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BackgroundLong-term opioid treatment in patients with chronic pain is often ineffective and possibly harmful. These patients are often managed by GPs who are calling for a clear overview of effective opioid reduction strategies for primary care.AimTo evaluate effectiveness of opioid reduction strategies applicable in primary care for patients with chronic pain on long-term opioid treatment.Design and settingSystematic review of controlled trials and cohort studies performed in primary care from inception date to 15 January 2021.MethodLiterature search conducted in EMBASE, MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, Google Scholar, and PsycINFO. Studies evaluating opioid reduction interventions applicable in primary care among adults on long-term opioid treatment for chronic non-cancer pain were included. Risk of bias was assessed using the Cochrane risk-of-bias tool (version 2) (RoB 2) or the Risk of bias in non-randomized studies — of interventions (ROBINS-I) tool. Narrative synthesis was performed because of clinical heterogeneity in study designs and types of interventions.ResultsIn total, five randomised controlled trials (RCTs) and five cohort studies were included (N = 1717, range n = 35 to n = 985) exploring various opioid reduction strategies. Of these, six studies had high/critical RoB, three moderate RoB, and one low RoB. Three cohort studies: investigating a GP-supervised opioid taper (critical ROBINS-I), an integrative pain treatment (moderate ROBINS-I), and group medical visits (critical ROBINS-I) demonstrated significant between-group opioid reduction.ConclusionResults carefully point in the direction of a GP supervised tapering and multidisciplinary group therapeutic sessions to reduce long-term opioid treatment. However, because of high risk of bias and small sample sizes, no firm conclusions can be made demonstrating the need for more high-quality research.

ObjectivesTo investigate the proportion of patients that pass a return to sport (RTS) test battery and assess changes in patient-reported outcomes and lower extremity muscle strength following three months of exericse-based rehabilitation in non-surgically treated patients with anterior cruciate ligament (ACL) injury.DesignProspective cohort study.SettingClinical environment (public municipal).ParticipantsThirty-nine ACL injured patients (54% female, median age (IQR) 28 years (24–35).Main outcome measuresThe Knee Injury and Osteoarthritis Outcome Score, Knee Outcome Survey Activities of Daily Living Scale, single hop for distance, crossover hop for distance, side hop test, the Agility T-test, and quadriceps and hamstrings isometric maximal voluntary contraction (MVC).ResultsFollowing 3 months of rehabilitation, patients had statistically significant improvements in all patients-reported outcomes and in quadriceps and hamstring MVC. Of 28 patients who completed all RTS tests, 11% passed six RTS criteria, 14% five criteria, 11% four criteria, 4% three criteria, 18% two criteria, 21% one criterion, and 21% none of the criteria.ConclusionsThe results suggest that three months of public municipal rehabilitation improves patient-reported outcomes and lower extremity muscle strength in non-surgically treated patients with ACL injury. However, only one in every 10 patients passed all RTS criteria.

This statement paper summarises and appraises the evidence on diagnosis, prevention, and treatment of common shoulder injuries in sports. We systematically searched Medline and Embase. The Grading of Recommendations Assessment, Development and Evaluation tool was applied to evaluate the overall quality of evidence.For diagnosis, we included 19 clinical tests from mixed populations. Tests for anterior instability, biceps-labrum complex injuries and full subscapularis rupture had high diagnostic accuracy (low to moderate quality of evidence).For prevention, the Oslo Sports Trauma Research Center, the Shoulder Control, the FIFA 11+ shoulder injury prevention programmes, and a baseball-specific programme (range of motion, stretching, dynamic stability and strengthening exercises) showed moderate to large effect size in reducing the risk of shoulder injury compared with no intervention (very low to moderate quality of evidence).For treatment, a rehabilitation programme including stretching, ice packs, electrotherapy and compression, and strengthening exercises showed a large effect size in reducing pain and disability compared with no intervention in athletes with subacromial impingement syndrome (very low to moderate quality of evidence). For the treatment of supraspinatus tendinopathy, hyperthermia treatment (heating the skin to 38°C–40°C) resulted in large effect size in reducing pain and disability compared with ultrasound or pendular swinging and stretching exercises (moderate quality of evidence). Strengthening exercise alone or in combination with stretching exercises promoted a large effect in reducing shoulder pain (cohort studies, no comparators) (very low quality of evidence). The quality of evidence for most estimates was low to moderate, indicating that future high-quality research may alter our recommendations for clinical practice.

