Adherence Support Strategies for Physical Activity Interventions in People With Chronic Musculoskeletal Pain-A Systematic Review and Meta-Analysis

Background : Chronic musculoskeletal (MSK) pain signi fi cantly impacts individuals ' quality of life. Regular physical activity is an important key to therapy. However, adherence to exercise is often below the intended levels. This systematic review aims to assess the effectiveness of adherence support strategies in physical activity randomized controlled trials (RCTs) for patients with chronic MSK pain, to address the challenge of motivation and adherence in this population. Methods : Ovid and CINAHL databases were searched for MSK " chronic pain, " " adherence " and " physical activity " (in various synonyms) for RCTs with a follow-up of at least 6 months. After a screening process that included several team members, a narrative synthesis and a metaanalysis on adherence and effect sizes of different outcomes were performed. Results : An initial database output of 5816 articles resulted in 76 RCTs that remained for analysis. These RCTs showed high heterogeneity of intervention design and outcome data. Adherence to exercise varied widely, with 21 RCTs achieving rates of 80% or higher using strategies like education, goal setting, self-monitoring, and personal feedback. The meta-analysis, based on 29 out of 76 RCTs, indicated a nonsigni fi cant correlation between adherence levels and an improved outcome (eg, pain or quality of life). No individual strategy emerged as superior, emphasizing the complexity and diversity of intervention designs. Conclusions : This review offers strategies, such as information/education and individual goal setting/feedback that may be bene fi cial for enhancing physical activity in patients with chronic MSK pain. Future research should focus on including promising adherence support strategies and providing data for adherence calculations.