***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE For long-term treatment effects , patients with subacute back pain need to adhere to treatment recommendations beyond the prescribed exercise treatment . Adherence rates are as low as 30 % , so we developed a cognitive-behavioural training programme to enhance patients ' self-efficacy , maximise severity perceptions and reduce barrier perceptions . METHOD A 2 x 4 ( group x time ) repeated measurement design was applied . Forty-seven patients with non-specific , subacute back pain were r and omly assigned to a training group ( exercise treatment plus cognitive-behavioural training programme ) or a control group ( exercise treatment only ) . RESULTS Repeated measures ANOVA revealed significant main and interaction effects ; the training group reported enhanced self-efficacy and severity perceptions , reduced barrier perceptions , and self-reported that they exercised more often than the control group over time . However , no group differences regarding pain intensity emerged . CONCLUSION Our findings demonstrate that a short and inexpensive cognitive-behavioural training programme is an effective tool to enable back pain patients to follow treatment recommendations on a regular basis . PRACTICE IMPLICATION S The short and simple intervention can easily be conducted by personnel , other than psychologists , i.e. , physiotherapists STUDY OBJECTIVES To underst and reasons for compliance and non-compliance with a home based exercise regimen by patients with osteoarthritis of the knee . DESIGN A qualitative study , nested within a r and omised controlled trial , examining the effectiveness of physiotherapy in reducing pain and increasing mobility in knee osteoarthritis . In the intervention arm , participants undertook a series of simple exercises and repositioning of the kneecap using tape . In depth interviews were conducted with a subset of participants in the intervention arm using open ended questions , guided by a topic schedule , to encourage patients to describe their experiences and reflect on why they did or did not comply with the physiotherapy . Interviews were audiotaped , fully transcribed and analysed thematically according to the method of constant comparison . A model explaining factors influencing compliance was developed . SETTING Patients were interviewed at home . The study was nested within a pragmatic r and omised controlled trial . PARTICIPANTS Twenty participants in the intervention arm of the r and omised trial were interviewed three months after they had completed the physiotherapy programme . Eight were interviewed again one year later . MAIN RESULTS Initial compliance was high because of loyalty to the physiotherapist . Reasoning underpinning continued compliance was more complex , involving willingness and ability to accommo date exercises within everyday life , the perceived severity of symptoms , attitudes towards arthritis and comorbidity and previous experiences of osteoarthritis . A necessary precondition for continued compliance was the perception that the physiotherapy was effective in ameliorating unpleasant symptoms . CONCLUSIONS Non-compliance with physiotherapy , as with drug therapies , is common . From the patient 's perspective , decisions about whether or not to comply are rational but often can not be predicted by therapists or research ers . Ultimately , this study suggests that health professionals need to underst and reasons for non-compliance if they are to provide supportive care and trialists should include qualitative research within trials whenever levels of compliance may have an impact on the effectiveness of the intervention We investigated the effects of home-based daily exercise on joint mobility , functional capacity , pain , and depression in patients with ankylosing spondylitis ( AS ) . The patients were r and omly assigned to a wait-list control group or to an exercise-therapy group . The exercise-therapy group performed a 20-min exercise program once per day for 8 consecutive weeks . After 8 weeks , compared with the control group , the exercise group showed improvements in joint mobility ( cervical flexion , extension , shoulder flexion , abduction , hip abduction , and knee flexion ) , finger – floor distance , and functional capacity . Pain and depression scores were significantly lower after the exercise program in the exercise group than in the control group . These findings indicate that exercise therapy increases joint mobility and functional capacity , and decreases pain and depression in patients with AS .  Home-based exercise , which is easily accessible to patients , might be an effective intervention for AS Concern has been raised about the lack of participant compliance  in diary studies that use paper- and -pencil as opposed to electronic formats . Three studies explored the magnitude of compliance problems and their effects on data quality . Study 1 used r and om signals to elicit diary reports and found close matches to self-reported completion times , matches that could not plausibly have been fabricated . Studies 2 and 3 examined the psychometric and statistical equivalence of data obtained with paper versus electronic formats . With minor exceptions , both methods yielded data that were equivalent psychometrically and in patterns of findings . These results serve to at least partially mollify concern about the validity of paper diary methods OBJECTIVE Treatment recommendations for fibromyalgia ( FM ) include regular physical exercise . In this prospect i ve study we examined predictors for adherence to stretching and aerobic exercises in women provided with an individualized home based program .  