Unravelling interacting barriers and facilitators to adherence and delivery of exercise-based care in the treatment of Subacromial Pain Syndrome–an exploratory qualitative study

Lise Kronborg Poulsen*, Jeanette Wassar Kirk, Nanna Raunsø, Anna Birgitte Møller Stamp, Kristian Damgaard Lyng, Mikkel Bek Clausen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Purpose: Subacromial Pain Syndrome (SAPS) is a common persistent pain condition. Exercise-based care is first-line recommendation, but an insufficient exercise dose hampers effectiveness. This study explores individual and contextual barriers and facilitators for delivery of and adherence to exercise-based care in people with SAPS. Materials and Methods: Participants in this exploratory qualitative study were involved in the management of SAPS in Denmark. Triangular interviews and analyses were conducted within 3 themes (delivery of recommended services, adherence to recommendations, and frames of the clinical pathways) using the Theoretical Domains Framework (TDF) and the Behavioural Change Wheel model (BCW) to map barriers and facilitators into the Capability, Opportunity, Motivation and Behaviour (COM-B) model. Results: From interviews with 10 persons with SAPS and 37 healthcare practitioners and double-deductive analyses, 30 subjects of target behaviour within 13 TDF domains emerged across perspectives and COM-B components. Central barriers to delivery and adherence were inconsistencies in diagnostic terminology, cross-professional disagreements, beliefs, and expectations towards pathway services. Conclusion: We identified interrelated individual and contextual barriers to delivery and adherence across all aspects of the BCW, underpinning the complexity of the subject. Findings support that effectiveness of exercise-based care is linked to contextual barriers to delivery and adherence.

Original languageEnglish
JournalDisability and Rehabilitation
ISSN0963-8288
DOIs
Publication statusE-pub ahead of print - 24. Aug 2024

Keywords

  • barriers
  • behaviour change
  • clinical recommendations
  • exercise
  • health professionals
  • qualitative study
  • rehabilitation
  • Subacromial Pain Syndrome

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