The following is a summary of “Physiotherapists’ barriers and facilitators to the implementation of a behavior change-informed exercise intervention to promote the adoption of regular exercise practice in patients at risk of recurrence of low back pain: a qualitative study,” published in the January 2024 issue of Primary Care by Moniz, et al.

Recurrences of low back pain (LBP) are common and linked to significant disability and healthcare costs. While regular exercise is believed to be effective in preventing LBP recurrences, promoting this behavior among patients by physiotherapists presents challenges. For a study, researchers sought to explore the perceived barriers and facilitators encountered by physiotherapists in implementing a behavior change-informed exercise intervention to encourage regular exercise practice among patients at risk of LBP recurrence.

Two focus groups involving primary healthcare physiotherapists were conducted using a semi-structured interview schedule based on the Behaviour Change Wheel, incorporating the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). The focus groups were held via videoconference, recorded, and transcribed verbatim. A deductive content analysis, utilizing a coding matrix derived from the COM-B and TDF, was performed by two independent researchers, with a third researcher resolving any disagreements.

Fourteen physiotherapists participated in the focus groups. Analysis revealed 13 barriers (involving 4 COM-B components and 7 TDF domains) and 23 facilitators (comprising 5 COM-B and 13 TDF) to implementing a behavior change-informed exercise intervention. The predominant barriers included a need for more skills and confidence to execute the proposed intervention, stemming from its deviation from their usual practice and the need to acquire new skills. However, physiotherapists with prior experience with similar interventions or whose rationale aligned with the new intervention showed more positive determinants, such as potential benefits for themselves and their profession, improved quality of care, and a willingness to adapt clinical practice. Conversely, those encountering difficulties in prior implementation cited context-related barriers, including time constraints, scheduling conflicts, and resource limitations.

Identified barriers and facilitators provided insights into physiotherapists’ implementation of behavior change-informed exercise interventions for patients at risk of LBP recurrence in primary healthcare settings. These findings informed the systematic, theory-based development of a training program aimed at physiotherapists to support successful intervention implementation.

Reference: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02274-y