METHODS Thirty-nine women kept exercise diaries for 12 weeks . RESULTS For both types of exercise , women who were less physically fit at baseline engaged in more exercise during the program . Yet for stretching , more lower body pain at baseline predicted engaging in less stretching exercise over time , whereas for aerobic exercise , more baseline upper body pain predicted more exercise over time . As time passed , participants with higher baseline physical fitness and /or older age were reducing their aerobic exercise practice at significantly faster rates , as were those women with higher baseline stress . CONCLUSION Given that adequate levels of adherence were limited to about half of the participants for both types of exercise , steps to reduce barriers to exercise ( e.g. , stress ) need to be taken when prescribing exercise in the treatment of FM OBJECTIVE Great efforts have been made to find effective treatments for back pain . Nevertheless , the effectiveness of a particular treatment can depend on patient compliance . The objective of this study was to prospect ively investigate whether patients ' demographic factors , clinical factors , external barriers in following the treatment , and perceptions of disability , quality of life , depression , and control over health were predictive of compliance with a physical therapy program carried out with patients with low back pain . METHODS This was an exploratory prospect i ve cohort study that was carried out in New York City during 1999 . All study participants answered a question naire at the initial clinical evaluation by a physical therapist and were followed during the treatment . The study assessed compliance with the three treatment regimens that were prescribed for every patient : attending scheduled physical therapy sessions , following a program of home exercises , and watching back-education videotapes . Depending on the individual patient , the planned treatment program could last from 2 to 6 weeks . The study employed a battery of instruments to measure patient characteristics that included perceived functional limitations , perceived quality of life , depression , and their beliefs about their health . Student 's t tests and chi-square tests were used to determine if non- and low-compliant patients differed significantly from high-compliant patients . Logistic regression was used to estimate adjusted odds ratios expressing the association of selected variables with compliance . RESULTS We found that 51 % of the patients were either noncompliant or low-compliant overall with the low back pain treatment program . There were differences in compliance behavior among the three treatment regimens , with compliance being highest for watching the back-education videotapes and lowest for doing the home exercises . Poor compliance overall was positively associated with the expectation of barriers in following the proposed treatment , with comorbidity , and with longer duration of treatment in this program . CONCLUSIONS The findings of our study indicate that patient compliance with back pain treatment is a serious and complex problem . Nevertheless , while this study was only an exploratory one , we believe that the results of this study can be used by care providers to identify patients likely to become noncompliant and also by research ers to plan specific studies on the effectiveness of treatment programs for patients with low back pain The aim of this study was to examine the effects of threat appraisal  ( perceived susceptibility to re-injury or retarded rehabilitation and perceived severity of injury )  and coping appraisal ( self-efficacy , treatment efficacy and outcome value ) , in the framework of Protection Motivation Theory ( PMT ) , on compliance to a sports physiotherapist 's prescribed modalities and rest . During extensive developmental work , a Sports Injury Rehabilitation Beliefs Survey was constructed with 19 items to assess the PMT components . Five compliance measures were developed from physiotherapist and patient surveys . Data from 62 subjects ( 68 % female , mean + /- S.D. age 21.7 + /- 2.85 years , and involved in many recreational and competitive activities ) were obtained from a single university-based sports injury clinic , in a prospect i ve study . The study revealed that over half the subjects were subsequently non-compliant to some degree . Greater perceptions of both susceptibility to retarded rehabilitation and injury severity , at the first appointment , were related to subsequent non-compliant behaviour . Greater self-efficacy in the ability to perform prescribed rehabilitation modalities , stronger beliefs in the treatment efficacy , and higher value attached to rehabilitation , were all related to compliant behaviour .  Compliance to restricted activity ( or rest )  was only related to greater perceptions of susceptibility . The findings provide some support for PMT in this context and offer a basis for design ing sports therapist interventions which focus on threat and coping appraisal Paper diaries are commonly used in health care and clinical research to assess patient experiences . There is concern that patients do not comply with diary protocol s , possibly invalidating the benefit of diary data . Compliance with paper diaries was examined with a paper diary and with an electronic diary that incorporated compliance-enhancing features .  