National-Specific Barriers and Facilitators to Physical Activity in RMDs: The COPA Initiative

Overview

This study developed and piloted the COPA-BFQ questionnaire to identify social, environmental, and system-level barriers and facilitators to physical activity (PA) in individuals with rheumatic musculoskeletal disorders (RMDs) across France, Switzerland, the Netherlands, and Turkey. Distinct country-specific determinants influencing PA adherence were identified, highlighting the need for tailored interventions.

Background

Rheumatic and musculoskeletal diseases (RMDs) such as rheumatoid arthritis, axial spondyloarthritis, and osteoarthritis are leading causes of disability worldwide. Physical activity is a key management strategy that improves symptoms, function, and psychological well-being in these populations. Despite established benefits and EULAR recommendations, adherence to PA remains insufficient, partly due to disease-specific and extra-personal barriers. Understanding social, environmental, and systemic factors across countries is essential to enhance PA engagement and implement guidelines effectively.

Data Highlights

The COPA-BFQ questionnaire was developed with 27 items across three domains: social (7 items), environmental (13 items), and system (7 items). It was administered digitally to approximately 100 patients per country (France, Switzerland, the Netherlands, Turkey) between August 2024 and April 2025. Participants rated each item as a barrier, facilitator, or neutral, with strength scored from 0 to 10. Demographics and PA frequency were also collected. The study ensured linguistic validity through the TRAPD translation approach and preliminary testing with patients.

Key Findings

• The COPA-BFQ is a novel, validated instrument capturing extra-personal determinants of PA in RMD populations across multiple European countries.
• Distinct country-specific social, environmental, and system-level barriers and facilitators to PA were identified, reflecting differences in healthcare access, infrastructure, and cultural factors.
• Common barriers included limited access to specialized health professionals and transport infrastructure variability.
• Facilitators varied by country but generally involved supportive healthcare systems and patient education.
• Adaptive questioning allowed nuanced assessment of the strength of each barrier or facilitator, enhancing the questionnaire's sensitivity.

Clinical Implications

Clinicians should consider country-specific social and systemic factors when promoting physical activity in patients with RMDs. Tailored interventions addressing identified barriers such as healthcare access and transport limitations may improve PA adherence. Utilizing tools like the COPA-BFQ can guide personalized strategies and inform healthcare policy to support PA engagement.

Conclusion

The COPA initiative successfully developed a cross-national tool to identify extra-personal determinants of physical activity in RMDs, revealing important country-specific challenges and facilitators. Addressing these factors is critical for effective implementation of EULAR PA recommendations and improving patient outcomes.

References

1. EULAR Recommendations and Related Research (2024) -- Physical Activity in Rheumatic Musculoskeletal Disorders
2. COPA Initiative Study Protocol (2024) -- Development and Validation of COPA-BFQ