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. 2025 Jun;23(2):e70108.
doi: 10.1002/msc.70108.

Barriers and Facilitators for Implementing Interventions for Treating Patients With Chronic Musculoskeletal Pain: A Qualitative Scoping Review Using the Theoretical Domains Framework

Mette Dahl Klausen  1 , Line Lindberg  1   2   3 , Simon Kristoffer Johansen  1   3 , Michael Skovdal Rathleff  1   3 , Kristian Damgaard Lyng  1   3
Affiliations

Barriers and Facilitators for Implementing Interventions for Treating Patients With Chronic Musculoskeletal Pain: A Qualitative Scoping Review Using the Theoretical Domains Framework

Mette Dahl Klausen et al. Musculoskeletal Care. 2025 Jun.

Abstract

Background: Chronic musculoskeletal (MSK) pain poses a significant societal burden, yet many evidence-based interventions fail to reach clinical practice, highlighting an implementation gap. This study aimed to identify barriers and facilitators in implementing MSK pain interventions across healthcare settings.

Methods: We conducted a scoping review following the Joanna Briggs Institute approach. We searched MEDLINE, EMBASE, CINAHL, PubMed and PsycINFO (up to December 2023) for peer-reviewed qualitative studies exploring the perspectives of patients (18+) and healthcare professionals (HCPs) on implementing MSK pain interventions. Studies were screened independently by two authors, and data were analysed using the General Inductive Approach and mapped to the Theoretical Domains Framework (TDF).

Results: From 18,220 records, 22 studies were included, involving 307 HCPs and 76 patients across all healthcare sectors. Six major themes emerged: (1) long way from usual care, (2) trust and commitment, (3) support, (4) time and finance, (5) knowledge and skills and (6) patient preferences. The most frequently reported TDF domain was 'Environmental Context and Resources', with key barriers including time constraints, low reimbursement, and insufficient support. Facilitators included leadership, communication, and social networks.

Conclusion: Implementation of MSK pain interventions is hindered by systemic barriers at individual, organisational, and political levels. Addressing these barriers through targeted strategies is essential for improving sustainable clinical implementation and enhancing patient care.

Keywords: barriers and facilitators; implementation science; implementation strategy; musculoskeletal pain; qualitative research; scoping review; theoretical domains framework.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flowchart.
FIGURE 2
FIGURE 2
Overview of major themes and subthemes.
FIGURE 3
FIGURE 3
Identified TDF barriers and facilitators.
See this image and copyright information in PMC

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