Barriers and facilitators to physical activity for people with persistent musculoskeletal pain: systematic review and synthesis using the Theoretical Domains Framework

Abstract

Background

Physical activity (PA) is recommended for people with persistent musculoskeletal pain due to its benefits on symptoms, function and general health. This systematic review aimed to identify the barriers and facilitators to PA for people with persistent musculoskeletal pain and categorise these using the Theoretical Domains Framework (TDF). It also aimed to identify the prominence of each TDF domain and similarities and differences between included conditions and PA types.

Methods

Eligible studies reported barriers and/or facilitators to PA for adults with persistent musculoskeletal pain. Barriers and facilitators were coded using the TDF. Thematic analysis was then conducted within each TDF domain. TDF domains and barrier and facilitators were then compared across the different conditions and PA types.

Results

Thirty articles were included. ‘Environmental context and resources’, ‘social influences’ and ‘beliefs about consequences’ are the most prominent TDF domains for both barriers and facilitators, whereas ‘beliefs about capabilities’ and ‘emotion’ are prominent domains specifically for barriers, and ‘reinforcement’ and ‘behavioural regulation’ for facilitators. These domains were consistent across conditions and most PA types.

Conclusions

These findings can inform future intervention development. Healthcare professionals may benefit from prioritising addressing the more prominent TDF domains to enhance patients’ PA.

Keywords:

• Physical activity
• persistent musculoskeletal pain
• barriers
• facilitators
• exercise
• Theoretical Domains Framework

Acknowledgements and author contributions

G. Booth and M. Ussher conceptualised the study. All authors contributed to the design of the study. G. Booth conducted the search. G. Booth, A. Gilbert and A. Howarth completed the screening and study selection. G. Booth, N. Sharma and J. Greenwood conducted the data extraction. G. Booth and J. Greenwood assessed study quality. G. Booth, D’ Lima, M. Ussher, A. Gilbert and N. Sharma contributed to the data analysis. G. Booth, D. D’Lima and M. Ussher drafted the initial manuscript which was reviewed by all other authors. All authors approved the final version of the manuscript.

Disclosure statement

The authors report no conflicts of interest.

Ethical approval statement

Ethical approval was not required for this study due it being a systematic review.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.