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  • 29 Unraveling interacting barriers and facilitators to adherence and delivery of exercise-based care in the treatment of subacromial pain syndrome (SAPS)

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Shoulder Pain
29 Unraveling interacting barriers and facilitators to adherence and delivery of exercise-based care in the treatment of subacromial pain syndrome (SAPS)
  1. Lise Kronborg Poulsen1,
  2. Jeanette Wassar Kirk2,3,
  3. Nanna Raunsø1,
  4. Anna-Birgitte Møller Stamp1,
  5. Kristian Damgaard Lyng4,5,
  6. Mikkel Bek Clausen1
  1. 1Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Denmark
  2. 2Department of Clinical Research, Hvidovre University Hospital, Denmark
  3. 3Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Denmark
  4. 4Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
  5. 5Center for General Practice at Aalborg University, Department of Clinical Medicine, Aalborg University, Denmark

Abstract

Introduction Subacromial Pain Syndrome (SAPS) is a common persistent pain condition. Exercise-based care is recommended as first-line, 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 In this exploratory qualitative study, we recruited participants involved in the management of SAPS in Denmark by snowball and purposive sampling in Oct 2021-Nov 2022. Triangular interviews and analyses were conducted within 3 deductive themes (delivery of recommended services, adherence to clinical recommendations, and frames of the clinical pathways) using the Theoretical Domains Framework (TDF) and the corresponding Behavioral Change Wheel model (BCW) to map barriers and facilitators into components the Capability, Opportunity, Motivation and Behavior (COM-B) model.

Results Based on interviews with 10 persons with SAPS and 37 healthcare practitioners (12 medical doctors, 25 physiotherapists) and double-deductive analyses, 30 subjects of target behavior within 13 TDF domains emerged across all components of the COM-B and across perspectives. Central barriers to delivery and adherence were inconsistency in diagnosis terminology, cross-professional disagreements, beliefs, and expectations in terms of pathway services. Individual and contextual barriers and facilitators to delivery and adherence were significantly interrelated.

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. Clinical practitioners should consider addressing these barriers to improve care.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjsem-2024-sportskongres2024.29

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