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Saueressig T, Owen PJ, Pedder H, Arora NK, Simons M, Kaczorowski S, Miller CT, Donath L, Belavy DL. Boosting treatment outcomes via the patient-practitioner relationship, treatment-beliefs or therapeutic setting. A systematic review with meta-analysis of contextual effects in chronic musculoskeletal pain. J Orthop Sports Phys Ther 2024; 54:440-456. [PMID: 38687160 DOI: 10.2519/jospt.2024.12259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE: To ascertain whether manipulating contextual effects (e.g. interaction with patients, or beliefs about treatments) boosted the outcomes of non-pharmacological and non-surgicaltreatments for chronic primary musculoskeletal pain. DESIGN: Systematic review of randomized controlled trials. DATA SOURCES: We searched for trials in six databases, citation tracking, and clinical trials registers. We included trials that compared treatments with enhanced contextual effects with the same treatments without enhancement in adults with chronic primary musculoskeletal pain. DATA SYNTHESIS: The outcomes of interest were pain intensity, physical functioning, global ratings of improvement, quality of life, depression, anxiety, and sleep. We evaluated risk of bias and certainty of the evidence using Cochrane Risk of Bias tool 2.0 and the GRADE approach, respectively. RESULTS: Of 17637 records, we included 10 trials with 990 participants and identified 5 ongoing trials. The treatments were acupuncture, education, exercise training, and physical therapy. The contextual effects that were improved in the enhanced treatments were patient-practitioner relationship, patient beliefs and characteristics, therapeutic setting/environment, and treatment characteristics. Our analysis showed that improving contextual effects in non-pharmacological and non-surgical treatments may not make much difference on pain intensity (mean difference [MD] : -1.77, 95%-CI: [-8.71; 5.16], k = 7 trials, N = 719 participants, Scale: 0-100, GRADE: Low)) or physical functioning (MD: -0.27, 95%-CI: [-1.02; 0.49], 95%-PI: [-2.04; 1.51], k = 6 , N = 567, Scale: 0-10, GRADE: Low) in the short-term and at later follow-ups. Sensitivity analyses revealed similar findings. CONCLUSION: Whilst evidence gaps exist, per current evidence it may not be possible to achieve meaningful benefit for patients with chronic musculoskeletal pain by manipulating the context of non-pharmacological and non-surgical treatments. TRIAL REGISTRATION: This systematic review was prospectively registered in PROSPERO (registration number: CRD42023391601).
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Affiliation(s)
- Tobias Saueressig
- Physio Meets Science GmbH, Johannes Reidel Str. 19, 69181 Leimen; Germany
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong VIC 3220, Australia
| | - Hugo Pedder
- University of Bristol, Population Health Sciences, Bristol Medical School, UK
| | - Nitin Kumar Arora
- (Hochschule für Gesundheit [University of Applied Sciences], Department of Applied Health Sciences, Division of Physiotherapy, Bochum
- German Sport University, Department of Intervention Research in Exercise Training, Cologne, Germany
| | - Marieke Simons
- (Hochschule für Gesundheit [University of Applied Sciences], Department of Applied Health Sciences, Division of Physiotherapy, Bochum
| | - Svenja Kaczorowski
- (Hochschule für Gesundheit [University of Applied Sciences], Department of Applied Health Sciences, Division of Physiotherapy, Bochum
| | - Clint T Miller
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong VIC 3220, Australia
| | - Lars Donath
- German Sport University, Department of Intervention Research in Exercise Training, Cologne, Germany
| | - Daniel L Belavy
- (Hochschule für Gesundheit [University of Applied Sciences], Department of Applied Health Sciences, Division of Physiotherapy, Bochum
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Pottkotter K, Hazlett M, Mansfield CJ, Rethman K, Fritz JM, Quatman-Yates CC, Briggs MS. Understanding social determinants of health and physical therapy outcomes in patients with low back pain: A scoping review. Musculoskeletal Care 2024; 22:e1888. [PMID: 38747557 DOI: 10.1002/msc.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Low back pain (LBP) is the number one cause of disability worldwide; however, it is not clear how social determinants of health (SDOH) impact care management and outcomes related to physical therapy (PT) services for patients with LBP. OBJECTIVE The purposes of this scoping review are to examine and assimilate the literature on how SDOH and PT care relate to non-specific LBP outcomes and identify gaps in the literature to target for future research. METHODS Data were extracted from eight electronic databases from January 2011 to February 2022. Reviewers independently screened all studies using the PRISMA extension for scoping review guidelines. Data related to study design, type of PT, type of non-specific LBP, patient demographics, PT intervention, SDOH, and PT outcomes were extracted from the articles. RESULTS A total of 30,523 studies were screened, with 1961 articles undergoing full text review. Ultimately, 76 articles were identified for inclusion. Sex and age were the most frequent SDOH examined (88% and 78% respectively) followed by education level (18%). Approximately half of the studies that examined age, sex, and education level identified no effect on outcomes. The number of studies examining other factors was small and the types of outcomes evaluated were variable, which limited the ability to pool results. CONCLUSIONS Sex and age were the most frequent SDOH examined followed by education level. Other factors were evaluated less frequently, making it difficult to draw conclusions. Study design and heterogeneity of determinants and outcomes were barriers to examining the potential impact on patients with LBP.