Objectives: To identify the prevalence, frequency, adverse effects, and reasons for analgesic use in youth athletes. Design: Systematic review and meta-analysis. Methods: Systematic searches in Embase, Medline, and SPORT-Discus from inception to September 2021, screening of reference lists, and citation tracking were performed to identify observational studies including athletes aged 15–24 years and reporting data on prevalence and/or frequency of analgesic use. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effect proportion meta-analyses, stratified by type of analgesic medication and prevalence measure, estimated the prevalence of analgesic use. Data on usage frequency, adverse events, and reasons for analgesic use was synthesized narratively. Results: Forty-nine studies were included (44,381 athletes), of which 19 were good/high quality. Seven categories of analgesics were identified across 10 prevalence time-points. Meta-analyses suggested common use of NSAIDs (point prevalence 48 % [95 % CI 23 % to 73 %], in-season prevalence 92 % [95 % CI 88 % to 95 %]). The lowest prevalence was found for use of local anesthetic injections within the previous 12 months (2 % [95 % CI 1 % to 3 %]). Seven to 50 % of athletes reported weekly analgesics use. The proportion of adverse events ranged from 3.3 % to 19.2 %. Reasons for using analgesics included treatment of sports-related pain or injury, to treat illness, and to enhance performance. Conclusions: Analgesics are commonly used in youth athletes, but estimates vary depending on type of analgesic and prevalence measure. As the majority of studies were of poor methodological quality, future high-quality research should include prospective data collection of analgesic use to understand consumption trajectories.

OBJECTIVE: To determine the proportions of patients who (1) perceived their symptoms to be satisfactory, (2) perceived their treatment to have failed, or (3) perceived that they improved to an important degree at 3 months after arthroscopic meniscal surgery; and to determine Knee injury and Osteoarthritis Outcome Score (KOOS) subscale scores corresponding to the Patient Acceptable Symptom State (PASS), treatment failure, and the minimal important change (MIC) for improvement.DESIGN: Prospective cohort study.METHODS: Patients from the Knee Arthroscopy Cohort Southern Denmark who had arthroscopic meniscal surgery were included. The PASS, treatment failure, and MIC improvement values were calculated for the KOOS subscales with anchor-based approaches, using the adjusted predictive modeling method. Subgroup analyses were performed by stratifying by age (40 years or younger versus older than 40 years) and surgery type.RESULTS: Six hundred fourteen patients (44% female; mean ± SD age, 50 ± 13 years) were included. At 3 months after arthroscopic meniscal surgery, 45% of patients perceived their symptoms to be satisfactory, 19% perceived the treatment to have failed, and 44% to 60% perceived that they had improved to an important degree across the 5 KOOS subscales (for PASS/treatment failure, respectively: pain, 74 and 60 points; symptoms, 72 and 61 points; function in activities of daily living, 81 and 68 points; sport and recreational function, 43 and 26 points; and knee-related quality of life, 52 and 40 points; for MIC improvement: pain, 12 points; symptoms, 8 points; function in activities of daily living, 12 points; sport and recreational function, 17 points; and knee-related quality of life, 9 points). The PASS values were 6 to 17 points higher for patients 40 years or younger compared to patients older than 40 years.CONCLUSION: At 3 months after meniscal surgery, approximately half of the patients perceived their symptoms to have improved to an important degree, 4 in every 10 patients perceived their symptoms to be satisfactory, and 2 in every 10 patients perceived the treatment to have failed. J Orthop Sports Phys Ther 2021;51(6):281-288. Epub 30 Jan 2021. doi:10.2519/jospt.2021.10149.

The mechanisms underlying pain reductions following exercise therapy in patients with knee osteoarthritis (OA) are poorly understood. One mechanism could be changes in mechanical knee joint loading. To investigate if a neuromuscular exercise therapy and patient education intervention could alter knee joint loading assessed by Dual-Energy X-ray Absorptiometry (DXA) in people with knee OA. Participants with symptomatic knee OA were evaluated before and 26 weeks after an 8-week supervised neuromuscular exercise therapy and patient education intervention (Good Life with OsteoArthritis in Denmark). DXA scans were used to estimate the medial-to-lateral tibial plateau bone mineral density (BMD) ratio. The Knee Injury and Osteoarthritis Outcome Score was used to assess improvements in knee pain, symptoms, physical function, and knee-related quality of life. Changes in physical function were assessed with the 30-second chair stand test and the 40-meter fast paced walk test. Of 42 participants recruited, 30 (21 females, mean age 64 ± 7.9 years) had full data available. Medial-to-lateral tibial BMD ratio increased non-significantly by 0.02 (95% CI −0.01 to 0.06) (indicating higher medial load) from baseline to 26-weeks follow-up. Participants had statistically significant improvements of 21% in pain, 17% in symptoms, 14% in ADL, 17% in knee-related quality of life, 13% in chair stand ability, and 6% in walking speed. In this exploratory cohort study, following an 8-weeks supervised exercise therapy and patient education intervention, the medial-to-lateral tibial BMD ratio did not seem to change.

