Musculoskeletal disorders are one of the most prevalent chronic diseases around the world. Additionally, they contribute significantly to the global burden of disease. Tuina manipulation played a crucial role in treating musculoskeletal diseases from ancient times to the present. However, there are no systematic investigations on the efficacy characteristics of Tuina manipulation for alleviating musculoskeletal pain.

To objective of the study was to investigate the factors that have an influence on the effectiveness of Tuina manipulation in treating musculoskeletal pain.

In October 2021, we interviewed physicians from Beijing's Tuina Department using the purpose sampling method and the snowball sampling strategy. Interviews were carried out following a semi-structured format to determine the factors influencing Tuina manipulation for musculoskeletal pain. In accordance with the study's aims, the interview outline was drafted and discussed with the research group, and the interview was ended when saturation of information had been reached. To develop a theoretical model, the interview content is organized into text using three-level coding and rooted theory using the qualitative analysis software NVivo 11.

A total of 16 interviewees were interviewed effectively. The interviews were open coded to obtain 21 initial categories. And The 21 initial categories were summarized into five main categories: "health care providers" "patients" "medical environment" "regional divergence" and "advantages of disease" . In addition to selective coding, the factors of musculoskeletal pain are summarized as the intrinsic factors of "people" ( "health care provider" and "patients" ) , the external factors of "environment" ( "medical environment" and "regional divergence" ) , and the causative factors of "disease" ( "advantages of disease" ) . By combing these factors with Tuina manipulation, it becomes a tree-like model of influencing factors in the treatment of musculoskeletal pain.

The factors affecting the treatment of musculoskeletal pain by Tuina manipulation are composed of three factors: the internal factors of "people" , the external factors of "environment" and the causative factors of "diseases" . "Health care providers" constitute the most critical factors, as their diagnosis, treatment plan, and technical level significantly affect the final result of treatment. The patient's compliance is largely a secondary factor, while external factors indicate that good doctor-patient communication leads to success. From the causative factors of "disease" , it can be seen that Tuina has a more prominent effect in the treatment of musculoskeletal diseases.