The How and Why of Exercise Prescription. Patients' Experience of Prescribed Exercise in Musculoskeletal Physiotherapy.

RATIONALE: Musculoskeletal physiotherapy, including the exercise prescription element, should be patient-centred with an active patient involved in the decision making. Currently, exercise prescription relies heavily on published literature and clinical expertise, however there is limited published research on the patient's experience with the exercise prescription process in a one-on-one outpatient setting. AIMS AND OBJECTIVES: This study aimed to explore patients' experiences of the exercise prescription process in musculoskeletal physiotherapy and to develop a grounded understanding of the elements that are important considerations to patients in a one-on-one rehabilitation setting. METHODS: Twenty participants who had recently completed outpatient physiotherapy for a musculoskeletal condition took part in a semi-structured interview. Data collection and analysis occurred concurrently, with recruitment continuing until theoretical saturation was reached. Data were analysed using published grounded theory methods. RESULTS: Two main categories emerged describing the patient experience of exercise prescription, WHY and HOW, with individualisation of the program to the patient acting as the core concept. WHY encompassed education, feedback and collaboration, which built patients' understanding, trust and confidence in their exercise program and supported a therapeutic alliance. HOW encompassed exercise selection, prescription method, dosage parameters, progressive overload and prescription tools, reflecting how the program was practically developed and delivered. These elements were interdependent, with the WHY elements informing the HOW elements, all converging on individualisation as the core concept for an effective exercise prescription process. CONCLUSION: Patients value an individualised, collaborative approach to exercise prescription that integrates education, ongoing feedback and prescription methods tailored to their goals and context. These findings offer physiotherapists patient-informed insight to complement existing clinician focused literature to guide the exercise prescription process.