Features of physical activity interventions associated with effectiveness in musculoskeletal disorders: systematic review and meta-analysis

Abstract

Background: Physical activity (PA) can help manage age-related decline in musculoskeletal (MSK) function. However the features of effective interventions to promote PA remain unclear. Methods: Systematic review with meta-analyses were conducted to examine the effectiveness of PA interventions in adults with MSK disorders. Univariate meta-regression and sub-group analyses guided by incidence/concurrence matrices explored the association between intervention features (behaviour change techniques (BCTs) and modes of delivery). Findings: Thirty-five trials were included. Overall interventions effectively increased PA (SMD=0.40, 95%CI 0.14-0.65, p=0.002). Greater increases in PA were associated with interventions with fewer sessions (beta=-0•022, 95%CI -0.044 to -0.0002, p=0.04) and those that were self-management-based rather than instructor-based (p=0.002). Most common BCTs were behavioural practice-rehearsal (75%), demonstration of the behaviour (67%) and goal setting (behaviour) (33%). In over 90% of cases, ‘behavioural practice-rehearsal’ was used together with ‘graded task’, ‘demonstration of behaviour’, and in instructor-based interventions. Neither the number of BCTs nor any individual BCT was associated with increased effectiveness. Discussion: PA interventions can be effective in MSK disorders. Considering the concurrence of intervention features is important for understanding potentially synergistic effects.