Department of Physical Therapy, University of Murcia, Murcia, Spain.
BMC Musculoskelet Disord. 2009 Dec 9;10:155. doi: 10.1186/1471-2474-10-155.
Evidence suggests that to facilitate physical activity sedentary people may adhere to one component of exercise prescriptions (intensity, duration or frequency) without adhering to other components. Some experts have provided evidence for determinants of adherence to different components among healthy people. However, our understanding remains scarce in this area for patients with neck or low back pain. The aims of this study are to determine whether patients with neck or low back pain have different rates of adherence to exercise components of frequency per week and duration per session when prescribed with a home exercise program, and to identify if adherence to both exercise components have distinct predictive factors.
A cohort of one hundred eighty-four patients with chronic neck or low back pain who attended physiotherapy in eight primary care centers were studied prospectively one month after intervention. The study had three measurement periods: at baseline (measuring characteristics of patients and pain), at the end of physiotherapy intervention (measuring characteristics of the home exercise program) and a month later (measuring professional behaviors during clinical encounters, environmental factors and self-efficacy, and adherence behavior).
Adherence to duration per session (70.9% +/- 7.1) was more probable than adherence to frequency per week (60.7% +/- 7.0). Self-efficacy was a relevant factor for both exercise components (p < 0.05). The total number of exercises prescribed was predictive of frequency adherence (p < 0.05). Professional behaviors have a distinct influence on exercise components. Frequency adherence is more probable if patients received clarification of their doubts (adjusted OR: 4.1; p < 0.05), and duration adherence is more probable if they are supervised during the learning of exercises (adjusted OR: 3.3; p < 0.05).
We have shown in a clinic-based study that adherence to exercise prescription frequency and duration components have distinct levels and predictive factors. We recommend additional study, and advise that differential attention be given in clinical practice to each exercise component for improving adherence.
有证据表明，为了促进身体活动，久坐不动的人可能会遵守运动处方的一个组成部分（强度、持续时间或频率），而不遵守其他组成部分。一些专家已经提供了健康人群中不同组成部分依从性的决定因素的证据。然而，对于患有颈部或下背痛的患者，我们在这方面的理解仍然很少。本研究的目的是确定患有颈部或下背痛的患者在接受家庭运动计划治疗时，每周频率和每次运动持续时间的运动成分的依从率是否不同，以及是否有不同的预测因素来预测对这两个运动成分的依从性。
前瞻性研究了 184 名在 8 个初级保健中心接受物理治疗的慢性颈痛或下背痛患者，在干预后 1 个月进行研究。该研究有三个测量期：基线期（测量患者和疼痛的特征）、物理治疗干预结束时（测量家庭运动计划的特征）和一个月后（测量临床就诊时的专业行为、环境因素和自我效能以及依从行为）。
每次运动持续时间的依从性（70.9% +/- 7.1）比每周运动频率的依从性（60.7% +/- 7.0）更有可能。自我效能是两个运动成分的相关因素（p < 0.05）。规定的运动总数可以预测频率的依从性（p < 0.05）。专业行为对运动成分有明显的影响。如果患者在澄清疑虑时（调整后的 OR：4.1；p < 0.05），则更有可能坚持运动频率，如果他们在学习运动时得到监督（调整后的 OR：3.3；p < 0.05），则更有可能坚持运动持续时间。
我们在一项基于诊所的研究中表明，运动处方频率和持续时间成分的依从性具有不同的水平和预测因素。我们建议进一步研究，并建议在临床实践中对每个运动成分给予不同的关注，以提高依从性。
