Factors contributing to non-compliance with active physiotherapy guidelines among chronic low back pain patients in India.
G Shankar Ganesh, Abdur Raheem Khan, Ashfaque Khan
PMID 39777288WHAT IT FOUND
Indian patients with chronic low back pain avoided active exercise because guidelines ignored cultural norms, like wearing a saree.
They also distrusted therapists who failed to explain the rationale for exercises or who charged more for passive electrotherapy than active care.
Key findings
01Patients rejected exercises that conflicted with cultural norms and traditional attire, such as wearing a saree.
02Participants perceived that institutions prioritized expensive equipment over human resources, leading them to believe electrotherapy was more appropriate than exercise.
03Patients felt physiotherapists failed to communicate the rationale for exercise recommendations or adapt treatment to changing symptoms.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Findings are specific to the Indian context and may not generalize to other cultures or healthcare systems. Data relied on patient recall of past events, which may be influenced by their current symptom status. The study did not assess consultations with other healthcare providers, limiting the view on conflicting advice. Participants were recruited from the authors' networks and workplaces, which may introduce selection bias.
Declared interests
The authors declared no conflicts of interest. The study was approved by the Integral University Ethics Committee.
The easy way to misread this
Do not conclude that active exercise is ineffective or that patients are simply non-compliant. The study shows that adherence is heavily influenced by cultural fit, communication quality, and systemic factors like cost and equipment availability, not just the clinical evidence for the intervention.