Factors Associated With Rehabilitative Home Exercise Adherence Among Older Adults With Chronic Back Pain: Secondary Analysis of a Randomized Trial

Objectives: The purpose of this study was to assess the association between baseline factors and adherence to rehabilitative home exercise (RHE) after 12 weeks of chiropractic spinal manipulation (CSM) plus RHE instruction, and whether adherence was associated with improvement in back-related disability in adults ≥65 years with chronic low back pain (CLBP). Methods: This secondary analysis used randomized trial data collected in 2010 through 2013 from community-dwelling older adults with CLBP and disability in a metropolitan area in the upper mid-west United States. We defined adherence as exercising ≥ 4 days/week, and clinically meaningful disability improvement as ≥ 30% reduction in Oswestry Disability Index (ODI). Baseline factors (demographic, low back, activity, function) associated with adherence and change in disability were tested with chi-square and logistic regression. Results: Among 176 participants, mean age was 71.1 years, 59.7% were female, and median back pain duration was 13.5 years. Baseline average back pain and ODI were moderate. Over 12 weeks of treatment, median CSM visits was 11; RHE instruction was 4. Over half the participants (56.3%) reported RHE adherence of ≥ 4x/week at 12 weeks. No baseline factors were associated with 12-week RHE adherence (all P > .05), and adherence was not associated with change in ODI. Only adherence at 4 weeks was positively associated with 12-week adherence (P < .001). Conclusions: Among this sample of older adults with CLBP, baseline patient characteristics did not predict adherence to home exercise recommendations. Further, adherence was not associated with clinically meaningful change in disability.