Journal of Orthopaedic & Sports Physical Therapy
Published Online: April 7, 2025Volume0IssuejaPages1-46
https://www.jospt.org/doi/10.2519/jospt.2025.12905
Abstract
OBJECTIVE: To investigate the barriers and facilitators to physical activity and exercise among people with chronic low back pain (CLBP).
DESIGN: A qualitative evidence synthesis.
DATA SOURCES: We searched the MEDLINE, EMBASE, CINAHL, SPORTDiscus, and PsycINFO databases from inception to July 2023. This review was prospectively registered on the Open Science Framework (OSF) (https://archive.org/details/osf-registrations-uwnqh-v1)
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Qualitative or mixed-methods studies with a qualitative approach were included. Studies must have recruited adults, of both sexes, aged 18 years or older with chronic LBP.
DATA SYNTHESIS: We used a thematic analysis approach in our review. First, participant quotes in the “Results” section of included studies were analysed and coded. Second, the codes were used to create our coding framework. Then, the coding framework was applied to included studies. Finally, two reviewers independently analysed the themes constructed in our qualitative evidence synthesis to identify barriers and facilitators for people with CLBP to engage in physical activity.
RESULTS: Fifty-seven studies were included. The quality assessment (CASP) revealed that most studies (77%) had minor concerns. Barriers to physical activity were mainly related to pain intensity, fear of movement, intervention type, lack of information, motivation, and support. Facilitators of physical activity were adequate information, professional and social support, perceived benefits, and favorable conditions to engage in physical activity. Based on the GRADE-CERQual, most themes and subthemes presented moderate quality of evidence.
CONCLUSION: The barriers to people with chronic LBP engaging in physical activity included pain intensity and fear of re-injury, type of intervention, lack of information, motivation and support, and occupational and socio-environmental factors. The main facilitators were receiving information and support from health professionals, motivational activities, knowledge about benefits of the intervention and external factors.