Conceptualising and measuring adherence to exercise for musculoskeletal pain: The Adherence To Exercise for Musculoskeletal Pain Tool (ATEMPT)

Aim: To develop and test a measurement tool for adherence to exercise for musculoskeletal (MSK) pain. Purpose: A valid and reliable measure of adherence to exercise will improve the interpretation of whether outcomes observed in studies of exercise interventions for MSK pain are due to the intervention itself or the levels of adherence exhibited by participants. This will reduce the potential for underestimation of the clinical effectiveness of exercise caused by low levels of adherence. Objectives: The measure was developed via the following stages. Firstly, a systematic review was conducted to explore the current definitions of adherence to exercise for MSK pain in the literature. Secondly, adherence to exercise for MSK pain was conceptualised from the perspective of relevant stakeholders using concept mapping methodology. Thirdly, items for the new measure were developed and data were obtained from physiotherapy patients with MSK pain to assess the psychometric properties of the new measure. Results: The systematic review revealed that most studies did not state a clear definition of adherence or used definitions not developed for exercise or MSK pain. The concept mapping study identified six dimensions relating to adherence to exercise for MSK pain: communication with experts; targets; how exercise is prescribed; patient knowledge and understanding; motivation and support; and psychological approach and attitudes. A 48-item measure of exercise adherence was developed and distributed to 382 physiotherapy patients. Psychometric analysis revealed that a short-form, 6-item unidimensional version demonstrated suitable content and structural validity, favourable internal consistency, good test-retest reliability, and satisfactory measurement error. Conclusion: Adherence to exercise for MSK pain has been conceptualised for the first time and the findings used to develop a new measure of exercise adherence. The 6-item (ATEMPT) is a psychometrically tested measure of exercise adherence and can be used in research and clinical settings