain conditions. The objective of this study was to examine adherence and barriers to clinician-prescribed HEPs in adult patients with musculoskeletal pain.

Design: Retrospective cohort study

Setting: Suburban, academic medical center outpatient facility

Participants: A total of 203 patients with musculoskeletal pain conditions seen in the pain clinic who were prescribed physical therapy and HEP from 2019-2020 were included in this analysis.

Interventions: Not applicable.

Main Outcome Measures: Demographic and clinical information, including the targeted body part(s) addressed in PT and HEP were collected from electronic medical records. Patients were asked if enough instructions and/or handouts were given for their HEP, how frequently they adhered to HEP, and their reasons for non-adherence.

Results: Patients had a mean age of 54.1 ± 15.8 years with a range of 17-84 and included 133 (65.5%) females, and 101 (40.8%) patients receiving a HEP for more than one body part. Of 203 patients, 99 (48.8%) adhered to HEP programs, 56 (27.6%) partially adhered, and 48 (23.6%) did not adhere. 187 (92.1%) patients reported receiving enough HEP instructions, and 175 (86.2%) reported receiving handouts. Chi-square and t-test analyses revealed “age” (t, p=0.019) and “sufficient instructions” (p=0.012) as significant determinants of adherence, while gender and handouts were not. The presence of pain in more than one body part was significantly associated with motivational barriers for non-adherence (p < 0.001). Fear/confidence barriers to HEP adherence were significantly associated with gender (p=0.0119), with males showing a higher frequency of fear/confidence.

Conclusions: Age as well as patients’ perception of sufficiently provided instructions were significant determinants of non-adherence. Pain in more than one body part was associated with a motivational barrier to HEP adherence, while male gender was associated with a confidence barrier. These results emphasize the importance of therapist-provided instructions to overcome physical, motivational, and confidence-based barriers.

Author(s) Disclosures: The authors have no conflicts of interest to declare