National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Adverse Drug Events (ADE) (1)
- Arthritis (1)
- Asthma (2)
- Back Health and Pain (2)
- Behavioral Health (3)
- Blood Thinners (1)
- Cancer (5)
- Cancer: Breast Cancer (4)
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- Colonoscopy (1)
- Communication (1)
- Community-Based Practice (1)
- Comparative Effectiveness (2)
- COVID-19 (1)
- Dental and Oral Health (1)
- Depression (2)
- Diabetes (6)
- Education: Patient and Caregiver (2)
- Elderly (1)
- Eye Disease and Health (1)
- Guidelines (1)
- Healthcare Costs (3)
- Healthcare Delivery (1)
- Healthcare Utilization (3)
- Health Information Technology (HIT) (4)
- Health Literacy (2)
- Health Promotion (2)
- Heart Disease and Health (4)
- Hepatitis (2)
- Human Immunodeficiency Virus (HIV) (5)
- Imaging (1)
- Low-Income (1)
- Medicaid (3)
- Medical Expenditure Panel Survey (MEPS) (2)
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- Obesity (1)
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- Outcomes (1)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (5)
- (-) Patient Adherence/Compliance (48)
- Patient and Family Engagement (1)
- Patient Self-Management (3)
- Prevention (4)
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- Provider (1)
- Provider: Pharmacist (3)
- Quality Measures (1)
- Racial and Ethnic Minorities (2)
- Respiratory Conditions (1)
- Screening (3)
- Shared Decision Making (1)
- Sickle Cell Disease (1)
- Sleep Problems (1)
- Social Determinants of Health (3)
- Stress (1)
- Surgery (3)
- Telehealth (3)
- Treatments (2)
- Vaccination (1)
- Vulnerable Populations (1)
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- Young Adults (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 48 Research Studies DisplayedCibrian FL, Monteiro E, Ankrah E
Parents' perspectives on a smartwatch intervention for children with ADHD: rapid deployment and feasibility evaluation of a pilot intervention to support distance learning during COVID-19.
This paper explores how smartwatch technology, including timing notifications, can support children with ADHD during distance learning due to COVID-19. The researchers used a Digital Health Intervention which included a smartwatch and a smartphone. Their results demonstrated that children successfully adopted the use of the smartwatch, and parents believed that the intervention was helpful, especially in supporting the development of organizational skills in their children. The authors included suggestions to help professionals teach children with ADHD to use smartwatches to improve organization and task completion, especially as it applies to supporting remote instruction.
AHRQ-funded; HS026058.
Citation: Cibrian FL, Monteiro E, Ankrah E .
Parents' perspectives on a smartwatch intervention for children with ADHD: rapid deployment and feasibility evaluation of a pilot intervention to support distance learning during COVID-19.
PLoS One 2021 Oct 27;16(10):e0258959. doi: 10.1371/journal.pone.0258959..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Telehealth, Health Information Technology (HIT), Patient Adherence/Compliance
Morrone KA, Manwani D, Cabana MD
Efficient clinical counseling for sickle cell disease.
Sickle cell anemia (SCA) is a chronic illness that requires frequent health care visits for preventative management. Aims of this overview were to review challenges faced in outpatient subspecialty medicine and describe evidence-based techniques for more effective communication for patients with sickle cell anemia.
AHRQ-funded; HS025297.
Citation: Morrone KA, Manwani D, Cabana MD .
Efficient clinical counseling for sickle cell disease.
J Natl Med Assoc 2021 Aug;113(4):382-87. doi: 10.1016/j.jnma.2021.01.006..
Keywords: Sickle Cell Disease, Chronic Conditions, Clinician-Patient Communication, Communication, Patient Adherence/Compliance
Xu L, Xie D, Griffin KS
Objective adherence to dental device versus positive airway pressure treatment in adults with obstructive sleep apnea.
Although mandibular advancement device (MAD) treatment of adults with obstructive sleep apnea (OSA) is generally less efficacious than positive airway pressure (PAP), the two treatments are associated, with similar clinical outcomes. As a sub-analysis of a randomized trial comparing the effect of MAD versus PAP on blood pressure, this study compared objectively measured adherence to MAD versus PAP treatment in adults with OSA.