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Affiliation(s)
- Kristy Pottkotter
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
| | - Miriam Hazlett
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
| | - Cody J Mansfield
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
| | - Katherine Rethman
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
| | - Julie M Fritz
- College of Health, The University of Utah, Salt Lake City, Utah, USA
| | - Catherine C Quatman-Yates
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
| | - Matthew S Briggs
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
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Alt A, Luomajoki H, Roese K, Luedtke K. How do non-specific back pain patients think about their adherence to physiotherapy, and what strategies do physiotherapists use to facilitate adherence? A focus group interview study. J Man Manip Ther 2024; 32:150-158. [PMID: 37725067 PMCID: PMC10956927 DOI: 10.1080/10669817.2023.2258699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Long-term effectiveness of physiotherapy (PT) for low back pain (LBP) depends on the adherence of patients. Objectives: (1) Identify aspects associated with the adherence of patients with LBP to physiotherapy, and (2) identify factors to facilitate adherence of patients with LBP to PT. METHOD Focus group interviews were conducted with 10 patients with LBP (n = 10, 5 women) and 11 physiotherapists (5 women) from Germany and Switzerland, treating patients with LBP. Data analysis was based on structured content analysis. Deductive and inductive categories were identified and coded. RESULTS Patients with LBP requested more and effective home programs, long-term rehabilitation management, and individualized therapy to achieve a higher level of adherence. Physiotherapists requested more time for patient education. Communication, quality of the therapist-patient relationship, and individualized therapy were identified as essential factors by both representatives. CONCLUSION Patients and physiotherapists identified aspects contributing to adherence. These may guide the development of multidimensional measurement tools for adherence. In addition, this information can be used to develop PT approaches to facilitate the level of adherence.
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Affiliation(s)
- A Alt
- Department of Physiotherapy, Universität zu Lübeck, Institute of Health Sciences, Lübeck, Germany
| | - H Luomajoki
- Institute of physiotherapy, Zürich University of applied Sciences ZHAW, Winterthur, Switzerland
| | - K Roese
- Department of Occupational Therapy, Universität zu Lübeck, Institute of Health Sciences, Lübeck, Germany
| | - K Luedtke
- Department of Physiotherapy, Universität zu Lübeck, Institute of Health Sciences, Lübeck, Germany
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Wood L, Foster NE, Dean SG, Booth V, Hayden JA, Booth A. Contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain: a realist review. Br J Sports Med 2024; 58:222-230. [PMID: 38176852 DOI: 10.1136/bjsports-2023-107598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Therapeutic exercises are a core treatment for low back pain (LBP), but it is uncertain how rehabilitative exercise facilitates change in outcomes. Realist reviews explore how the context (C) of certain settings or populations and underlying mechanisms (M) create intended or unintended outcomes (O). Our objective was to explore and understand the behavioural mechanisms by which therapeutic exercise creates change in outcomes of adherence, engagement and clinical outcomes for patients with LBP. METHODS This was a realist review reported following the Realist and Meta-narrative Evidence Syntheses: Evolving Standards guidance. We developed initial programme theories, modified with input from a steering group (experts, n=5), stakeholder group (patients and clinicians, n=10) and a scoping search of the published literature (n=37). Subsequently, an information specialist designed and undertook an iterative search strategy, and we refined and tested CMO configurations. RESULTS Of 522 initial papers identified, 75 papers were included to modify and test CMO configurations. We found that the patient-clinician therapeutic consultation builds a foundation of trust and was associated with improved adherence, engagement and clinical outcomes, and that individualised exercise prescription increases motivation to adhere to exercise and thus also impacts clinical outcomes. Provision of support such as timely follow-up and supervision can further facilitate motivation and confidence to improve adherence to therapeutic exercises for LBP. CONCLUSIONS Engagement in and adherence to therapeutic exercises for LBP, as well as clinical outcomes, may be optimised using mechanisms of trust, motivation and confidence. These CMO configurations provide a deeper understanding of ways to optimise exercise prescription for patients with LBP.
