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Purpose: To investigate self-reported work ability in patients with musculoskeletal disorders in physiotherapy treatment. What characterizes patients with reduced work ability, whether work ability changes during treatment and characteristics of patients reporting no improvement. Design: Cohort study Material: 1498 patients with musculoskeletal disorders of working age who attend physiotherapy in primary healthcare. Method: Questionnaires at baseline and after three months. Results: 63% reported reduced work ability at baseline. Factors associated with reduced work ability were reduced daily activity level, physical work, psychological complaints, widespread pain, and high pain intensity. Participants with reduced work ability improved their average work ability by 1.7 on the WAS (work ability scale 0-10), however 53% did not achieve improvement. Characteristics of patients without improvement in work ability were long-term complaints, widespread pain, and psychological complaints. Conclusion: It seems difficult to improve work ability for patients with long-term and complex disorders in physiotherapy treatment. Physiotherapists should pay particular attention to psychological factors that inhibit improvement in work ability.