AHRQ-funded; HS019738.
Citation: Xu L, Xie D, Griffin KS .
Objective adherence to dental device versus positive airway pressure treatment in adults with obstructive sleep apnea.
J Sleep Res 2021 Aug;30(4):e13240. doi: 10.1111/jsr.13240..
Keywords: Sleep Problems, Patient Adherence/Compliance, Treatments, Dental and Oral Health, Respiratory Conditions
Lopez-Olivo MA, des Bordes JK, Lin H
A randomized controlled trial comparing two self-administered educational strategies for patients with knee osteoarthritis.
The authors conducted a randomized clinical trial in patients with knee osteoarthritis to assess the efficacy of providing a video for entertainment education, in combination with two booklets, compared with providing the booklets alone. They found that, although both education strategies were associated with improved knowledge and reduced decisional conflict at 6 months, receiving the video + booklets in combination, compared with receiving the booklets alone, proved to be more effective in changing behaviors and appeared to have some advantages for Spanish speakers and those who were less educated.
AHRQ-funded; HS019354.
Citation: Lopez-Olivo MA, des Bordes JK, Lin H .
A randomized controlled trial comparing two self-administered educational strategies for patients with knee osteoarthritis.
ACR Open Rheumatol 2021 Mar;3(3):185-95. doi: 10.1002/acr2.11222..
Keywords: Arthritis, Orthopedics, Education: Patient and Caregiver, Patient Self-Management, Patient Adherence/Compliance, Shared Decision Making, Health Promotion
Heneghan MB, Hussain T, Barrera L
Access to technology and preferences for an mHealth intervention to promote medication adherence in pediatric acute lymphoblastic leukemia: approach leveraging behavior change techniques.
This study’s objectives were to examine access to mobile technology and preferences for an mHealth intervention to improve medication adherence in pediatric acute lymphoblastic leukemia (ALL). Parents of children with ALL as well as adolescents and young adults (AYAs) with ALL who received maintenance chemotherapy were given a cross-sectional survey. Findings showed that parents, adolescents, and AYAs reported ubiquitous access to mobile technology and strong interest in multiple adherence-specific mHealth app features. Parents and AYAs provided valuable insight into preferred features for a multifunctional behavioral intervention to promote medication adherence in pediatric ALL.
AHRQ-funded; HS023011.
Citation: Heneghan MB, Hussain T, Barrera L .
Access to technology and preferences for an mHealth intervention to promote medication adherence in pediatric acute lymphoblastic leukemia: approach leveraging behavior change techniques.
J Med Internet Res 2021 Feb 18;23(2):e24893. doi: 10.2196/24893..
Keywords: Children/Adolescents, Young Adults, Caregiving, Cancer, Medication, Patient Adherence/Compliance, Health Information Technology (HIT), Treatments
Snyder ME, Chewning B, Kreling D
An evaluation of the spread and scale of PatientToc™ from primary care to community pharmacy practice for the collection of patient-reported outcomes: a study protocol.
Patient-reported outcomes (PROs), measuring adherence challenges pertaining to both remembering and intention to take medication, offer a rich data source for pharmacists and prescribers to use to resolve medication non-adherence. PatientToc™ is a PROs collection software developed to facilitate collection of PROs data from low-literacy and non-English speaking patients in Los Angeles. This study evaluated the spread and scale of PatientToc™ from primary care to community pharmacies for the collection and use of PROs data pertaining to medication adherence.
AHRQ-funded; HS025943.
Citation: Snyder ME, Chewning B, Kreling D .
An evaluation of the spread and scale of PatientToc™ from primary care to community pharmacy practice for the collection of patient-reported outcomes: a study protocol.
Res Social Adm Pharm 2021 Feb;17(2):466-74. doi: 10.1016/j.sapharm.2020.03.019..
Keywords: Medication, Patient Adherence/Compliance, Primary Care, Provider: Pharmacist, Provider, Health Information Technology (HIT)
Hill SC, Abdus S
AHRQ Author: Hill SC Abdus S
The effects of Medicaid on access to care and adherence to recommended preventive services.