Systematic reviews of exercise therapy for knee osteoarthritis (OA) have largely ignored the variability in comparator interventions.To assess how effect estimates of exercise therapy for knee OA as reported in randomized controlled trials vary depending on the comparator interventions.We followed the Cochrane Handbook and PRISMA guidance to conduct and report this meta-epidemiological study. Randomised controlled trials (RCTs) were identified from systematic reviews published in 2015 or later and reference lists of included studies. Exercise therapy RCTs testing interventions that adhered to the American College of Sports Medicine (ACSM) guidelines compared to any comparator intervention in people with knee OA and reporting outcomes of knee pain, physical function and/or quadriceps strength at the end of intervention were included.Thirty-five RCTs with 2412 participants were included. Comparator interventions included no intervention, non-ACSM compliant exercise therapy, education/self-management, and passive modalities. For pain, standardized mean difference (SMD) for ACSM compliant exercise therapy compared to passive modalities was 1.76 (95% CI 0.49, 3.04), no intervention 0.93 (95% CI 0.50; 1.36), education/self-management 0.27 (95% CI 0.07, 0.47), and non-ACSM compliant exercise therapy 0.09 (95% CI -0.06, 0.23). For physical function, SMD for ACSM compliant exercise therapy compared to passive modalities was 1.29 (95% CI 0.41, 2.17), no intervention 0.76 (95% CI 0.15, 1.36), non-ACSM compliant exercise therapy 0.25 (95% CI -0.00, 0.51) and education/self-management 0.21 (95% CI -0.14, 0.55). For quadriceps strength, SMD for ACSM compliant exercise therapy compared to no intervention was 0.69 (95% CI 0.42, 0.96), non-ACSM compliant exercise therapy 0.23 (95% CI -0.01, 0.46), education/self-management -0.02 (95% CI -0.45, 0.42) and passive modalities 0.80 (95% CI -0.10, 1.71).The effect of exercise therapy for knee OA varies significantly depending on the comparator intervention. This variability should be assessed routinely in systematic reviews.

Purpose: In randomized controlled trials (RCTs), the effectiveness of exercise therapy for knee osteoarthritis (OA) has been determined by comparing it to a variety of comparator interventions. While several efforts have been made to investigate whether effect estimates differ between subgroups of patients and interventions, systematic reviews of exercise therapy for knee OA have largely ignored the variability in interventions provided in comparator groups and its implications for interpreting and comparing effect sizes. The aims of this systematic review and meta-analysis were to (i) assess the impact of variability in comparator group interventions on effect estimates of pain in exercise trials including people with knee OA, and (ii) investigate the association between participant and intervention characteristics and effect estimates.Methods: MEDLINE, EMBASE, and The Cochrane Database of Systematic Reviews were searched for systematic reviews synthesizing the effect of exercise therapy for knee OA published between January 2015 and October 2020. Included RCTs were extracted from reference lists and screened for eligibility. RCTs comparing exercise therapy compliant with the American College of Sports Medicine (ACSM) criteria for muscle strength training or aerobic training to any comparator intervention measuring patient-reported pain were eligible for inclusion. Comparator interventions were grouped as no intervention, non-ACSM exercise therapy, education/self-management, and passive modalities, and compared using stratified random-effects meta-analyses. Associations between participant and intervention characteristics (age, sex, BMI, duration of intervention, difference in attention, difference in number of treatment sessions, baseline pain,) and effect estimates were assessed using univariate meta-regression analyses.Results: Thirty-five trials including 2412 participants (68% female, mean age 62 ± 5) and 44 study comparisons were included. No intervention was applied in the comparator group in 18 comparisons, non-ACSM exercise therapy in 15, education/self-management in six, and passive modalities in five. Stratified meta-analyses showed statistically significant differences in effect estimates depending on type of intervention provided in the comparator group. Statistically significant effects in favor of ACSM exercise therapy were found when compared to passive modalities (SMD 1.76, 95% CI 0.49 to 3.04), no intervention (SMD 0.93, 95% CI 0.50 to 1.36) and education/self-management (SMD 0.27, 95% CI 0.07 to 0.47). Contrary, no statistically significant effect was found when comparing ACSM exercise therapy to non-ACSM exercise therapy (SMD 0.09, 95% CI -0.06 to 0.23) Meta-regression analyses adjusted for participant and trial characteristics showed no associations with effect estimates. Overall quality of evidence was low to moderate across subgroups. Main reasons for downgrading included risk of bias, inconsistency, and risk of publication bias.Conclusion: The effect of exercise therapy compliant with the ACSM criteria for muscle strength training or aerobic training for knee OA pain vary considerably depending on the intervention provided in the comparator group. This variability should be considered when interpreting and comparing effect sizes of exercises therapy to other interventions.

