Understanding barriers to adherence to home exercise programs in patients with musculoskeletal neck pain

Background: Home exercise program (HEP) prescription is commonplace in physical therapy (PT). Adherence to HEPs is generally poor, with non-adherence as high as 70%. Poor adherence may negatively impact outcomes. Objectives: To (i) qualitatively assess patients’ thoughts and beliefs regarding HEP performance and (ii) quantitatively define the relationship between adherence to HEPs and functional outcomes and identify variables that impact adherence. Design: Mixed-methods. Method: Part 1 involved semi-structured interviews with patients attending PT for neck pain. Responses were assessed using thematic analysis. Part 2 involved a retrospective chart review of patients seen in outpatient PT for neck pain. Between-group (adherent and non-adherent) differences in functional scores were analyzed using a linear mixed model. Sex, age, and functional score data was entered into a regression model to explore their ability to predict adherence. Results: 25 participants were interviewed. Qualitative analysis revealed the following themes associated with adherence to a HEP: (i) prior PT, (ii) observability of outcomes, (iii) expectations of PT, and (iv) experience of pain. Retrospective data from 187 patients was analyzed. Functional scores at discharge were significantly higher (p = 0.03, mean difference = 12.4) in the adherent group. Age (OR = 0.98; 95% CI = 0.93–1.02), male sex (OR = 1.23; 95% CI = 0.22–6.91), and functional scores at intake (OR = 0.99; 95% CI = 0.92–1.07) were not significant predictors of non-adherence. Conclusions: Individual patient experiences such as delayed improvement in symptoms and/or experience of pain associated with HEP performance may contribute to poor adherence to HEPs. Adherence to a HEP was associated with superior functional outcomes compared to non-adherence. Age, sex, and functional scores were not predictors of non-adherence.