Patient and clinician perspectives of online-delivered exercise programmes for chronic musculoskeletal conditions: a mixed-methods systematic review

Purpose: To synthesize common or differing perceptions of patients’ and clinicians’ that influence uptake of online-delivered exercise programmes (ODEPs) for chronic musculoskeletal (MSK) conditions. Methods: Eight databases were searched from inception to April 2023 for studies including (1) patients with and/or clinicians delivering ODEPs for chronic MSK conditions, and (2) synchronous ODEPs, where information is exchanged simultaneously (mode A); asynchronous ODEPs, with at least one synchronous feature (mode B); or no ODEPs, documenting past experiences and/or likelihood of participating in an ODEP (mode C). Critical Appraisal Skills Programme checklists were used to assess study quality. Perceptions of patients’ and clinicians’ influencing uptake of ODEPs were extracted. Quantitative and qualitative data were synthesised and integrated. Results: Twenty-one studies were included (twelve quantitative, seven qualitative, and two mixed-methods) investigating the perceptions of 1275 patients and 534 clinicians on ODEP mode A (n = 7), mode B (n = 8), and mode C (n = 6). Sixteen of the 23 identified perceptions related to satisfaction, acceptability, usability, and effectiveness were common, with 70% of perceptions facilitating uptake and 30% hindering uptake. Conclusions: Findings highlight the need to promote targeted education for patients and clinicians addressing interconnected perceptions, and to develop evidence-based perception-centred strategies encouraging integrated care and guideline-based management of chronic MSK conditions.