Using MEPS data, the authors sought to quantify the impact of Medicaid enrollment on access to care and adherence to recommended preventive services. They found that Medicaid enrollment decreased the probability of having unmet needs for medical care and of experiencing delays getting prescription drugs. Medicaid enrollment increased the probability of having a usual source of care, of having a routine checkup, and of having a flu shot in past year.
AHRQ-authored.
Citation: Hill SC, Abdus S .
The effects of Medicaid on access to care and adherence to recommended preventive services.
Health Serv Res 2021 Feb;56(1):84-94. doi: 10.1111/1475-6773.13603..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicaid, Access to Care, Prevention, Patient Adherence/Compliance
Oikonomidi T, Ravaud P, Cosson E
AHRQ Author: Montori V
Evaluation of patient willingness to adopt remote digital monitoring for diabetes management.
Investigators sought to identify the minimum effectiveness patients report they require to adopt 36 different remote digital monitoring (RDM) scenarios. Adults with type 1 or type 2 diabetes living in 30 countries assessed three randomly selected scenarios from a total of 36 that described different combinations of digital monitoring tools. The investigators found that patients required greater health benefits to adopt more intrusive RDM modalities, food monitoring, and real-time feedback by a health care professional. They recommended that patient monitoring devices be designed to be minimally intrusive.
AHRQ-authored.
Citation: Oikonomidi T, Ravaud P, Cosson E .
Evaluation of patient willingness to adopt remote digital monitoring for diabetes management.
JAMA Netw Open 2021 Jan;4(1):e2033115. doi: 10.1001/jamanetworkopen.2020.33115..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, Chronic Conditions, Care Management, Patient Self-Management, Patient Adherence/Compliance
Graham JL, Shahani L, Grimes RM
The influence of trust in physicians and trust in the healthcare system on linkage, retention, and adherence to HIV care.
The present study was designed to determine if trust in physicians and the healthcare system among persons newly diagnosed with HIV infection was predictive of patients' subsequent linkage, retention, and adherence to HIV care. No significant association was found between trust-in-physicians and linkage to care or adherence to antiretroviral therapy.
AHRQ-funded; HS016093.
Citation: Graham JL, Shahani L, Grimes RM .
The influence of trust in physicians and trust in the healthcare system on linkage, retention, and adherence to HIV care.
AIDS Patient Care STDS 2015 Dec;29(12):661-7. doi: 10.1089/apc.2015.0156..
Keywords: Human Immunodeficiency Virus (HIV), Patient Adherence/Compliance, Outcomes, Healthcare Utilization
Lee YJ, Boden-Albala B, Jia H
The association between online health information-seeking behaviors and health behaviors among Hispanics in New York City: a community-based cross-sectional study.
The specific aim of this study was to examine the association between online health information-seeking behaviors and health behaviors (physical activity, fruit and vegetable consumption, alcohol use, and hypertension medication adherence) among Hispanics. It concluded that given the promising, although modest, associations between online health information-seeking behaviors and some health behaviors, efforts are needed to improve Hispanics' ability to access and understand health information.
AHRQ-funded; HS022961; HS019853.
Citation: Lee YJ, Boden-Albala B, Jia H .
The association between online health information-seeking behaviors and health behaviors among Hispanics in New York City: a community-based cross-sectional study.
J Med Internet Res 2015 Nov 26;17(11):e261. doi: 10.2196/jmir.4368.
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Keywords: Education: Patient and Caregiver, Web-Based, Telehealth, Patient Adherence/Compliance, Racial and Ethnic Minorities
Zhou M, Chang HY, Segal JB
Adherence to a novel oral anticoagulant among patients with atrial fibrillation.
The researchers examined adherence and persistence to dabigatran among adults with atrial fibrillation. Among those using dabigatran alone (n = 2,713), 41 percent were nonadherent with therapy, and 32 percent had gaps of 60 days or greater. Among those observed for 9 months who used dabigatran alone, rates of nonadherence were 47 percent, whereas 48 percent discontinued therapy during follow-up.
AHRQ-funded; HS018960.
Citation: Zhou M, Chang HY, Segal JB .
Adherence to a novel oral anticoagulant among patients with atrial fibrillation.
