Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study
Objectives There is an emergent body of evidence supporting exercise therapy and physical activity in the management of musculoskeletal pain. The purpose of this study was to explore potential barriers and facilitators with patients and physiotherapists with patellofemoral pain involved in a feasibi...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2019-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/6/e023805.full |
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| author | Michael Skovdal Rathleff Phillipa Logan Marcus Bateman Benjamin E Smith Fiona Moffatt Paul Hendrick James Selfe Toby O Smith |
| author_facet | Michael Skovdal Rathleff Phillipa Logan Marcus Bateman Benjamin E Smith Fiona Moffatt Paul Hendrick James Selfe Toby O Smith |
| author_sort | Michael Skovdal Rathleff |
| collection | DOAJ |
| description | Objectives There is an emergent body of evidence supporting exercise therapy and physical activity in the management of musculoskeletal pain. The purpose of this study was to explore potential barriers and facilitators with patients and physiotherapists with patellofemoral pain involved in a feasibility randomised controlled trial (RCT) study. The trial investigated a loaded self-managed exercise intervention, which included education and advice on physical activity versus usual physiotherapy as the control.Design Qualitative study, embedded within a mixed-methods design, using semi-structured interviews.Setting A UK National Health Service physiotherapy clinic in a large teaching hospital.Participants Purposively sampled 20 participants within a feasibility RCT study; 10 patients with a diagnosis of patellofemoral pain, aged between 18 and 40 years, and 10 physiotherapists delivering the interventions.Results In respect to barriers and facilitators, the five overlapping themes that emerged from the data were: (1) locus of control; (2) belief and attitude to pain; (3) treatment expectations and preference; (4) participants’ engagement with the loaded self-managed exercises and (5) physiotherapists’ clinical development. Locus of control was one overarching theme that was evident throughout. Contrary to popular concerns relating to painful exercises, all participants in the intervention group reported positive engagement. Both physiotherapists and patients, in the intervention group, viewed the single exercise approach in a positive manner. Participants within the intervention group described narratives demonstrating self-efficacy, with greater internal locus of control compared with those who received usual physiotherapy, particularly in relation to physical activity.Conclusions Implementation, delivery and evaluation of the intervention in clinical settings may be challenging, but feasible with the appropriate training for physiotherapists. Participants’ improvements in pain and function may have been mediated, in some part, by greater self-efficacy and locus of control.Trial registration number ISRCTN35272486; Pre-results. |
| format | Article |
| id | doaj-art-21b96beee29743c6a2655e9908c61860 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-21b96beee29743c6a2655e9908c618602025-02-04T06:05:12ZengBMJ Publishing GroupBMJ Open2044-60552019-06-019610.1136/bmjopen-2018-023805Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative studyMichael Skovdal Rathleff0Phillipa Logan1Marcus Bateman2Benjamin E Smith3Fiona Moffatt4Paul Hendrick5James Selfe6Toby O Smith73 Center for General Practice, Aalborg University, Aalborg, Denmark2 School of Medicine, University of Nottingham, Nottingham, UKDerby Shoulder Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK1 Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UKPhysiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK5 School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UKDepartment of Health Professions, Manchester Metropolitan University, Manchester, UKWarwick Clinical Trials Unit, University of Warwick, Coventry, UKObjectives There is an emergent body of evidence supporting exercise therapy and physical activity in the management of musculoskeletal pain. The purpose of this study was to explore potential barriers and facilitators with patients and physiotherapists with patellofemoral pain involved in a feasibility randomised controlled trial (RCT) study. The trial investigated a loaded self-managed exercise intervention, which included education and advice on physical activity versus usual physiotherapy as the control.Design Qualitative study, embedded within a mixed-methods design, using semi-structured interviews.Setting A UK National Health Service physiotherapy clinic in a large teaching hospital.Participants Purposively sampled 20 participants within a feasibility RCT study; 10 patients with a diagnosis of patellofemoral pain, aged between 18 and 40 years, and 10 physiotherapists delivering the interventions.Results In respect to barriers and facilitators, the five overlapping themes that emerged from the data were: (1) locus of control; (2) belief and attitude to pain; (3) treatment expectations and preference; (4) participants’ engagement with the loaded self-managed exercises and (5) physiotherapists’ clinical development. Locus of control was one overarching theme that was evident throughout. Contrary to popular concerns relating to painful exercises, all participants in the intervention group reported positive engagement. Both physiotherapists and patients, in the intervention group, viewed the single exercise approach in a positive manner. Participants within the intervention group described narratives demonstrating self-efficacy, with greater internal locus of control compared with those who received usual physiotherapy, particularly in relation to physical activity.Conclusions Implementation, delivery and evaluation of the intervention in clinical settings may be challenging, but feasible with the appropriate training for physiotherapists. Participants’ improvements in pain and function may have been mediated, in some part, by greater self-efficacy and locus of control.Trial registration number ISRCTN35272486; Pre-results.https://bmjopen.bmj.com/content/9/6/e023805.full |
| spellingShingle | Michael Skovdal Rathleff Phillipa Logan Marcus Bateman Benjamin E Smith Fiona Moffatt Paul Hendrick James Selfe Toby O Smith Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study BMJ Open |
| title | Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study |
| title_full | Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study |
| title_fullStr | Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study |
| title_full_unstemmed | Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study |
| title_short | Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study |
| title_sort | barriers and facilitators of loaded self managed exercises and physical activity in people with patellofemoral pain understanding the feasibility of delivering a multicentred randomised controlled trial a uk qualitative study |
| url | https://bmjopen.bmj.com/content/9/6/e023805.full |
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