Treatment Adherence in Low Back Pain Self-Management Care: A Concept Analysis Using the Walker and Avant Method

Abstract

One of the musculoskeletal conditions that can affect physical function, work productivity, and quality of life is low back pain (LBP). Management of LBP commonly requires individuals to continue recommended care and self-management activities beyond healthcare settings. However, treatment adherence in the context of LBP self-management has not always been conceptually distinguished from related constructs. This study aimed to clarify the concept of treatment adherence in self-management of LBP by identifying its defining attributes, antecedents, consequences, and empirical referents. A concept analysis was conducted using the Walker and Avant framework. A literature search was performed in PubMed, ScienceDirect, and Web of Science selected for their relevant biomedical, clinical, and health-care coverage. Publications from 2020 to 2025 were screened using MeSH terms and keywords. The literature was examined for descriptions of adherence, self-management behaviors, treatment implementation, and maintenance of recommended care in people with LBP. Eligible English full-text articles were synthesized following Walker and Avant, with PRISMA used to report the screening process. Nine relevant studies were identified and analyzed. The defining attributes of treatment adherence were active involvement and personal responsibility. Antecedents included knowledge and understanding of the condition and treatment goals. Consequences included improved symptom control, physical function and activity, maintenance of self-management behaviors, and potentially reduced healthcare utilization. Empirical referents included observable implementation and maintenance of recommended behaviors, exercise participation, activity management, medication use when prescribed, and clinical or functional outcomes. Treatment adherence in self-management of low back pain is a sustained behavioral process characterized by active engagement, consistency, maintenance of recommended treatment behaviors, self-efficacy, and motivation, providing a clear conceptual basis for nursing practice and future adherence measurement.