J Manag Care Spec Pharm 2015 Nov;21(11):1054-62. doi: 10.18553/jmcp.2015.21.11.1054.
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Keywords: Blood Thinners, Patient Adherence/Compliance, Heart Disease and Health, Cardiovascular Conditions, Medication
Goyal A, de Lemos JA, Peng SA
Association of patient enrollment in Medicare Part D with outcomes after acute myocardial infarction.
The researchers investigated whether enrollment versus nonenrollment in Medicare's prescription drug plan (Part D) is associated with better outcomes after acute myocardial infarction (AMI). They found that only half of Medicare-insured patients with AMI were enrolled in Part D by hospital discharge, and their 30-day and 1-year adjusted outcomes did not differ substantially from nonenrollees.
AHRQ-funded; HS021092.
Citation: Goyal A, de Lemos JA, Peng SA .
Association of patient enrollment in Medicare Part D with outcomes after acute myocardial infarction.
Circ Cardiovasc Qual Outcomes 2015 Nov;8(6):567-75. doi: 10.1161/circoutcomes.115.001650.
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Keywords: Heart Disease and Health, Medicare, Patient-Centered Outcomes Research, Medication, Patient Adherence/Compliance
Stuart BC, Davidoff AJ, Erten MZ
AHRQ Author: Davidoff AJ
Changes in medication management after a diagnosis of cancer among Medicare beneficiaries with diabetes.
The researchers sought to determine whether a new cancer diagnosis is associated with changes in medication adherence among Medicare beneficiaries with diabetes. They concluded that cancer diagnosis among patients with diabetes reduced adherence with evidence-based medications, particularly if patients’ life expectancy was short.
Citation: Stuart BC, Davidoff AJ, Erten MZ .
Changes in medication management after a diagnosis of cancer among Medicare beneficiaries with diabetes.
J Oncol Pract 2015 Nov;11(6):429-34. doi: 10.1200/jop.2014.003046..
Keywords: Medication, Medicare, Cancer, Diabetes, Patient Adherence/Compliance
Miller GE, Sarpong EM, Hill SC
AHRQ Author: Miller GE, Sarpong EM, Hill SC
Does increased adherence to medications change health care financial burdens for adults with diabetes?
The aim of the present study was to investigate increased out-of-pocket drug costs and financial burdens of achieving adherence to oral antidiabetic medications and medications for prevalent comorbidities. The researchers found that the mean simulated additional out-of-pocket drug costs of achieving adherence were $310 for uninsured adults treated for diabetes. These additional drug costs would increase the percentage of uninsured adults with financial burden.
AHRQ-authored.
Citation: Miller GE, Sarpong EM, Hill SC .
Does increased adherence to medications change health care financial burdens for adults with diabetes?
J Diabetes 2015 Nov;7(6):872-80. doi: 10.1111/1753-0407.12292..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Diabetes, Patient Adherence/Compliance, Medication
LaFleur J, Hoop R, Korner E
Predictors of early discontinuation of pegylated interferon for reasons other than lack of efficacy in United States veterans with chronic hepatitis C.
The researchers determined whether selected patient characteristics predicted discontinued therapy for reasons other than lack of efficcacy (non-LOE) using national databases of U.S. veterans. They found that predictors of greatest magnitude included comorbidities of myocardial infarction/congestive heart failure, renal disease, platelets 100/mm or more, Black race, albumin 3.5 mg/dl or more, sleep aid use, and poor persistence with antidepressants and antihypertensive agents.
AHRQ-funded; HS018582.
Citation: LaFleur J, Hoop R, Korner E .
Predictors of early discontinuation of pegylated interferon for reasons other than lack of efficacy in United States veterans with chronic hepatitis C.
Gastroenterol Nurs 2015 Nov-Dec;38(6):417-28. doi: 10.1097/sga.0000000000000214.
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Keywords: Chronic Conditions, Hepatitis, Medication, Patient Adherence/Compliance
Kahn B, Freeland Z, Gopal P
Predictors of guideline concordance for surveillance colonoscopy recommendations in patients at a safety-net health system.
