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Table 2 Summary of themes, concepts and examples of free text responses regarding barriers to the use of exercise for CKP

From: What influences general practitioners’ use of exercise for patients with chronic knee pain? Results from a national survey

Theme Concepts Given as a response option Example of coded response
Service-related Insufficient time in consultations [Nil additional free text comments given]
Difficulty accessing physiotherapy “Takes 18 weeks to see a physio”
Limitations to accessing services “Pressure on reducing referrals” “Loss of local fitness initiative” “Lack of any facilities in our local area for people to group exercise - no sports or leisure facility.” “Cost of exercise to patient e.g. Gym membership”
My GP colleagues do not use or value exercise [Nil additional free text comments given]
Services do not meet expectations “…some patients wait for 3/12 and once they’ve seen they’ve been given a leaflet to do exercise at home, this does not meet patients’ expectations” “Only get 2 physio sessions if we refer them” “Physiotherapy appointments are not long enough”
Geographical problems “Remote location of practice deters patients from travelling to a gym” “Patients are too scared to walk in local area”
GP-related Insufficient expertise to give detailed information [Nil additional free text comments given]
Uncertainty about the most appropriate type of exercise [Nil additional free text comments given]
Uncertainty about the effects of exercise [Nil additional free text comments given]
Uncertainty about the safety of exercise [Nil additional free text comments given]
Cannot access necessary resources “Lack of structured approach I know the info is out there somewhere - don’t have time or energy to search” “Detailed leaflet sounds good - if I have time I will look at arthritis UK website”
GP does not prioritise exercise “Perhaps I should give it a higher priority”
Unclear what physio offers “Little feedback from physiotherapy about advice offered/range of services”
Patient-related Patients prefer other management options “When mention physiotherapy and exercise most patients don’t want this - ‘they just give you exercises and it makes the pain worse’”
Exercise does not match patient needs/expectations “Patients want a ‘quick fix’ losing weight and increasing exercise is more difficult” “Patients so overweight that they cannot even consider exercise - in fact this annoys them” “Patient appearing so debilitated by chronic pain that exercise cannot be tolerated” “Patient refusal to engage with regular exercise due to perceived time constraints and fear of harming themselves” “I advise on quad strengthening, patients often sceptical this is enough to help relieve their symptoms” “Specialist colleagues appear to always want MRI/CT/xray/arthroscopy + people talk to each other (I had this + the specialist did….)”
Achieving patient behaviour change is difficult “Very difficult to get many patients to change lifestyle sufficiently to effect enough real change to help knee pain” “Many pts are lazy!” “patient reluctance” “Requires significant patient re-education and elements of motivational interviewing so potentially v time consuming”
Other Other “physiotherapy (referral) needs to be prioritised”