The aim of this study was to determine the 4-week prevalence of pain medication use in youth athletes, the type of medication used, the reasons for use, and from where the athletes obtained the medication. 466 handball players (aged 14-18) were surveyed about their pain medication use within the preceding 4 weeks. The questionnaire consisted of 3 parts: type of pain medication used (if any; non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen/paracetamol, and acetylsalicylic acid (ASA)), the reasons for use, and from where it was obtained. 190 players (41% [95% CI 36%-45%]) reported pain medication use within the last 4 weeks. Paracetamol was the most reported type (n = 157, 83% [95% CI 77%-88%]), followed by NSAIDs (n = 98, 52% [95% CI 44%-59%]); 67 reported “injury-related reasons” for their use, and most participants reported to obtain the pain medication via “from home or bought over-the-counter (OTC)” (n = 167, 88% [95% CI 82%-92%]). Pain medication use in youth handball players is common, particularly among female players, and a substantial proportion of the overall use is due to injury-related reasons. The vast majority of the players got their pain medication from home or purchased it OTC. Further research is needed to comprehend these patterns of use, including the long-term use.

Background Joint hypermobility in athletes is associated with increased risk of knee injuries, but its role in relation to shoulder injuries has not been scrutinized. Therefore, our aim was to synthesize the evidence on the association between joint hypermobility and shoulder injuries in athletes. Methods Data sources were MEDLINE, CINAHL, EMBASE, and SPORTDiscus from inception to 27th February 2021. Eligibility criteria were observational studies of athletes (including military personnel), mean age ≥ 16 years, and with a transparent grouping of those with and without joint hypermobility. A broad definition of joint hypermobility as the exposure was accepted (i.e., generalised joint hypermobility (GJH), shoulder joint hypermobility including joint instability). Shoulder injuries included acute and overuse injuries, and self-reported pain was accepted as a proxy for shoulder injuries. The Odds Ratios (OR) for having shoulder injuries in exposed compared with non-exposed athletes were estimated using a random effects meta-analysis. Subgroup analyses were performed to explore the effect of sex, activity type, sports level, study type, risk of bias, and exposure definition. Risk of bias and the overall quality of evidence were assessed using, respectively, the Newcastle–Ottawa Scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Among 6207 records, six studies were included with 2335 (range 118–718) participants (34.1% females; athlete mean age 19.9 years). Athletes with joint hypermobility were more likely to have shoulder injuries compared with athletes without joint hypermobility (OR = 3.25, 95% CI 1.64, 6.43, I2 = 75.3%; p = 0.001). Exposure definition (GJH, OR = 1.97, 95% CI 1.32, 2.94; shoulder joint hypermobility, OR = 8.23, 95% CI 3.63, 18.66; p = 0.002) and risk of bias (low, OR = 5.25, 95% CI 2.56, 10.8; high, OR = 1.6, 95% CI 0.78, 3.29; p = 0.024) had large impacts on estimates, while the remaining subgroup analyses showed no differences. The overall quality of evidence was low. Conclusion Joint hypermobility in athletes is associated with a threefold higher odds of having shoulder injuries, highlighting the need for prevention strategies in this population. However, due to low quality of evidence, future research will likely change the estimated strength of the association. Protocol registration Open Science Framework registration osf.io/3wrn9.

