IDENTIFYING BARRIERS AND ENABLERS TO EXERCISE ADHERENCE IN PEOPLE WITH CHRONIC LOW BACK PAIN: A QUALITATIVE STUDY

Abstract

INTRODUCTION Exercise leads to clinically meaningful pain reductions in people with chronic low back pain and is recommended as a first line treatment. However, it has been shown that exercise effectiveness decreases over time and no longer has a meaningful effect for chronic low back pain at long-term follow up. It is likely that a lack of exercise adherence is a major contributing factor responsible for these reductions in efficacy. We aimed to identify the barriers and enablers to exercise adherence from the perspective of people with chronic low back pain. METHODS This qualitative study was underpinned by a constructivist epistemology and used a critical realist ontological perspective. Adults (18-65yrs) with chronic low back pain who had exercised since the onset of their back pain were recruited to participate in focus groups and individual interviews. Audio data were transcribed and then analysed in two stages: (1) inductive coding using reflexive thematic analysis, followed by (2) deductive analysis through mapping codes onto the Theoretical Domains Framework. RESULTS Five enablers and three barriers were identified across six of the fourteen Theoretical Domain Framework domains. Exercise identity and confidence in deciding to self-manage pain were enablers, whereas beliefs about the consequences of exercise, exercise context and relationships could function as either/both barriers and enablers. CONCLUSION Analysis of these barriers and enablers found that they were not static factors isolated to influencing a single decision of ‘to exercise or not’. Instead barriers and enablers were complex and fluid, with participants reporting conflicting barriers and enablers that were subject to change, depending on context. These findings improve our understanding of the barriers and enablers to exercise adherence from the individual perspective of people with chronic low back pain and can be utilised for more effective exercise treatment in this population.