Essay: Research proposal: Perceived barriers that influence adherence to home exercise program in patients with chronic low back pain

Background information:
A randomized controlled trial was conducted by Celia Albaladejo, Francisco M. Kovacs, Ana Royuela, Rafael del Pino, Javier Zamora, PhD, and the Spanish Back Pain Research Network to assess the efficacy of a short education program and short physiotherapy program for treating low back pain (LBP) in primary care1. 348 low back pain patients were randomized to 3 groups control, education, and education physiotherapy. While all the patients received a booklet and group talk on health education, the patients in the education plus physiotherapy group received education on postural hygiene, 4 one-hour physiotherapy sessions of exercise and stretching, which they were encouraged to continue at home.
After the 6 -month follow -up, the results of this study suggested that improvements in the control group were negligible whereas addition of a short physiotherapy program with exercises to be intended to be continued at home led to improvements in disability, pain, and quality of life1.
Low back pain is a common problem encountered in daily life. Treatment for low back pain usually involves prescription of individually designed exercise therapy treatment at the clinic which is to be followed at home. Several studies from the past have concluded that exercise appears to be effective in decreasing disability, pain and improving function.
Adhering to a regular exercise program is extremely important to achieve improvements in pain levels and in improving quality of life. Recurrence of low back pain can also be prevented if one religiously follows the exercise regime. It is a known fact that patients avoid exercising at home thus delaying their recovery and have various factors to blame. The study conducted was limited to delivering an effective exercise program and does not take into account a patients point of view of being involved with these exercises at home.
Many studies conducted in the past talk about effectiveness of a home exercise program in treating patients with low back pain, but there is a paucity of studies analyzing the barriers patients perceive in implementing these exercise programs at home. Studying the difficulties or barriers patients perceive in adhering to a home exercise program can aid physical therapists to formulate ways in which their patients will be able to adhere to the prescribed home exercise program.
The purpose of this study is to explore the perceived barriers to home exercise program in patients with low back pain. The research questions that this study will address are:
(1) How do patients describe their experiences of a prescribed home exercise program?
(2) What are the difficulties or barriers that patients perceive while trying to adhere to a prescribed home exercise program?
(3) What are the can be done to increase patient adherence to home exercise program?
According to Creswell, a phenomenological study focusses on the lived experiences of a concept or a phenomenon. It studies the common shared experiences of several individuals2. Thus the qualitative approach plan suitable for this study will be phenomenology.
The participants in this study will be patients with mechanical low back pain referred to physical therapy opd and will be recruited from this set up. These patients will be performing the exercises taught to them as a part of their home exercise program. According to Creswell, the participants involved in a phenomenological study should belong to a heterogeneous group ranging from 3-4 individuals to 10 to 152. The sample size of this study will comprise a heterogeneous group of 15 individuals with mechanical low back pain.
Inclusion criteria:
(1) Patients with mechanical low back pain who have completed physical therapy sessions at a clinic recently and were involved in home exercise program. (2) Patients who are 18 years and older. (3) Patients who can read and understand English.
Exclusion criteria:
(1) Patients with back pain due to trauma. (2) Patients with any underlying disease or other physical condition. (3) Patients with radiating pain.
Data collection procedures:
Informed consent will be obtained from the participants. Semi-structured in-depth individual interviews lasting for about 45 minutes will be conducted on patients. The semi structured interviews may comprise questions such as,
‘What are your experiences of a home exercise program’?
‘What situation have affected or influenced your experiences’?
‘Can you explain if you perceived any barriers or assistance to the prescribed exercise program’?
Simultaneously data will be collected by practicing therapists to understand what they feel about the barriers patients may perceive in adhering to a home exercise program.
Audio taping will be performed, and data will then be transcribed.
Data analysis:
The transcripts will be read and re-read several times independently by different researchers on the team without any prejudice. At this stage, bracketing will be done. This will be done so that the researcher can bracket his own thoughts so as to only concentrate only on the participant’s interpretation. Memoing of the data will be done. Significant statements from the transcripts will be highlighted and listed. Thus horizontalization of data will be done. The transcripts will be coded by the researchers independently and divided into categories. These identified significant statements will then be developed into clusters of meaning called meaningful units or themes.
Themes will be based on textual description by comprising details of what the patients have experienced in terms of a home exercise program.
Themes will include structural description by comprising information about the situation or factors that influences how patients experienced the exercise program.
Sub-themes may be produced and finally a table comprising of themes and sub-themes will be formed.
Two different researchers from outside the program would be called upon to look for any bias reflected from the transcribed information, to check if there was relevant information in the transcripts and to delete any irrelevant information from the transcripts. Exhaustive description of the phenomenon will be done. Thus the essence of the phenomenon will be understood by the readers.