BackgroundTo our knowledge, there is no intervention which includes personalised exercise therapy and self-management support for people with multimorbidity, although these interventions may be as effective as for people with single chronic conditions. Therefore, we developed a novel intervention, including personalised exercise therapy and self-management support for people with multimorbidity.MethodsWe followed the Medical Research Council framework and conducted one scoping review, five systematic reviews, two registry-based studies, one qualitative interview study and a mixed-methods feasibility study. Following an iterative approach, together with feedback from people with multimorbidity and relevant stakeholders, we developed the MOBILIZE intervention.ResultsThe intervention included 24 (60 minutes) sessions of personalised exercise therapy and 24 (30 minutes) sessions of self-management support twice a week for 12 weeks, delivered in small groups by specifically trained physiotherapists. The intervention targets physiological, psychosocial, behavioural, and contextual factors to improve health-related quality of life and physical function in people living with multimorbidity.ConclusionsWe developed a personalised exercise therapy and self-management support programme for people with multimorbidity. The intervention will be tested for its safety and effectiveness in a randomised controlled trial.

BACKGROUNDSex appears to be an important contributor to differences in the perception and experience of pain, with a growing body of evidence reporting sex-specific differences in both the prevalence of painful conditions, in response to pain management interventions, and in response to experimentally induced pain. However, studies have to a lesser extent focused on differences in self-reported pain intensity in people who seek care for musculoskeletal pain. The aim of this study was to describe sex-specific differences in primary symptom site and pain intensity in patients seeking care in Danish private physiotherapy clinics.METHODSCross-sectional study of patients seeking care in Danish private physiotherapy clinics within the FysioDanmark® network between January 2017 and March 2020. Data were available via the FysioDanmark® clinical database and obtained from questionnaires distributed to patients prior to their first consultation. Patients were asked to indicate the primary symptom site for which they sought treatment. From this information, patients were categorised as having symptoms in one of the following categories: Back; Neck; Shoulder; Hip; Knee; Ankle/foot; and Non-specific. Pain intensity experienced by patients ‘most of the time’ was assessed using a 11-point Numeric Rating Scale (NRS) ranging from 0 (no pain) to 10 (worst imaginable pain) for the primary symptom site. Data on primary symptom site was presented as percentage distribution and 95% confidence intervals (95%CI). Pain intensity for males and females was reported as median, interquartile range (IQR), and upper and lower adjacent values stratified by primary symptom site and age (10-year intervals age groups).RESULTSIn total 64,505/186,808 patients (35%) responded to the questionnaire. Patients whose treatment was fully paid by the healthcare system (n=939) were excluded as they were not comparable to the other patients (e.g. severe disability). Data from the remaining 63,566 first visits by 61,097 persons constituted the final study sample. Included patients had a mean age of 41.8 (SD 16.2) years and 57% were female. The age distribution was similar for males and females. In total, 23% (95%CI: 22.6 to 23.2) of the patients consulted a physiotherapist for back symptoms, 20% (95%CI: 19.5 to 20.1) non-specific symptoms, 16% (95%CI: 15.6 to 16.2) shoulder symptoms, 15% (95%CI: 14.5 to 15.1) knee symptoms, 13% (95%CI: 12.7 to 13.1) for neck symptoms, 8% (95%CI: 7.6 to 8.1) ankle/foot symptoms, and 5% (95%CI: 4.7 to 5.1) hip symptoms. In males, the most common reason for consulting a physiotherapist was back symptoms followed by shoulder and non-specific symptoms, which together constituted 62% of all reported problems. In females, the most common reason for consulting a physiotherapist was non-specific symptoms, followed by back and neck symptoms, which together constituted 57% of all reported problems. Overall, females reported slightly higher pain intensity compared to males (4 (IQR: 2 to 6) vs. 3 (IQR: 2 to 5). When stratifying by primary symptom site, females reported slightly higher pain intensity (1 point) compared to males across all primary symptom sites. Similarly, females reported slightly higher pain intensity compared to males in all age groups (1 to 1.5 points), except in the youngest age group. Females in older age groups reported higher pain intensity than females in the younger age groups. This was not observed to the same extent in males.CONCLUSIONAmong patients seeking care in Danish private physiotherapy clinics, males most commonly presented with back symptoms, followed by shoulder and non-specific symptoms, whereas females most commonly presented with non-specific symptoms, followed by back and neck symptoms.In general, females reported higher pain intensity compared to males across the different primary symptom sites and age groups (10-year intervals). Also, females in older age groups reported higher pain intensity than females in the younger age groups. This was not observed to the same extent in males. These findings provide knowledge on a large group of patients consulting physiotherapists in the real-world clinical setting. BACKGROUNDSex appears to be an important contributor to differences in the perception and