SPESİFİK OLMAYAN BEL AĞRILI HASTALARDA TERAPÖTİK EGZERSİZLERE OLAN UYUM

Öz

Amaç: Bel ağrısında terapötik egzersizlere olan uyum, bireylerin uzun ömürlülüğünü, yaşam kalitesini ve sağlık bakım maliyetlerini önemli ölçüde etkileyebilir. Spesifik olmayan bel ağrısında, belirli hasta özellikleri ile egzersize olan uyumun özelliklerini ve ilişkisini açıklayan yeterli sayıda araştırma yoktur. Bu araştırma, (i) eğitim ile uyum arasındaki ilişkiyi, (ii) algılanan ağrı düzeyi ile uyum arasındaki ilişkiyi ve (iii) eğitim ve ağrı düzeyinin, egzersize olan uyumda anlamlı prediktörler olup olmadığını incelemeyi amaçlamıştır. Yöntem: Bu çalışma, spesifik olmayan bel ağrılı 50 birey ile fizyoterapi polikliniği ortamında nicel araştırma olarak yapılmıştır. Toplanan veriler şunlardır: Sosyodemografik özellikler, Görsel Analog Skala (GAS) ile ölçülen ağrı seviyesi ve Egzersize Uyum Derecelendirme Ölçeği (EUDÖ) ölçülen egzersize olan uyum. Hipotez testleri için kullanılan istatistiksel yöntemler; (i) Küçük Bağımsız Örneklerde t testi, (ii) Pearson Korelasyon Katsayısı ve (iii) Doğrusal Regresyon Analizi. Sonuçlar: Sonuçlar, (i) üniversite eğitimi almış kişilerde egzersize uyumun daha iyi olduğunu, (ii) artmış uyumun ağrı düzeyini azalttığını ve (iii) eğitimin daha güçlü bir prediktör olduğu durumlarda uyumu öngörmede, eğitimin ve ağrı düzeyinin önemli olduğunu göstermektedir. Tartışma: Üniversite eğitimli kişiler terapötik egzersize daha yatkındır ve bu uyum fizyoterapi sonuçlarını belirler. Bu araştırmanın klinik uygulamaya katkısı, spesifik olmayan bel ağrısında egzersize uyum ve eğitim düzeyi ilişkisi ve doğası ve bunun fizyoterapi sonuçları üzerindeki önemli etkisine ilişkin bulguları yansıtmaktadır.

Anahtar Kelimeler

• Bel Ağrısı
• Egzersiz
• Fizik Tedavi Modaliteleri
• Hasta Uyumu

ADHERENCE TO THERAPEUTIC EXERCISE IN PATIENTS WITH NONSPECIFIC LOW BACK PAIN

Abstract

Purpose: Adherence to therapeutic exercises for low back pain can significantly impact longevity, quality of life, and health care costs. There is insufficient research describing the nature and relationship between specific patient characteristics and exercise adherence in non-specific low back pain (NSLBP). This research aimed to examine: (i) the relationship between education and adherence, (ii) the relationship between perceived pain level and adherence, and (iii) whether education and pain level are significant predictors of adherence. Methods: Observational analytic research was conducted in a physiotherapy outpatient setting on a sample of 50 subjects with NSLBP. Data collected were: sociodemographic, pain level according to the visual analogue scale (VAS) and adherence measured by the Exercise Adherence Rating Scale (EARS). For hypotheses testing, statistical methods used were; t-test for small independent samples (i), Pearson correlation coefficient (ii) and linear regression analysis (iii). Results: The results show that: (i) people with a college education are more adherent, (ii) increasing adherence reduces pain level, and (iii) education and pain level are significant in predicting adherence, where education is a stronger predictor. Conclusion: College-educated persons are more prone to therapeutic exercise, and adherence determines physiotherapy outcomes. The contribution of research to clinical practice is reflected in the findings of the nature and relationship between education level and exercise adherence in NSLBP and its significant impact on physiotherapy outcomes.

Keywords

• Exercise
• Low Back Pain
• Patient Adherence
• Physical Therapy Modalities

References

1. 1. Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, Blyth FM, Smith E, Buchbinder R, Hoy D. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299.
2. 2. Driscoll T, Jacklyn G, Orchard J, Passmore E, Vos T, Freedman G, Lim S, Punnett L. The global burden of occupationally related low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):975-81.
3. 3. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367.
4. 4. Burton AK, Balagué F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Müller G, van der Beek AJ; COST B13 Working Group on Guidelines for Prevention in Low Back Pain. Chapter 2. European guidelines for prevention in low back pain: November 2004. Eur Spine J. 2006;15 Suppl 2(Suppl 2):S136-68.
5. 5. National Institute for Health and Care Excellence Internet. Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59]. London: NICE, Published: 30 November 2016 Last updated: 11 December 2020. Available from: https://www.nice.org.uk/guidance/ng59
6. 6. Dustine JL, Gordon B, Wang Z, Luo X. Chronic disease and the link to physical activity. J Sport Health Sci. 2013;2(1):3-11.
7. 7. Oliveira VC. Self-management of non-specific low back pain. J Yoga Phys Ther. 2014;12(4):367.
8. 8. Friedrich M, Gittler G, Arendasy M, Friedrich KM. Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain. Spine (Phila Pa 1976). 2005;30(9):995-1000.

