Common reported barriers and facilitators for self-management in adults with chronic musculoskeletal pain: A systematic review of qualitative studies

Spink, Alison; Wagner, I. J.; Orrock, Paul J

doi:10.1016/j.msksp.2021.102433

Cited by 27 publications

(28 citation statements)

References 71 publications

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“…This may explain why a change in activation with routine care was not achieved, with participants highlighting low expectations that treatment could change their situation ( theme: expectational priming ) and a sense of disconnect from their healthcare providers ( theme: lived expertise ). Our rationale for exploring social aspects of pain management is supported by a recent systematic review of patient experiences of pain management that highlighted receiving emotional and motivational support and having an opportunity to share their concerns with others as key facilitators of treatment success [ 51 ]. For CALD communities, this therapeutic effect may be more pronounced among those who align with fundamental cultural values of collectivism, where social cohesiveness and interdependence are prioritized and strongly linked to identity [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

The feasibility of implementing a cultural mentoring program alongside pain management and physical rehabilitation for chronic musculoskeletal conditions: results of a controlled before-and-after pilot study

Brady

Sidhu

Jennings

et al. 2023

BMC Musculoskelet Disord

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Background Culturally diverse communities face barriers managing chronic musculoskeletal pain conditions including navigation challenges, sub-optimal healthcare provider engagement and difficulty adopting self-management behaviours. Objectives To explore the feasibility and trends of effectiveness of implementing a cultural mentoring program alongside clinical service delivery. Methods This quasi-experimental controlled before-and-after multiple case study was conducted in three hospital-based services that provide treatment for patients with musculoskeletal pain. Two prospective cohorts, a pre-implementation and a post-implementation cohort, of adults with chronic musculoskeletal pain who attended during the 6-month recruitment phase, were eligible if they self-identified with one of the cultures prioritised for mentoring by the clinic. The pre-implementation cohort received routine care for up to 3-months, while the post-implementation cohort received up to 3-months of cultural mentoring integrated into routine care (3 to 10 sessions), provided by a consumer (n = 6) with lived experience. Feasibility measures (recruitment and completion rates, attendance, satisfaction), and trends of effectiveness (Patient Activation Measure and Health Literacy Questionnaire items one and six) were collated over 3-months for both cohorts. Outcomes were presented descriptively and analysed using Mann-Whitney U-tests for between-group comparisons. Translation and transcription of post-treatment semi-structured interviews allowed both cohorts’ perspectives of treatment to be analysed using a Rapid Assessment Process. Results The cultural mentor program was feasible to implement in clinical services with comparable recruitment rates (66% pre-implementation; 61% post-implementation), adequate treatment attendance (75% pre-implementation; 89% post-implementation), high treatment satisfaction (97% pre-implementation; 96% post-implementation), and minimal participant drop-out (< 5%). Compared to routine care (n = 71), patients receiving mentoring (n = 55) achieved significantly higher Patient Activation Measure scores (median change 0 vs 10.3 points, p < 0.01) at 3-months, while Health Literacy Questionnaire items did not change for either cohort over time. Three themes underpinned participant experiences and acceptability of the mentoring intervention: ‘expectational priming’, ‘lived expertise’ and ‘collectivist orientation’ to understand shared participant experiences and explore the potential differential effect of the mentoring intervention. Conclusion Participant experiences and observations of improved patient activation provide support for the acceptability of the mentoring intervention integrated into routine care. These results support the feasibility of conducting a definitive trial, while also exploring issues of scalability and sustainability.

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Section: Discussionmentioning

confidence: 99%

The feasibility of implementing a cultural mentoring program alongside pain management and physical rehabilitation for chronic musculoskeletal conditions: results of a controlled before-and-after pilot study

Brady

Sidhu

Jennings

et al. 2023

BMC Musculoskelet Disord

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“…Our findings are consistent with several other studies that have investigated barriers and facilitators of people with CMP. However, these studies primarily focus on people with CMP taking part in a specific self-management interventions during research projects (Spink et al, 2021,Devan et al, 2018,Bair et al, 2009,Franklin et al, 2016,Gordon et al, 2017). Thus, previous studies focus on the clinical encounter as the driver for behavioral change, and negate to reflect upon the formative effects of navigating everyday contexts via trail and error (Corbin and Strauss, 1988,Corbin and Strauss, 1985).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, previous studies focus on the clinical encounter as the driver for behavioral change, and negate to reflect upon the formative effects of navigating everyday contexts via trail and error (Corbin and Strauss, 1988,Corbin and Strauss, 1985). Previously identified barriers for self-management include external factors, like financial constraints, lack of social support and accessibility related to participation in self-management programs (Spink et al, 2021,Devan et al, 2018,Gordon et al, 2017). Still the studies focus on barrier identification meant that the question of how to support people with CMP and clinicians’ health information management, to ensure that self-management- band social support delivered is applicable and easily integrated into the healthcare specialists’ treatments and personal ecologies of people with CMP alike (Moen and Brennan, 2005).…”

