Adherence to Home-Based Exercises in Musculoskeletal Disorders

Home exercise programs are recommended by physicians to patients and when appropriate, their caregivers as interventions to be performed outside the clinical setting. In this treatment approach, the physician provides detailed instructions on how the exercises should be carried out. These programs consist of individualized therapeutic exercises designed to be performed at home, with the aim of complementing and reinforcing the interventions delivered in the clinic. Addressing this gap, the present study aims to evaluate adherence to individualized home-based exercise programs among patients with diverse musculoskeletal conditions and to determine whether adherence behaviors differ across diagnostic groups. In addition, the study seeks to identify demographic, clinical, psychosocial, and functional factors associated with exercise compliance. By integrating structured clinical evaluations with validated outcome measures, this study aims not only to clarify the determinants of exercise adherence but also to contribute to the development of more effective, condition-specific strategies to enhance sustained engagement in home-based rehabilitation.

Meeting the inclusion and exclusion criteria; various musculoskeletal diseases; Patients presenting for degenerative, orthopedic or neurological rehabilitation will be included in the study by obtaining written informed consent after an individualized home exercise program after a detailed clinical examination.

Questions such as age, gender, height, weight, education level, employment status, income level and sociodemographic and clinical characteristics of the participants (diagnosis of the disease, duration, comorbidity/cumulative disease score status, medical treatment status, if any, pain/weakness level, functional status) will be recorded.

All patients will receive an individualized home exercise program based on their clinical condition. Exercises will be determined by the physical therapy and rehabilitation physician, taking into account the minimum clinical needs and individual characteristics of the patient. People receiving active physical therapy; will not be included in the study. In terms of content, general physical therapy will consist of exercises, not specific exercises that are rarely practiced or performed by a health professional. The number of sets of exercises per day, how many times they will be done in each set and how many days a week will be defined and recorded. The exercises will be explained to the patient by the physician and the printed paper describing these exercises will be given to the patient.

Three condition-specific subcohorts will be defined: chronic degenerative, orthopedic (post-operative) and neurological patients. Patients in the degenerative, orthopedic, or neurological rehabilitation groups will be provided with a patient-specific home exercise program, and their adherence and adaptations to the program will be evaluated and compared. Patients will do the home-based exercise program for 6 weeks. Patients will undergo both clinical and outcome-based assessments at baseline and again at the completion of the home exercise program (6 weeks).

Among the result criteria; Primary variables; Beck Depression Index (BDI) for mood, Health Assessment Questionnaire (HAQ) for quality of life, Kinesiophobia assessment; Tampa Kinesiophobia Scale, Visual Analog Scale (VAS 0-10), for Activities of Daily Living; Barthel Activities of Daily Living Index Secondary variables; to assess how an individual's health condition affects their daily life for exercise adherence; The Exercise Adherence Rating Scale/Exercise Attitude Questionnarie. All assessments will be evaluated by a group-blind investigator after 6 weeks with clinical examination and a set of evaluation scales/questionnaires. The patients' clinical status, satisfactions, their adherence to exercise therapy, and the factors influencing this adherence will be evaluated. Patients whose diagnosis was established after a detailed examination and for whom an exercise program was prescribed will be included in the study. The decision will be based solely on the patient's ability to perform the exercises and adherence to the inclusion and exclusion criteria. Other factors that could potentially introduce bias, such as education level or the patient's willingness to exercise, will not be considered in determining treatment, in order to minimize selection bias. Patients will be instructed not to take any analgesics within 24 hours prior to the assessment.

Inclusion criteria

• Be 18 years of age or older
• To have a musculoskeletal disease (degenerative, neurological or orthopedic)
• To be given a home exercise program
• To have cognitive and language functions to communicate, to be a volunteer

Exclusion criteria

• Those with major psychiatric illness
• Those with cognitive dysfunction
• Those with communication disorders, reluctant/reluctant to participate
• Those with any condition other than a primary degenerative, orthopedic, or neurological disease that could significantly affect exercise adherence, including musculoskeletal or systemic disorders (e.g., severe anemia, heart failure, respiratory failure, uncontrolled diabetes, inflammatory rheumatic disease, recent fractures, or active infections).