Participants were chronic pain patients and they were assigned to use either a paper diary instrumented to track diary use or an electronic diary that time-stamped entries . Participants were instructed to make three pain entries per day at predetermined times for 21 consecutive days . Primary outcome measures were reported vs actual compliance with paper diaries and actual compliance with paper diaries ( defined by comparing the written times and the electronically-recorded times of diary use ) . Actual compliance was recorded by the electronic diary . Participants su bmi tted diary cards corresponding to 90 % of assigned times ( + /-15 min ) . However , electronic records indicated that actual compliance was only 11 % , indicating a high level of faked compliance . On 32 % of all study days the paper diary binder was not opened , yet reported compliance for these days exceeded 90 % . For the electronic diary , the actual compliance rate was 94 % . In summary , participants with chronic pain enrolled in a study for research were not compliant with paper diaries but were compliant with an electronic diary with enhanced compliance features . The findings call into question the use of paper diaries and suggest that electronic diaries with compliance-enhancing features are a more effective way of collecting diary information Attrition in an experimental osteoarthritis intervention was studied among 364 ( 130 male ) volunteers ( ages 60 - 87 ) . Subjects were r and omly assigned to control , social support , education , or combined treatment groups . A series of discriminant function analyses showed that the final intervention groups were more homogeneous than the original sample s. The most robust predictor of attrition was having either high or very low depression scores . Social support variables were predictors of poor attendance in the social support group , indicating possible attrition bias in evaluating this treatment . The results indicate that psychosocial variables may be the best predictors of attrition in health intervention research among older subjects , and that variables related to attrition can be related to the content of the intervention BACKGROUND AND PURPOSE This correlational study describes factors that are related to patient compliance with exercise regimens during physical therapy .  We investigated whether patient compliance was related to characteristics of the patient or the patient 's illness , to the patient 's attitude , or to the physical therapist 's behavior . SUBJECTS AND METHODS Of a r and om sample of 300 physical therapists in private practice in the Netherl and s , 222 therapists responded to a question naire survey . Eighty-four respondents also made audio recordings . Material s of the study were 1,931 registration forms  , 1,837 audio-recorded sessions of physical therapy sessions  , and 1,681 patient question naires .  RESULTS The results show that the three main factors related to noncompliance were ( 1 ) the barriers patients perceive and encounter , ( 2 ) the lack of positive feedback , and ( 3 ) the degree of helplessness . The first factor , the barriers patients perceive and encounter , shows the strongest relation with noncompliance . The results also show that noncompliance is more strongly related to the characteristics of the illness than to the illness , a bad prognosis is negatively related to compliance , and much hindrance of the complaint is positively related to compliance . There was no difference between men and women with regard to patient compliance , but less educated patients were slightly more compliant than more highly educated patients . CONCLUSION AND DISCUSSION These correlational findings can be used to formulate hypotheses of cause and effect in future clinical research . Future research should take into account the type and efficacy of therapeutic exercise for different diseases . For physical therapy practice , it seems important that physical therapists carefully explore which problems patients encounter in their efforts to comply and that they seek solutions to those problems in mutual cooperation with their patients OBJECTIVE : To examine whether the relationships between psychological factors and rehabilitation adherence after  knee surgery  differ as a function of age . DESIGN AND SETTING : Participants completed inventories of self-motivation , social support , athletic identity , and psychological distress before anterior cruciate ligament ( ACL ) reconstruction . After surgery , participants recorded their completion of home rehabilitation exercises and cryotherapy , and the sport rehabilitation professionals providing their treatment reported on the patients ' attendance at , and adherence during , rehabilitation sessions . SUBJECTS : Sixty-one individuals with acute ACL tears . ME 
    Output:
    
The review included twenty high quality studies investigating barriers to treatment adherence in musculoskeletal population s. There was strong evidence that poor treatment adherence was associated with low levels of physical activity at baseline or in previous weeks , low in-treatment adherence with exercise , low self-efficacy , depression , anxiety , helplessness , poor social support/activity , greater perceived number of barriers to exercise and increased pain levels during exercise .