The aim of this study was to quantify and identify predictors for guideline-concordant surveillance recommendations after adenoma polypectomy. It found that underuse recommendations were more likely in patients with C3 adenomas; overuse recommendations were more likely in patients with high-grade dysplasia or fair prep quality and less likely in those with piecemeal resection, C3 adenomas, age>65, or Hispanic ethnicity.
AHRQ-funded; HS022418.
Citation: Kahn B, Freeland Z, Gopal P .
Predictors of guideline concordance for surveillance colonoscopy recommendations in patients at a safety-net health system.
Cancer Causes Control 2015 Nov;26(11):1653-60. doi: 10.1007/s10552-015-0661-x..
Keywords: Cancer: Colorectal Cancer, Colonoscopy, Guidelines, Patient Adherence/Compliance, Patient-Centered Outcomes Research
Baker DW, Brown T, Goldman SN
Two-year follow-up of the effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers.
After an earlier outreach intervention achieved 82 percent annual adherence to colorectal cancer (CRC) screening with fecal occult blood testing (FOBT), this study assessed adherence to FOBT after a second outreach. It found that a total of 88.7 percent of patients completed a fecal immunochemical test within 6 months of their second outreach.
AHRQ-funded; HS021141.
Citation: Baker DW, Brown T, Goldman SN .
Two-year follow-up of the effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers.
Cancer Causes Control 2015 Nov;26(11):1685-90. doi: 10.1007/s10552-015-0650-0..
Keywords: Cancer, Cancer: Colorectal Cancer, Patient Adherence/Compliance, Prevention, Screening
Highfield L, Rajan SS, Valerio MA
A non-randomized controlled stepped wedge trial to evaluate the effectiveness of a multi-level mammography intervention in improving appointment adherence in underserved women.
This study evaluated a theoretically based, systematically designed implementation strategy to support adoption and implementation of a patient navigation-based intervention, called Peace of Mind Program (PMP), aimed at improving breast cancer screening among underserved women.. Any potential confounding or bias will be controlled in the analysis. Outcomes such as appointment adherence, patient referral to diagnostics, time to diagnostic referral, patient referral to treatment, time to treatment referral, and budget impact of the intervention will be assessed.
AHRQ-funded; HS023255.
Citation: Highfield L, Rajan SS, Valerio MA .
A non-randomized controlled stepped wedge trial to evaluate the effectiveness of a multi-level mammography intervention in improving appointment adherence in underserved women.
Implement Sci 2015 Oct 14;10:143. doi: 10.1186/s13012-015-0334-x.
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Keywords: Cancer: Breast Cancer, Cancer, Screening, Patient Adherence/Compliance, Women, Vulnerable Populations, Prevention, Imaging
Rosenberg SM, Partridge AH
New insights into nonadherence with adjuvant endocrine therapy among young women with breast cancer.
This editorial described endocrine therapy and reasons for nonadherence in young women with breast cancer, including side effects and fertility concerns.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, Partridge AH .
New insights into nonadherence with adjuvant endocrine therapy among young women with breast cancer.
J Natl Cancer Inst 2015 Oct;107(10). doi: 10.1093/jnci/djv245.
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Keywords: Adverse Drug Events (ADE), Cancer: Breast Cancer, Medication, Patient Adherence/Compliance
Wiener ES, Mullins CD, Pincus KJ
A framework for pharmacist-assisted medication adherence in hard-to-reach patients.
This study aimed to create a model for use in patient-centered, pharmacist-led interactions to improve medication adherence. The Health Action Process Approach (HAPA), a behavioral change framework, was adapted to known barriers of medication adherence. The study concluded that the newly developed framework provides a patient centered approach to facilitate and improve pharmacist-patient conversations regarding medication adherence.
AHRQ-funded; HS022135.
Citation: Wiener ES, Mullins CD, Pincus KJ .
A framework for pharmacist-assisted medication adherence in hard-to-reach patients.
Res Social Adm Pharm 2015 Sep-Oct;11(5):595-601. doi: 10.1016/j.sapharm.2014.11.0.
Keywords: Medication, Patient Adherence/Compliance, Patient-Centered Outcomes Research, Access to Care, Provider: Pharmacist
Beach MC, Roter DL, Saha S
Impact of a brief patient and provider intervention to improve the quality of communication about medication adherence among HIV patients.
