Archives of physical medicine and rehabilitation · 2025
Finding Predictive Factors of Stabilization Exercise Adherence in Randomized Controlled Trials on Low Back Pain: An Individual Data Reanalysis Using Machine Learning Techniques.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Pfeifer Ann-Christin, Schröder-Pfeifer Paul, Schiltenwolf Marcus, Vogt Lutz, Schneider Christian, Platen Petra, Beck Heidrun, Wippert Pia-Maria, Engel Tilman, Wochatz Monique, Mayer Frank, Niederer Daniel
Аннотация
OBJECTIVE: To identify predictors of adherence in supervised and self-administered exercise interventions for individuals with low back pain.
DESIGN: Cohort study.
SETTING: Rehabilitation.
PARTICIPANTS: This preplanned reanalysis within the Medicine in Spine Exercise Network included 1511 participants with low back pain (57% female, mean age 40.9 years, SD ±14 years).
INTERVENTIONS: Participants underwent an initial 3-week supervised phase of sensorimotor exercises, followed by a 9-week self-administered phase.
MAIN OUTCOME MEASURES: Biological, psychological, and social factors potentially impacting training adherence were evaluated. During the supervised phase, adherence was tracked through a standardized training log. During the self-administered phase, adherence was monitored via a diary, with adherence calculated as the percentage of scheduled versus completed sessions. Adherence was analyzed both as an absolute percentage and as a dichotomized variable (adherent vs nonadherent, with a 70% adherence cut-off). Predictors for adherence were identified using Gradient Boosting Machines and Random Forests (R package caret). Seventy percent of the observations were used for training, whereas 30% were retained as a hold-out test-set.
RESULTS: The average overall adherence was 64% (±31%), with 81% (±28%) adherence during the supervised phase and 58% (±39%) in the self-administered phase. The root mean square error for the test-set ranged from 36.2 (R2=0.18, self-administered phase) to 19.3 (R2=0.47, supervised phase); prediction accuracy for dichotomized models was between 64% and 83%. Predictors of low to intermediate adherence included poorer baseline postural control, decline in exercise levels, and fluctuations in pain intensity (both increases and decreases).
CONCLUSION: Identified predictors could aid in recognizing individuals at higher risk for nonadherence in low back pain exercise therapy settings.
DESIGN: Cohort study.
SETTING: Rehabilitation.
PARTICIPANTS: This preplanned reanalysis within the Medicine in Spine Exercise Network included 1511 participants with low back pain (57% female, mean age 40.9 years, SD ±14 years).
INTERVENTIONS: Participants underwent an initial 3-week supervised phase of sensorimotor exercises, followed by a 9-week self-administered phase.
MAIN OUTCOME MEASURES: Biological, psychological, and social factors potentially impacting training adherence were evaluated. During the supervised phase, adherence was tracked through a standardized training log. During the self-administered phase, adherence was monitored via a diary, with adherence calculated as the percentage of scheduled versus completed sessions. Adherence was analyzed both as an absolute percentage and as a dichotomized variable (adherent vs nonadherent, with a 70% adherence cut-off). Predictors for adherence were identified using Gradient Boosting Machines and Random Forests (R package caret). Seventy percent of the observations were used for training, whereas 30% were retained as a hold-out test-set.
RESULTS: The average overall adherence was 64% (±31%), with 81% (±28%) adherence during the supervised phase and 58% (±39%) in the self-administered phase. The root mean square error for the test-set ranged from 36.2 (R2=0.18, self-administered phase) to 19.3 (R2=0.47, supervised phase); prediction accuracy for dichotomized models was between 64% and 83%. Predictors of low to intermediate adherence included poorer baseline postural control, decline in exercise levels, and fluctuations in pain intensity (both increases and decreases).
CONCLUSION: Identified predictors could aid in recognizing individuals at higher risk for nonadherence in low back pain exercise therapy settings.