Patient-perceived barriers and facilitators to increasing physical activity among patients with musculoskeletal disorders receiving outpatient physiotherapy: a qualitative investigation

  • McPhail S
  • Schippers M
  • Marshall A
  • et al.
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Background: There is an increasing burden of musculoskeletal disorders among increasingly sedentary and aging populations internationally. Musculoskeletal conditions can impair people's ability to undertake physical activity. A key step in the development of effective intervention strategies to assist inactive patients with musculoskeletal disorders to become more physically active is to understand their perceived barriers to undertaking physical activity in their daily lives. Whether perceived barriers are veritable or not, strategies that effectively address perceived barriers may facilitate improved physical activity outcomes among inactive patients. Purpose: The purpose of this qualitative study was to investigate perceived barriers and facilitators to undertaking physical activity reported by patients accessing outpatient physiotherapy clinics for musculoskeletal disorders. Methods: A questionnaire with open ended items was administered to patients n = 217 (73.3% of eligible patients) from three clinics that provide physiotherapy services for musculoskeletal disorders. The survey included questions to capture the clinical and demographic characteristics of the sample. It also comprised two open-ended questions requiring qualitative responses. The first asked the participant to describe factors that made physical activity more difficult, and the second asked which factors made it easier for them be physically active. Participants' responses to the two openended questions were read, coded and thematically analysed independently by two researchers; with a third researcher available to arbitrate any unresolved disagreement. Results: The mean (standard deviation) age of participants was 53 (15) years and 113 (52.1%) were male. A total of 112 (51.6%) participants reported having three or more health conditions, while n = 140 (64.5%) were classified as overweight or obese. Five overarching themes describing perceived barriers for undertaking physical activity were 'health conditions', 'time restrictions', 'poor physical condition', 'emotional, social and psychological barriers', and 'access to exercise opportunities'. Perceived physical activity facilitators were also aligned under five themes, namely 'improved health state', 'social, emotional and behavioural supports', 'access to exercise environment', 'opportunities for physical activities' and 'time availability' . Conclusion(s): It was clear from the breadth of responses that meaningful supports and physical activity promoting intervention approaches must be multidimensional. They should have the capacity to address a variety of physical, functional, social, psychological, motivational, environmental, lifestyle and other perceived barriers. It would appear that for such interventions to be effective, they should be flexible enough to address a variety of specific concerns. Participants were sampled from one geographical region and findings should not be extrapolated to dissimilar societies. Implications: Physiotherapy to reduce pain and improve function is likely to be an important catalyst in assisting inactive patients to become physically active. However, it is important that social, psychological, motivational, environmental and lifestyle related factors are considered when planning strategies to improve physical activity behaviours among patients with musculoskeletal disorders accessing physiotherapy interventions.




McPhail, S., Schippers, M., Marshall, A. L., Waite, M., & Kuipers, P. (2015). Patient-perceived barriers and facilitators to increasing physical activity among patients with musculoskeletal disorders receiving outpatient physiotherapy: a qualitative investigation. Physiotherapy, 101, e986.

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