Identifying gaps and key research questions in the implementation of self-management in musculoskeletal conditions

INTRODUCTION: Self-management is widely regarded as a core component of person-centred musculoskeletal care. Despite this recognition, translating supported self-management into routine primary care remains challenging. Conceptual variability, contextual influences, and misalignment between patient priorities and system incentives continue to hinder large-scale implementation. PURPOSE: This Professional Practice paper synthesises insights from an interactive international forum session exploring two guiding questions: (1) What are key research gaps in the implementation of self-management in musculoskeletal conditions? and (2) What challenges, barriers, and facilitators shape its implementation in primary care? IMPLICATIONS: Participants identified persistent gaps related to conceptual clarity, contextual variability across populations and health systems, limited understanding of mechanisms of action, and insufficient alignment between evaluated outcomes and what matters to patients. Implementation challenges were described at system, clinician, and patient levels, including funding structures, professional competencies, expectations of care, and the perceived burden of responsibility. Facilitators included shared definitions, mentoring, telehealth integration, community engagement, and deliberate de-implementation of low-value care. The findings suggest that advancing self-management requires moving beyond intervention efficacy toward greater conceptual clarity, contextual adaptation, co-creation with patients, and alignment between education, policy, and practice.