experience of pain, with a growing body of evidence reporting sex-specific differences in both the prevalence of painful conditions, in response to pain management interventions, and in response to experimentally induced pain. However, studies have to a lesser extent focused on differences in self-reported pain intensity in people who seek care for musculoskeletal pain. The aim of this study was to describe sex-specific differences in primary symptom site and pain intensity in patients seeking care in Danish private physiotherapy clinics.METHODSCross-sectional study of patients seeking care in Danish private physiotherapy clinics within the FysioDanmark® network between January 2017 and March 2020. Data were available via the FysioDanmark® clinical database and obtained from questionnaires distributed to patients prior to their first consultation. Patients were asked to indicate the primary symptom site for which they sought treatment. From this information, patients were categorised as having symptoms in one of the following categories: Back; Neck; Shoulder; Hip; Knee; Ankle/foot; and Non-specific. Pain intensity experienced by patients ‘most of the time’ was assessed using a 11-point Numeric Rating Scale (NRS) ranging from 0 (no pain) to 10 (worst imaginable pain) for the primary symptom site. Data on primary symptom site was presented as percentage distribution and 95% confidence intervals (95%CI). Pain intensity for males and females was reported as median, interquartile range (IQR), and upper and lower adjacent values stratified by primary symptom site and age (10-year intervals age groups).RESULTSIn total 64,505/186,808 patients (35%) responded to the questionnaire. Patients whose treatment was fully paid by the healthcare system (n=939) were excluded as they were not comparable to the other patients (e.g. severe disability). Data from the remaining 63,566 first visits by 61,097 persons constituted the final study sample. Included patients had a mean age of 41.8 (SD 16.2) years and 57% were female. The age distribution was similar for males and females. In total, 23% (95%CI: 22.6 to 23.2) of the patients consulted a physiotherapist for back symptoms, 20% (95%CI: 19.5 to 20.1) non-specific symptoms, 16% (95%CI: 15.6 to 16.2) shoulder symptoms, 15% (95%CI: 14.5 to 15.1) knee symptoms, 13% (95%CI: 12.7 to 13.1) for neck symptoms, 8% (95%CI: 7.6 to 8.1) ankle/foot symptoms, and 5% (95%CI: 4.7 to 5.1) hip symptoms. In males, the most common reason for consulting a physiotherapist was back symptoms followed by shoulder and non-specific symptoms, which together constituted 62% of all reported problems. In females, the most common reason for consulting a physiotherapist was non-specific symptoms, followed by back and neck symptoms, which together constituted 57% of all reported problems. Overall, females reported slightly higher pain intensity compared to males (4 (IQR: 2 to 6) vs. 3 (IQR: 2 to 5). When stratifying by primary symptom site, females reported slightly higher pain intensity (1 point) compared to males across all primary symptom sites. Similarly, females reported slightly higher pain intensity compared to males in all age groups (1 to 1.5 points), except in the youngest age group. Females in older age groups reported higher pain intensity than females in the younger age groups. This was not observed to the same extent in males.CONCLUSIONAmong patients seeking care in Danish private physiotherapy clinics, males most commonly presented with back symptoms, followed by shoulder and non-specific symptoms, whereas females most commonly presented with non-specific symptoms, followed by back and neck symptoms.In general, females reported higher pain intensity compared to males across the different primary symptom sites and age groups (10-year intervals). Also, females in older age groups reported higher pain intensity than females in the younger age groups. This was not observed to the same extent in males. These findings provide knowledge on a large group of patients consulting physiotherapists in the real-world clinical setting.

Background Behavior change and exercise are considered critical for successful self-management in people with multimorbidity, however, little is known about people’s needs, experiences, and preferences. Purpose The aim of this study was to qualitatively explore the perspectives of people living with multimorbidity, healthcare professionals, relatives, and patient advocates in relation to self-management and exercise behavior. Research design Analysis was carried out by means of a hybrid inductive-deductive approach using Framework Analysis that enabled the subsequent use of the COM-B model in relation to the study of exercise behavior specifically. Study sample We conducted 17 interviews (9 focus groups; 8 key informants) with 48 informants from four groups (22 people living with multimorbidity, 17 healthcare professionals, 5 relatives, and 5 patient advocates). Data analysis Through an inductive Framework analysis, we constructed three themes: Patient education, supporting behavior change, and lack of a “burning platform.” Subsequent deductive application of the COM-B profile (applied solely to data related to exercise behavior) unveiled a variety of barriers to exercise and self-management support (pain, fatigue, breathlessness, lack of motivation, financial issues, accessibility, decreased social support). Results Overall, the four groups shared common understandings while also expressing unique challenges. Conclusions Future interventions and/or policies targeting exercise behavior in people living with multimorbidity should address some of the barriers identified in this study.