Maintaining physical activity after pain management programmes for people with persistent musculoskeletal pain: a qualitative exploration of barriers, facilitators and activity patterns

• Barriers and facilitators to maintaining physical activity are multifactorial • Four unique patterns of physical activity maintenance were constructed • We used novel methods to generate interactions between barriers and facilitators • Barriers and facilitators map to 13 of 14 Theoretical Domains Framework domains Barriers and facilitators to maintaining physical activity are multifactorial Four unique patterns of physical activity maintenance were constructed We used novel methods to generate interactions between barriers and facilitators Barriers and facilitators map to 13 of 14 Theoretical Domains Framework domains Many patients with persistent musculoskeletal pain have difficulty maintaining physical activity (PA) long-term following pain management programmes (PMPs). We conducted a qualitative study to explore the barriers and facilitators to maintaining PA long-term after PMPs. We also explored PA patterns that describe trajectories of activity since PMP completion. One researcher conducted semi-structured interviews with 24 people with persistent musculoskeletal pain that completed PMPs, seven partners/spouses of these patient participants, and eight healthcare professionals working on PMPs. The healthcare professionals included four physiotherapists, two occupational therapists and two psychologists. Data were analysed using reflexive thematic analysis and the findings were mapped to the Theoretical Domains Framework. Five themes were generated: (1) Internal drivers for PA maintenance, (2) Fitting PA into life, (3) Symptoms and symptom management, (4) Social networks and influences and (5) Environmental influences. The findings were mapped onto 13 of the 14 Theoretical Domains Framework domains. Four PA patterns were constructed from participants experiences of PA maintenance: (1) Consistently active, (2) Initially consistently active post-PMP but then inconsistently active, (3) Inconsistently active since PMP and (4) Same or a reduction in PA level since the PMP. The findings can inform the development of an intervention to support PA maintenance following PMPs; the intervention can address barriers and facilitators and be tailored to different PA patterns.