Section: Discussionmentioning

confidence: 99%

Exploring Self-Management Barriers and Facilitators Experience by People with Chronic Musculoskeletal Pain - A Qualitative Study

Christensen

Johansen

Slot

et al. 2023

Preprint

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Background: One in three people worldwide will experience chronic musculoskeletal pain (CMP). Due to the long-standing nature of CMP, it is inevitable that people with CMP will have to engage in some form of self-management. As highlighted by multiple clinical practice guidelines, it becomes pivotal that healthcare professionals provide effective self-management support. However, the current effectiveness of self-management interventions seems equivocal. This may be due to self-management interventions not being developed based on an in-depth understanding of the self-management challenges experienced by people with CMP. Objectives: This study explored the everyday barriers and facilitators for self-management experienced by people with CMP currently undergoing rehabilitation in a municipality setting. Methods: We conducted 11 one-time, single-person, qualitative interviews of people living with CMP. The interviews were based on a semi-structured interview guide with open-ended questions and analyzed using an inductive thematic analysis to identify the participants experienced barriers and facilitators for self-management in everyday situations. Findings: Three overarching barriers emerged: 1) biographical disruption, 2) uncertainty and psychological distress, and 3) lack of social support. Further, three overarching facilitators emerged: 1) acceptance and optimism 2) pain-relieving strategies and 3) social support. These barriers and facilitators far exceeded participants capability to control their pain. Conclusion: The majority of the barriers and facilitators concerned the management of cognitive, emotional, social or personal consequences of CMP. Integrating these barriers and facilitators into the development of future self-management interventions may have the potential to improve the effectiveness of these interventions.

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“…Although self-management of LBP with selfBACK was supposed to work as an adjunct to usual care, this was achieved by some but for others, not integrating HCP follow-up limited implementation. HCPs remain key players in supporting self-management behavior [ 50 ], and we suggest incorporating solutions that allow users and HCPs to share the app content and monitor progress. Having the opportunity to discuss app content and features with the HCP should be incorporated in future, similar apps.…”

Section: Discussionmentioning

confidence: 99%

One size does not fit all: Participants’ experiences of the selfBACK app to support self-management of low back pain—a qualitative interview study

et al. 2022

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Background Low back pain (LBP) is one of the most common reasons for disability globally. Digital interventions are a promising means of supporting people to self-manage LBP, but implementation of digital interventions has been suboptimal. An artificial intelligence-driven app, selfBACK, was developed to support self-management of LBP as an adjunct to usual care. To better understand the process of implementation from a participant perspective, we qualitatively explored factors influencing embedding, integrating, and sustaining engagement with the selfBACK app, and the self-perceived effects, acceptability, and satisfaction with the selfBACK app. Methods Using a qualitative interview study and an analytic framework approach underpinned by Normalization Process Theory (NPT), we investigated the experiences of patients who participated in the selfBACK randomized controlled trial (RCT). Interviews focused on the motivation to participate in the RCT, experiences of using the selfBACK app, and views about future intended use and potential of using digital health interventions for self-management of LBP. Participants were purposively sampled to represent diversity in age, sex, and implementation reflected by a proxy measure of number of app-generated self-management plans during the first three months of RCT participation. Results Twenty-six participants aged 21–78, eleven females and fifteen men, with two to fourteen self-management plans, were interviewed between August 2019 and April 2020. A broad range of factors influencing implementation of selfBACK within all constructs of NPT were identified. Key facilitating factors were preferences and beliefs favoring self-management, a friendly, motivational, and reassuring supporter, tailoring and personalization, convenience and ease of use, trustworthiness, perceiving benefits, and tracking achievements. Key impeding factors were preferences and beliefs not favoring self-management, functionality issues, suboptimal tailoring and personalization, insufficient time or conflicting life circumstances, not perceiving benefits, and insufficient involvement of health care practitioners. Self-perceived effects on pain and health, behavior/attitude, and gaining useful knowledge varied by participant. Conclusions The high prevalence of LBP globally coupled with the advantages of providing help through an app offers opportunities to help countless people. A range of factors should be considered to facilitate implementation of self-management of LBP or similar pain conditions using digital health tools.

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Common reported barriers and facilitators for self-management in adults with chronic musculoskeletal pain: A systematic review of qualitative studies

Cited by 27 publications

References 71 publications

The feasibility of implementing a cultural mentoring program alongside pain management and physical rehabilitation for chronic musculoskeletal conditions: results of a controlled before-and-after pilot study

The feasibility of implementing a cultural mentoring program alongside pain management and physical rehabilitation for chronic musculoskeletal conditions: results of a controlled before-and-after pilot study

Exploring Self-Management Barriers and Facilitators Experience by People with Chronic Musculoskeletal Pain - A Qualitative Study

One size does not fit all: Participants’ experiences of the selfBACK app to support self-management of low back pain—a qualitative interview study

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