9. 9. Hayden JA, van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med. 2005;142(9):765-75.
10. 10. van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J. 2011;20(1):19-39.
11. 11. Hayden JA, van Tulder MW, Tomlison G. Systematic review: strategies for using exercise therapy to improve chronic low back pain outcomes. Ann Intern Med. 2005;142:765–75.
12. 12. Karnad P, McLean S, eds. Physiotherapists’ perceptions of patient adherence to home exercises in chronic musculoskeletal rehabilitation. Int J Physiother Rehabil. 2011;1:14–29.
13. 13. Di Fabio RP, Mackey G, Holte J. Disability and status in patients with low back pain receiving workers’ compensation. A described study with implications for the efficacy of physical therapy. Phys Ther. 1995;75:180–93.
14. 14. Beinart NA, Goodchild CE, Weinman JA, Ayis S, Godfrey EL. Individual and intervention-related factors associated with adherence to home exercise in chronic low back pain: a systematic review. Spine J. 2013;13:1940-1950.
15. 15. Crandall S, Howlett S, Keysor JJ. Exercise adherence interventions for adults with chronic musculoskeletal pain. Phys Ther. 2013;93:17-21.
16. 16. Austin S, Qu H, Shewchuk RM. Association between adherence to physical activity guidelines and health-related quality of life among individuals with physician-diagnosed arthritis. Qual Life Res. 2012;21:1347-1357.
17. 17. Gordon R, Bloxham S. A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel). 2016;4(2):22.
18. 18. Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Jimeno-Serrano FJ, de Oliveira Sousa SL, del Baño-Aledo ME, Lomas-Vega R. How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study. BMC Health Serv Res. 2010;10:60.
19. 19. Slade SC, Patel S, Underwood M, Keating JL. What are patient beliefs and perceptions about exercise for nonspecific chronic low back pain? A systematic review of qualitative studies. Clin J Pain. 2014;30(11):995-1005.
20. 20. Rivera-Torres S, Fahey TD, Rivera MA. Adherence to Exercise Programs in Older Adults: Informative Report. Gerontol Geriatr Med. 2019;5:2333721418823604.
21. 21. Areerak K, Waongenngarm P, Janwantanakul P. Factors associated with exercise adherence to prevent or treat neck and low back pain: A systematic review. Musculoskelet Sci Pract. 2021;52:102333.
22. 22. Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, Harris JD. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2(3):e088.
23. 23. Newman-Beinart NA, Norton S, Dowling D, Gavriloff D, Vari C, Weinman JA, Godfrey EL. The development and initial psychometric evaluation of a measure assessing adherence to prescribed exercise: the Exercise Adherence Rating Scale (EARS). Physiotherapy. 2017;103(2):180-5.
24. 24. Adhikari SP, Dev R, Shrestha JN. Cross-cultural adaptation, validity, and reliability of the Nepali version of the Exercise Adherence Rating Scale: a methodological study. Health Qual Life Outcomes. 2020;18(1):328.
25. 25. de Lira MR, de Oliveira AS, França RA, Pereira AC, Godfrey EL, Chaves TC. The Brazilian Portuguese version of the Exercise Adherence Rating Scale (EARS-Br) showed acceptable reliability, validity and responsiveness in chronic low back pain. BMC Musculoskelet Disord. 2020;21(1):294.
26. 26. Takasaki H, Kawazoe S, Miki T, Chiba H, Godfrey E. Development and validity assessment of a Japanese version of the Exercise Adherence Rating Scale in participants with musculoskeletal disorders. Health Qual Life Outcomes. 2021;19(1):169.
27. 27. Fehrmann E, Kotulla S, Fischer L, Kienbacher T, Tuechler K, Mair P, Ebenbichler G, Paul B. The impact of age and gender on the ICF-based assessment of chronic low back pain. Disabil Rehabil. 2019;41(10):1190-1199.
28. 28. Franco KFM, Franco Y, Oliveira NTB, Padula RS, Cabral CMN. Predictive factors for progression through the difficulty levels of Pilates exercises in patients with low back pain: a secondary analysis of a randomized controlled trial. Braz J Phys Ther. 2018;22(6):512–8.
29. 29. Taulaniemi A, Kankaanpää M, Rinne M, Tokola K, Parkkari J, Suni JH. Fear-avoidance beliefs are associated with exercise adherence: secondary analysis of a randomised controlled trial (RCT) among female healthcare workers with recurrent low back pain. BMC Sports Sci Med Rehabil. 2020;12:28.
30. 30. European Union. Internet. Description of the eight EQF levels. Available from: https://europa.eu/europass/hr/description-eight-eqf-levels
31. 31. Mannion AF, Helbling D, Pulkovski N, Sprott H. Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome. Eur Spine J. 2009;18(12):1881-91.
32. 32. Nava-Bringas TI, Roeniger-Desatnik A, Arellano-Hernández A, Cruz-Medina E. Adherencia al programa de ejercicios de estabilización lumbar en pacientes con dolor crónico de espalda baja [Adherence to a stability exercise program in patients with chronic low back pain]. Cir Cir. 2016;84(5):384-91.
33. 33. Saner J, Bergman EM, de Bie RA, Sieben JM. Low back pain patients' perspectives on long-term adherence to home-based exercise programmes in physiotherapy. Musculoskelet Sci Pract. 2018;38:77-82.
34. 34. Dhondt E, Van Oosterwijck J, Cagnie B, Adnan R, Schouppe S, Van Akeleyen J, Logghe T, Danneels L. Predicting treatment adherence and outcome to outpatient multimodal rehabilitation in chronic low back pain. J Back Musculoskelet Rehabil. 2020;33(2):277-293.
35. 35. Ris I, Broholm D, Hartvigsen J, Andersen TE, Kongsted A. Adherence and characteristics of participants enrolled in a standardised programme of patient education and exercises for low back pain, GLA:D® Back - a prospective observational study. BMC Musculoskelet Disord. 2021;22(1):473.
36. 36. Chan D, Can F. Patients’ adherence/compliance to physical therapy home exercises. Fizyoter Rehabil. 2010;21(3):132-139.