Key determinants for successful lifestyle change to address chronic musculoskeletal pain: The patient's perspective.

Abstract

Lifestyle medicine aims to improve whole-person health, but unique implementation challenges exist when applying lifestyle medicine to address musculoskeletal pain. (1) To identify patient-perceived factors that affect patients' ability to make and maintain lifestyle changes in the context of having chronic musculoskeletal pain. (2) To summarize specific, patient-reported key strategies for success that clinicians can efficiently discuss with patients to facilitate lifestyle change. Mixed methods study. Musculoskeletal lifestyle medicine program within a tertiary care academic center. A purposively sampled, sociodemographically diverse group of adult patients who presented to a musculoskeletal-oriented lifestyle medicine program to address chronic musculoskeletal pain and coexisting metabolic disease. Not applicable. Participants' semistructured interview responses were triangulated with their final program disposition and mean (SD) change on Patient-Reported Outcomes Measurement Information System (PROMIS) physical and mental health measures from initial to final program visit. Among 38 patients (median age 59 [range 31-74] years, 28 [74% women]), chronic pain and impaired mobility were common barriers to lifestyle change. Nevertheless, with instruction regarding how to move safely, increasing physical activity was also frequently described as patients' most impactful lifestyle change. Patients reported a wide variety of effective facilitators and motivators for change, some of which were affected by patients' gender, childhood food culture, and other life circumstances. Patients with depression commonly described clinician investment and accountability via the lifestyle medicine program as key facilitators. Although mean PROMIS score changes were modest, patients nearly universally made at least one lifestyle change and perceived related clinical benefits, even among patients whose success was not perceived by the clinical team. Patients with chronic musculoskeletal pain can successfully make lifestyle changes. They commonly cite clinician support as a key facilitator to safely increasing physical activity and identifying tailored strategies to overcome barriers to change.