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OBJECTIVES: There is no gold standard for measuring adherence to prescribed home exercise. Self-report diaries are commonly used however lack of standardisation, inaccurate recall and self-presentation bias limit their validity. A valid and reliable tool to assess exercise adherence behaviour is required. Consequently, this article reports the development and psychometric evaluation of the Exercise Adherence Rating Scale (EARS). DESIGN: Development of a questionnaire. SETTING: Secondary care in physiotherapy departments of three hospitals. PARTICIPANTS: A focus group consisting of 8 patients with chronic low back pain (CLBP) and 2 physiotherapists was conducted to generate qualitative data. Following on from this, a convenience sample of 224 people with CLBP completed the initial 16-item EARS for purposes of subsequent validity and reliability analyses. METHODS: Construct validity was explored using exploratory factor analysis and item response theory. Test-retest reliability was assessed 3 weeks later in a sub-sample of patients. RESULTS: An item pool consisting of 6 items was found suitable for factor analysis. Examination of the scale structure of these 6 items revealed a one factor solution explaining a total of 71% of the variance in adherence to exercise. The six items formed a unidimensional scale that showed good measurement properties, including acceptable internal consistency and high test-retest reliability. CONCLUSIONS: The EARS enables the measurement of adherence to prescribed home exercise. This may facilitate the evaluation of interventions promoting self-management for both the prevention and treatment of chronic conditions.

Original publication




Journal article



Publication Date





180 - 185


Adherence, Assessment, Chronic illness, Compliance, Measurement, Prescribed exercise, Adult, Aged, Exercise Therapy, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Patient Compliance, Physical Therapy Modalities, Psychometrics, Reproducibility of Results, Surveys and Questionnaires, Young Adult