Poor communication: Poor communication was identified by all participants as a barrier to adherence with communication gaps or poor relationships sometimes existing between therapist and patient or between therapist and referring doctor. This may arise in part due to language, social or intellectual differences. Most participants identified that many GPs do not acknowledge physiotherapy. Those GPs that do may enforce their own treatment plans. Consequently therapists may be unwilling or unable to change doctors’ recommendations and continue the treatment programme without regard for treatment outcome. This may influence patients who may then be unwilling to deviate from the GP recommended protocol thus creating strains on the patient-therapist relationship. Some participants suggested that this scenario may be changing and that therapists are getting better at communicating with doctors and supporting changes in treatment with evidence.