# Exploring Barriers and Facilitators to Self‐Management for Patients With Persistent Musculoskeletal Conditions Following NHS‐Led Hydrotherapy: A Service Evaluation

## TL;DR

This study explores why patients with long-term musculoskeletal conditions struggle to manage their health after hydrotherapy and suggests forming support groups to help them.

## Contribution

The study identifies barriers to self-management after NHS-led hydrotherapy and proposes a patient-led support group as a novel solution.

## Key findings

- Most patients did not maintain self-management due to lack of support and financial issues.
- A majority of patients supported forming a hydrotherapy support group.
- Functional scores improved after hydrotherapy, but self-efficacy remained low.

## Abstract

Persistent musculoskeletal (MSK) disorders are one of the leading reasons for years lived with disability within the UK. Guidelines encourage integrating self‐management support. Hydrotherapy supports patients with persistent MSK conditions; however, self‐management following NHS‐led hydrotherapy has been inconsistent.

To identify outcomes of hydrotherapy alongside the barriers, facilitators, and contributory factors affecting self‐management in the local persistent MSK pain population.

Between April 2023 and May 2023, a service evaluation was undertaken exploring factors affecting self‐management in the local persistent MSK pain population following NHS‐led hydrotherapy. Demographics, clinical factors, functional status (MSK‐HQ) and patient‐reported experiences, including barriers and facilitators to self‐management, were recorded. Data was analysed using descriptive statistics alongside exploration of themes.

Ninety patients completed hydrotherapy. White British (n = 24) and Indian British (n = 23) were the most common groups to attend. Multiple joint (n = 27) and spinal conditions (n = 26) were the most common MSK conditions. Mean pre‐ and post‐MSK‐HQ scores were 20.8 and 26.1, respectively. Among the contactable patients (n = 69), 49 patients did not maintain independent water‐based self‐management reporting barriers such as ongoing support, access and financial concerns. Patients supported the establishment of a support group (n = 56) to help maintain water‐based exercises.

The local persistent MSK pain population lacks self‐efficacy for independent water‐based self‐management. A supportive and collaborative approach is proposed to address this via a patient‐led hydrotherapy support group.