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Defining adherence to therapeutic exercise for musculoskeletal pain: a systematic review
  1. Daniel L Bailey1,
  2. Melanie A Holden1,
  3. Nadine E Foster1,
  4. Jonathan G Quicke1,
  5. Kirstie L Haywood2,
  6. Annette Bishop1
  1. 1 Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
  2. 2 Warwick Research in Nursing, Warwick Medical School, Warwick University, Coventry, UK
  1. Correspondence to Daniel L Bailey, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK; d.bailey2{at}


Objective To establish the meaning of the term ‘adherence’ (including conceptual and measurement definitions) in the context of therapeutic exercise (TE) for musculoskeletal (MSK) pain.

Design Systematic review using a search strategy including terms for: adherence, TE and MSK pain. Identified studies were independently screened for inclusion by two researchers. Two independent researchers extracted data on: study type; MSK pain population; type of TE used; definitions, parameters, measurement methods and values of adherence.

Data sources Seven electronic databases were searched from inception to December 2016.

Eligibility criteria Any study type featuring TE for adults with MSK pain and containing a definition of adherence, or a description of how adherence was measured.

Results 459 studies were identified and 86 were included in the review. Most were prospective cohort studies and featured back and/or neck pain. Strengthening and stretching were the most common types of TE. A clearly identifiable definition of adherence was provided in 40% of the studies, with 12% using the same definition. Exercise frequency was the most commonly measured parameter of adherence, with self-report logs the most common measurement method. The most common value range used to determine satisfactory adherence was 80%–99% of the recommended exercise dose.

Conclusion No single definition of adherence to TE was apparent. We found no definition of adherence that specifically related to TE for MSK pain or described the dimensions of TE that should be measured. We recommend conceptualising adherence to TE for MSK pain from the perspective of all relevant stakeholders.

  • exercise
  • exercise rehabilitation

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  • Contributors DLB, NEF, MAH and AB contributed to the design of the review. DLB executed the search strategy with input from NEF, MAH and AB. DLB, NEF, AB and JGQ assessed studies for inclusion and extracted data from each of the included studies. DLB synthesised the data and developed the first draft. All authors interpreted the data, contributed to the critical revision of the manuscript and approved the final version.

  • Funding DLB is supported for this work through a Keele University, Research Institute for Primary Care and Health Sciences, ACORN PhD Studentship. NEF and AB were supported through a National Institute for Health Research (NIHR) Research Professorship awarded to NEF (NIHR-RP-011-015). Professor NEF is a NIHR Senior Investigator. JGQ is supported by a NIHR Academic Clinical Lectureship in Physiotherapy, awarded as part of Professor CM’s NIHR Research Professorship (NIHR-RP-2014-026). KLH is supported by Warwick Research in Nursing, Warwick Medical School, Warwick University.

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Keele University Research Institute for Primary Care and Health Sciences is committed to sharing access to our anonymised research databases derived from our population, consultation, clinical and randomised controlled trial cohorts. Researchers wanting to apply for access to individual patient data from archived studies should first email