Barriers and facilitators when implementing interventions for treating patients with musculoskeletal pain across multiple healthcare settings: a qualitative scoping review using the Theoretical Domains Framework (TDF)
Authors: Klausen Mette Dahl , Lindberg Line , Johansen Simon Kristoffer , Rathleff Michael Skovdal , Lyng Kristian Damgaard 
Published: January 2025

Background

Chronic musculoskeletal pain is among the most significant burdens to society. Despite years of research on effective interventions for managing chronic musculoskeletal (MSK) pain, most interventions have not reached clinical practice, underlining the significant implementation gap. Hence, understanding existing barriers and facilitators for implementing interventions may add crucial insights to guide future implementation efforts. This study aimed to identify barriers and facilitators for implementing interventions for managing patients with chronic MSK pain across healthcare settings.

Methods

We conducted a scoping review guided by the approach developed the Joanna Briggs Institute. The search was conducted in MEDLINE, EMBASE, CINAHL, PubMed, and PsycINFO from inception to December, 2023. We included peer-reviewed qualitative studies exploring perspectives of implementing interventions for patients living with chronic MSK pain (aged 18+ years) and healthcare professionals (HCPs) in any healthcare setting, published within the last 20 years. Quantitative studies and studies in languages other than English were excluded. Two authors independently selected the studies and extracted the data. We used General Inductive Approach to analyze the included studies. Secondly, we mapped the extracted data items to the Theoretical Domains Framework (TDF) to identify prevalent and salient barriers and challenges across the included studies.

Results

From 18.220 records, we included 22 studies involving 307 HCPs and 76 patients. Studies from all healthcare sectors were represented. Six major themes and six sub-themes were identified. The major themes were: 1) Long way from usual care, 2) Trust and commitment, 3) Support, 4) Time and finance, 5). Knowledge and skills and 6) What patients want. Across both groups, the TDF domain ‘Environmental Context and Resources’ was the most frequently reported barrier and facilitator for implementing the intervention (Barriers: HCP n = 84, 23.5%; patient n = 15, 4.2%; Facilitators: HCP n = 44, 16.6%; patient n = 10, 3.8%).

Conclusion

This scoping review identified barriers and facilitators to implementing interventions for the management of chronic musculoskeletal pan across individual, organizational, and political levels. Our analysis identified barriers including time constraints, low reimbursement rates, and insufficient support, while facilitators centered on leadership, communication, and social networks were identified. Targeted strategies addressing these barriers and facilitators are critical to enhancing sustainable and effective implementation in clinical practice in order to improve care of chronic musculoskeletal pain.

Trial registration

Open Science Framework, DOI 10.17605/OSF.IO/VZP9W

Contributions to the literature

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The current study is the first qualitative scoping review of barriers and facilitators for implementing interventions for patients with chronic MSK pain across multiple healthcare settings.

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Across healthcare settings barriers and facilitators exist across several levels, and highlighted from the theoretical domains framework, the environment, context, and resources (ECR) are among the most prominent barriers and facilitators for both HCPs and patients.

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This review’s findings add to existing implementation science literature by highlighting potential underlying contextual factors influencing intervention acceptance, such as the experience of ‘long way from usual care’.