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.