Physical activity for chronic back pain: qualitative interview study with patients and GPs in German primary care

BACKGROUND: Chronic back pain (CBP) is common among patients in primary care and is associated with significant personal and socioeconomic burden. Research has shown that physical activity (PA) is one of the most effective therapies to reduce pain; however, for GPs it remains challenging to advise and encourage individuals with CBP to exercise regularly. AIM: To provide insight into the views and experiences of PA in individuals with CBP, along with those of GPs, and to reveal the facilitators and barriers to engaging in, and maintaining, PA. DESIGN AND SETTING: Qualitative semi-structured interviews with individuals with CBP and GPs recruited via the local research practice network (Famprax) in Hessen, western-central Germany between June and December 2021. METHOD: Interviews were coded separately by consensus and analysed thematically. Findings of the two groups (GPs and patients with CBP) were compared and summarised. RESULTS: A total of 14 patients (n = 9 females and n = 5 males) and 12 GPs (n = 5 females and n = 7 males) were interviewed. Opinions and experiences of PA in individuals with CBP were similar both within and across the GP and patient groups. Interviewees expressed their views on internal and external barriers to PA, and provided strategies to address these barriers and concrete recommendations to increase PA. This study revealed a conflicting doctor–patient relationship ranging from paternalistic, to partnership based, to service provision, which could lead to negative perceptions on both sides, such as frustration and stigma. CONCLUSION: To the best of the authors’ knowledge, this is the first qualitative study exploring opinion and experience of PA in individuals with CBP and GPs in parallel. This study reveals a complex doctor– patient relationship and provides an important insight to motivation for, and adherence to, PA in individuals with CBP.