The authors designed this study to improve patient-provider communication about HIV medication adherence. They found that brief provider training, combined with patient coaching sessions, improved provider communication behaviors and increased dialogue regarding medication adherence.
AHRQ-funded; HS013903; 290010012.
Citation: Beach MC, Roter DL, Saha S .
Impact of a brief patient and provider intervention to improve the quality of communication about medication adherence among HIV patients.
Patient Educ Couns 2015 Sep;98(9):1078-83. doi: 10.1016/j.pec.2015.05.011.
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Keywords: Human Immunodeficiency Virus (HIV), Medication, Patient Adherence/Compliance, Patient and Family Engagement, Clinician-Patient Communication
Viswanathan S, Justice AC, Alexander GC
Adherence and HIV RNA suppression in the current era of highly active antiretroviral therapy.
The researchers examined trends in adherence to highly active antiretroviral therapy (HAART) and HIV RNA suppression. They found that, although all HIV-infected persons should be instructed to achieve perfect adherence, concerns of slightly lower adherence should not hinder prescribing new HAART regimens early in HIV infection.
AHRQ-funded; HS018372.
Citation: Viswanathan S, Justice AC, Alexander GC .
Adherence and HIV RNA suppression in the current era of highly active antiretroviral therapy.
J Acquir Immune Defic Syndr 2015 Aug 1;69(4):493-8. doi: 10.1097/qai.0000000000000643..
Keywords: Human Immunodeficiency Virus (HIV), Patient Adherence/Compliance, Medication
Shah ED, Siegel CA, Chong K
Patients with Crohn's disease are more likely to remain on biologics than immunomodulators: a meta-analysis of treatment durability.
The researchers aimed to clarify treatment durability by assessing subject discontinuations from clinical trials in the context of treatment efficacy. They found that for patients with Crohn’s disease, biologic therapies had higher durability than immunomodulators for induction and maintenance therapy.
AHRQ-funded; HS021747.
Citation: Shah ED, Siegel CA, Chong K .
Patients with Crohn's disease are more likely to remain on biologics than immunomodulators: a meta-analysis of treatment durability.
Dig Dis Sci 2015 Aug;60(8):2408-18. doi: 10.1007/s10620-015-3618-8..
Keywords: Patient Adherence/Compliance, Medication, Chronic Conditions, Comparative Effectiveness
Ratanawongsa N, Karter AJ, Quan J
Reach and validity of an objective medication adherence measure among safety net health plan members with diabetes: a cross-sectional study.
The objective of this study was to evaluate the performance of continuous medication gap (CMG) for diverse, low-income managed care members with diabetes. It concluded that CMG demonstrated acceptable inclusiveness and validity in a diverse, low-income safety net population, comparable with its performance in studies among other insured populations.
AHRQ-funded; HS020684; HS022561; HS017261.
Citation: Ratanawongsa N, Karter AJ, Quan J .
Reach and validity of an objective medication adherence measure among safety net health plan members with diabetes: a cross-sectional study.
J Manag Care Spec Pharm 2015 Aug;21(8):688-98. doi: 10.18553/jmcp.2015.21.8.688..
Keywords: Diabetes, Patient Adherence/Compliance, Patient Self-Management, Medication, Low-Income
Skolasky RL, Maggard AM, Li D
Health behavior change counseling in surgery for degenerative lumbar spinal stenosis. Part I: improvement in rehabilitation engagement and functional outcomes.
This study examined whether a brief motivational interviewing-based health behavior change counseling (HBCC) intervention increased patient participation in physical therapy and/or home exercise programs (HEPs), reduced disability, and improved health status after surgery for degenerative lumbar spinal stenosis. It found that HBCC can improve outcomes after spine surgery through improved rehabilitation participation.
AHRQ-funded; HS017990.
Citation: Skolasky RL, Maggard AM, Li D .
Health behavior change counseling in surgery for degenerative lumbar spinal stenosis. Part I: improvement in rehabilitation engagement and functional outcomes.
Arch Phys Med Rehabil 2015 Jul;96(7):1200-7. doi: 10.1016/j.apmr.2015.03.009..
Keywords: Back Health and Pain, Surgery, Patient Adherence/Compliance