Exploring barriers and facilitators to the adoption of regular exercise practice in patients at risk of a recurrence of low back pain (MyBack project): a qualitative study

This study aimed to explore potential barriers and facilitators to the adoption of regular exercise practice in patients at risk of a recurrence of low back pain (LBP). Eleven patients, who recovered from a previous episode of LBP, participated in two focus groups. The semi-structured interview schedule was informed by the Behaviour Change Wheel and the Theoretical Domains Framework. Focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis was performed by two researchers independently. Eighteen barriers and 19 facilitators were identified. The most common barriers included “lack of knowledge on how to manage a recurrence of LBP,” “lack of behavioural regulation strategies and having other priorities” and “lack of self-efficacy/confidence to practice exercise autonomously and deal with a new episode of LBP.” “Knowledge on exercise and recurrences,” “regular exercise habits,” “having specific behavioural regulation strategies,” “exercise practice with others,” “willingness to practice exercise and considering it a priority,” and “presence of positive emotions related with exercise practice” were the most common facilitators. These findings will inform the development of a behaviour change-informed exercise intervention to promote regular exercise practice among patients at risk of a recurrence of LBP. Exercise interventions are the most effective strategies to reduce the risk of a recurrence of LBP, but patients do not exercise regularly.Exercise interventions targeting specific determinants of behaviour change are needed to support the adoption of this practice.The findings of this study will allow the design of a health intervention to promote the adoption of regular exercise practice for people at risk of having a recurrence of LBP.Researchers, health professionals and policymakers should promote the implementation of evidence- based and theory-driven interventions for the secondary prevention of LBP to reduce its burden on health systems. Exercise interventions are the most effective strategies to reduce the risk of a recurrence of LBP, but patients do not exercise regularly. Exercise interventions targeting specific determinants of behaviour change are needed to support the adoption of this practice. The findings of this study will allow the design of a health intervention to promote the adoption of regular exercise practice for people at risk of having a recurrence of LBP. Researchers, health professionals and policymakers should promote the implementation of evidence- based and theory-driven interventions for the secondary prevention of LBP to reduce its burden on health systems.本研究旨在探讨下腰痛（low back pain, LBP）复发风险患者坚持规律锻炼实践的潜在障碍与促进因素。11名曾罹患下腰痛且已康复的患者参与了两次焦点小组讨论。本研究的半结构化访谈提纲基于行为改变轮（Behaviour Change Wheel）与理论领域框架（Theoretical Domains Framework）制定。焦点小组以视频会议形式开展，全程录制音视频并进行逐字转录。两名研究者独立开展演绎式内容分析。最终共识别出18项障碍因素与19项促进因素。其中最常见的障碍包括："对如何应对下腰痛复发缺乏相关知识""缺乏行为调节策略且存在其他优先事项"以及"自主开展锻炼以及应对新发下腰痛时缺乏自我效能/信心"。最常见的促进因素包括："掌握锻炼与复发相关知识""养成规律锻炼习惯""具备特定行为调节策略""与他人一同锻炼""愿意参与锻炼并将其视为优先事项"以及"存在与锻炼实践相关的积极情绪"。 本研究结果可为开发基于行为改变理论的锻炼干预方案提供依据，以助力下腰痛复发风险患者坚持规律锻炼。研究背景表明，锻炼干预是降低下腰痛复发风险的最有效策略，但患者往往无法规律锻炼；当前亟需针对行为改变特定决定因素的锻炼干预方案，以支持该锻炼实践的推行。本研究结果可用于设计面向下腰痛复发风险人群的健康干预方案，以推广规律锻炼实践。研究人员、卫生专业人员及政策制定者应推动实施循证且理论驱动的干预措施，开展下腰痛的二级预防，以减轻其对卫生系统的负担。 锻炼干预是降低下腰痛复发风险的最有效策略，但患者往往无法规律锻炼；亟需针对行为改变特定决定因素的锻炼干预方案，以支持该锻炼实践的推行。本研究结果可用于设计面向下腰痛复发风险人群的健康干预方案，以推广规律锻炼实践。研究人员、卫生专业人员及政策制定者应推动实施循证且理论驱动的干预措施，开展下腰痛的二级预防，以减轻其对卫生系统的负担。