BARRIERS AND ENABLERS TO EXERCISE ADHERENCE IN PEOPLE WITH CHRONIC LOW BACK PAIN: A SYSTEMATIC REVIEW OF QUALITATIVE EVIDENCE

Abstract

INTRODUCTION Exercise is a first line treatment for chronic low back pain, reducing pain and disability in the short-term. However, exercise benefits decrease over time, with a lack of long-term exercise adherence a potential reason for this. This study aimed to synthesize the perceptions and beliefs of individuals with chronic low back pain and identify their barriers and enablers to exercise adherence. METHODS We searched CENTRAL, EMBASE, CINAHL, SPORTDiscus, PubMed, PsycINFO, CINAHL, and Scopus databases from inception to 28th February 2023 for qualitative studies that explored the factors influencing exercise adherence for people with chronic low back pain. A hybrid approach combining inductive analysis using thematic synthesis and a deductive analysis, which included the Theoretical Domains Framework of behaviour change was used to analyse data. We assessed methodological quality using the Critical Appraisal Skills Programme checklist and the level of confidence of the themes found using the Confidence in the Evidence from Reviews of Qualitative Studies (GRADE-CERQual). RESULTS Twenty-three papers (n=21 studies) were included (n=478 participants). Four main themes impacted exercise adherence: 1) exercise, pain, and the body, 2) psychological factors, 3) social factors and 4) external factors. These themes contained 16 subthemes that were predominantly both barriers and enablers to exercise adherence. There was moderate to high confidence across the findings. CONCLUSION Our analysis found that individual’s experiences of barriers and enablers were most appropriately represented across a spectrum, where influencing factors could be a barrier or enabler to exercise adherence. Barriers and enablers were also found to be specific to pre-exercise, during exercise and post-exercise situations. This may lead to an improved and targeted approach to increasing exercise adherence. Further research is required to develop interventions that can use these findings for a more personalised and patient centred approach to treatment.