<b>Exercise Adherence in Patients with Musculoskeletal Disorders Presenting to HMC OPD: A Cross-Sectional Survey</b>

Background: Musculoskeletal disorders are among the leading causes of pain, disability, and reduced quality of life worldwide. Exercise therapy is a cornerstone of management, yet long-term effectiveness depends on patient adherence. Evidence suggests that only half to two-thirds of patients follow prescribed regimens, with poor adherence reducing treatment efficacy. In Pakistan, limited data exist on exercise adherence in musculoskeletal rehabilitation, and validated tools have rarely been applied. Objective: This study aimed to assess adherence to prescribed exercise programs among patients with musculoskeletal disorders using the standardized Exercise Adherence Rating Scale (EARS) in a tertiary care outpatient setting. Methods: A cross-sectional observational study was conducted at the Physiotherapy Outpatient Department of Hayatabad Medical Complex, Peshawar, over six months. A total of 48 patients with musculoskeletal conditions were recruited consecutively. Data were collected using the EARS questionnaire and analyzed with SPSS v22. Adherence was defined using mean EARS scores, and associations with demographic and clinical variables were tested using chi-square and Pearson’s correlation. Results: Sixty percent of patients were classified as adherent, while 40% were non-adherent. Compliance was significantly associated with frequency and duration of prescribed exercises (p=0.03 for both), whereas age, sex, education, and marital status showed no associations. Reported barriers included lack of time (25%) and low motivation (8%). Conclusion: Adherence to exercise regimens was moderate and strongly influenced by prescription characteristics and behavioral barriers. Optimizing program design and integrating adherence-enhancing strategies are critical to improving musculoskeletal rehabilitation outcomes.