A qualitative exploration of video-based motor action observation perceptions in patients with chronic low back pain and asymptomatic participants: An interpretative phenomenological analysis

BACKGROUND: Video-based action observation (AO) of exercise/motor-action content is increasingly delivered via social media. This expands reach and ecological validity but may shape motor simulation, perceived safety, and engagement. How people with chronic low back pain (CLBP) interpret and intend to use such videos remains underexplored. METHODS: We conducted an interpretative phenomenological analysis (IPA) of semi-structured interviews with purposively sampled adults (n = 20; 10 CLBP, 10 asymptomatic). Interviews probed perceptions of exercise/motor-action AO videos drawn from common platforms. Analysis followed IPA procedures with iterative coding, constant comparison, and team reflexivity, and is reported according to COREQ. RESULTS: Three interrelated themes were identified: (1) Emotional & motivational impact: CLBP participants frequently appraised bending, load and fast tempo as threatening and described protective avoidance rules. Motivation was present in both groups when videos felt safe and adaptable; (2) Self-assessment of physical capacity: Perceived competence increased when videos provided graded options and explicit safety cues. Anticipated task demand decreased with appropriate pacing/tempo, egocentric viewpoint, and credible modeling; (3) Cognitive movement assessment: Viewers attended to posture, tempo, breathing and error-avoidance cues. Action comprehension faltered when instructions were dense/fast or goals were unclear. Judgments about delivery (goal clarity, safety cues, pacing, viewpoint, modeling fidelity) shaped internal rehearsal and willingness to attempt. CONCLUSIONS: Individuals with and without CLBP perceive social-media-delivered exercise AO as useful when videos are tailored (graded options, clear safety messaging, appropriate pacing/viewpoint) and contextualized to pain-related concerns and digital literacy. These insights inform clinically oriented AO exercise-video libraries and implementation strategies (e.g., curated playlists, level-tagging, therapist-mediated briefing) to enhance acceptability and adherence in CLBP rehabilitation.