Patients' experiences of musculoskeletal pain self-management and perspectives on virtual physiotherapy in Saudi Arabia: a reflexive thematic analysis.

Abstract

Background Patients with musculoskeletal (MSK) pain in Saudi Arabia frequently employ self-directed management strategies in the absence of timely professional physiotherapy. This qualitative study was conducted as the first phase of a research programme investigating virtual MSK self-management in Saudi Arabia. Its findings subsequently informed the development and design of a hybrid virtual self-management programme for low-risk MSK patients. Methods Eight gender-separated focus groups (n = 36) were conducted in Arabic at a tertiary care facility in Riyadh between July and October 2025. Sessions were held in-person or via Zoom. Audio recordings were transcribed verbatim using automated transcription (TurboScribe AI) as a first-pass tool, and the resulting transcripts were subsequently verified line by line by the research team. Data were analysed using reflexive thematic analysis following Braun and Clarke's six-phase framework. The study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results Four interconnected themes were constructed: (1) Self-Management Without Structured Guidance - patients enacted symptom-driven strategies as rational responses to delayed professional care access; (2) Barriers to Physiotherapy Engagement and Adherence - structural, psychological, and relational factors disrupted access and adherence; (3) Limited Health Literacy and Educational Needs - community and individual knowledge gaps were identified, including a culturally specific educational need that has received limited attention in the MSK self-management literature for guidance on adapting Islamic prayer (Salah) during MSK pain; and (4) Conditional Acceptance of Virtual and Hybrid Physiotherapy Models - participants generally preferred hybrid care in which virtual delivery served as follow-up after in-person assessment and technique acquisition, not as an entry point to rehabilitation. Conclusions Patients described relying on informal self-management strategies, which they attributed to the systemic lack of timely access to professional care. To our knowledge, a culturally specific finding that has received limited attention in the musculoskeletal self-management literature is patients' need for guidance on adapting Islamic prayer (Salah) during MSK pain. These findings informed the development of a culturally adapted hybrid virtual self-management programme, with implications for patient education and physiotherapy service design at the study institution and similar tertiary settings in Saudi Arabia, aligned with the national Vision 2030 health strategy. Clinical trial number Not applicable.