Table 2. Examples of barriers and facilitators mapped to the TDF from semistructured interview responses.

Domain	Barriers	Facilitators
Knowledge	Limited awareness of updated evidence-based guidelines among practitioners.	Access to continuous education and workshops to bridge gaps in guideline knowledge
	Patients misunderstand the role of exercise, associating it with harm or ineffectiveness	Use of visual tools like videos and diagrams to simplify patient education
Skills	Lack of practical training opportunities in multidisciplinary settings	Leveraging digital tools (eg, apps) to enhance skill acquisition and patient guidance
Social/professional role	Disjointed collaboration between physicians and therapists; differing views on care priorities	Regular team meetings and aligned goals within multidisciplinary teams
Beliefs about capabilities	Low confidence in addressing comorbid conditions and tailoring interventions to individuals	Peer mentorship and case discussions to boost confidence in applying evidence-based interventions
Optimism	Patient scepticism about exercise’s effectiveness, especially with slow progress or initial pain	Clear communication of realistic benefits and managing patient expectations effectively
Beliefs about consequences	Fear of patient injury or exacerbation of symptoms due to inappropriate exercise protocols	Provision of scientific evidence showing the long-term benefits of exercise in improving joint function and reducing surgical interventions
Reinforcement	Reliance on traditional treatments (eg, massage or medication) over evidence-based practices	Other patients’ success stories and improved clinical outcomes to motivate patients
Intentions	Challenges in integrating exercise-based strategies into existing workflows	Seamless incorporation of exercise into multidisciplinary care plans
Environmental context	Limited infrastructure and resource allocation for rehabilitation, including insufficient funding and staff	Investment in telehealth platforms and advanced rehabilitation equipment
Social influences	Cultural norms favouring passive treatments like acupuncture over active rehabilitation approaches	Public awareness campaigns and education to shift societal perceptions of exercise
Emotion	Practitioners’ fear of patient complaints due to perceived lack of improvement or discomfort during exercise	Open dialogue with patients to address concerns and build trust, reducing resistance
Behavioural regulation	Inconsistent application of monitoring strategies to ensure patient adherence	Structured follow-up systems to maintain adherence to exercise plans

TDF, Theoretical Domains Framework.