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Affiliation(s)
- Lianne Wood
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Queensland, Australia
| | | | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Booth
- Information Resources Group, University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
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Burke CA, Seidler KJ, Rethorn ZD, Hoenig H, Allen K, Tabriz AA, Norman K, Murphy-McMillan LK, Sharpe J, Joseph LM, Dietch JR, Kosinski AS, Cantrell S, Gierisch JM, Ear B, Gordon A, Goldstein KM. Interventions to Improve Long-Term Adherence to Physical Rehabilitation: A Systematic Review. J Geriatr Phys Ther 2024; 47:00139143-990000000-00044. [PMID: 38215396 PMCID: PMC11239800 DOI: 10.1519/jpt.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To evaluate the impact of physical rehabilitation interventions, supplemented with one or more adherence-enhancing components, on outcomes among adults with hip or knee osteoarthritis or chronic lower back pain. DESIGN Primary literature search from inception of each database to July 27, 2021, guided by relevant search terms and keywords to search titles and abstracts. All articles meeting eligibility criteria were included for data abstraction. DATA SOURCES MEDLINE, CINAHL Complete, and Embase. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized and nonrandomized trials evaluating adherence-focused intervention components conducted in addition to an index usual care or usual care-like physical rehabilitation program among adults with hip or knee osteoarthritis or chronic low back pain. Eligible studies included a comparator group of the same index physical rehabilitation intervention without the adjunctive adherence components. Included studies measured outcomes at least 3 months after the rehabilitation course. RESULTS Of the 10 studies meeting inclusion criteria, 6 interventions were delivered concurrent to an index rehabilitation program and 4 were delivered sequentially. Of the 3 studies that reported a positive effect on long-term adherence, only 1 was a low risk of bias study. There is very limited evidence of a beneficial treatment effect of adjunct adherence interventions on long-term physical function, self-efficacy, or adverse events. CONCLUSION We found inadequate evidence evaluating adherence-enhancing interventions for the specific promotion of long-term adherence to home rehabilitation programs. Future studies should consider testing interventions specifically built to target behavioral maintenance of home rehabilitation programs.
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Affiliation(s)
- Colleen A. Burke
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Katie J. Seidler
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Zachary D. Rethorn
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Helen Hoenig
- Durham VA Health Care System, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Kelli Allen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- University of North Carolina at Chapel Hill, Chapel Hill
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
- Department of Oncological Sciences, University of South Florida, Tampa, Florida
| | - Katherine Norman
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Jason Sharpe
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Letha M. Joseph
- Durham VA Health Care System, Durham, North Carolina
- Duke University School of Nursing, Durham, North Carolina
| | | | - Andrzej S. Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sarah Cantrell
- Duke University School of Medicine, Durham, North Carolina
| | - Jennifer M. Gierisch
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Belinda Ear
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Adelaide Gordon
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Karen M. Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, North Carolina
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Feleus A, Wevers L, Schiphof D, Verhoef J, van Hooft S, van Staa A. Content Validition and Psychometric Evaluation of the Self-efficacy and Performance in Self-management Support Instrument for Physiotherapists. Arch Phys Med Rehabil 2024; 105:49-58. [PMID: 37385365 DOI: 10.1016/j.apmr.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/05/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To develop and psychometrically test the Self-Efficacy and Performance in Self-Management Support instrument for physiotherapists (SEPSS-PT), based on the SEPSS-36, the corresponding instrument for nurses. DESIGN Instrument development including content validation and psychometric evaluation (construct validity, factor structure, and reliability). SETTING Data were collected from literature, expertmeetings, and online questionnaire PARTICIPANTS: Next to a comprehensive literature study, experts (self-management experts (n=2); physiotherapists (n=10); patients (n=6)) and physiotherapists and physiotherapy students (n=334), participated in different stages of the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Not applicable. A literature study (n=42 reviews) and consultations with physiotherapists and patients identified the specific content for physiotherapy. The Five-A's model and overarching competencies of "supportive partnership attitude", were used to structure the items. Psychometric evaluation of the draft questionnaire (40 items) was tested in a sample of 334 physiotherapists and physiotherapy students from the Netherlands, of whom 33 filled out the questionnaire twice to establish the test-retest reliability. RESULTS Confirmatory factor analyses revealed satisfactory fit indices for both the 6-factor model and hierarchical model, with best fit for the 6-factor model. The questionnaire discriminated between physiotherapists and physiotherapy students, and between physiotherapists who did or did not consider self-management support important. The overall internal consistency (Cronbach's alpha) was high, both for the self-efficacy and the performance items. In most of the subscales, test-retest intra-class correlation coefficients for both overall self-efficacy and performance were good, but in 3 subscales insufficient for performance. CONCLUSION The SEPSS-PT questionnaire is a 40-item, Likert-scaled instrument with good content and construct validity, good internal consistency and reliability, and sufficient test-retest reliability. Future research in a larger and more diverse sample could confirm stability and discriminating power.
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Affiliation(s)
- Anita Feleus
- Department of Physiotherapy and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands.
| | - Lotte Wevers
- Department of Physiotherapy and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - John Verhoef
- Department of Physical Therapy & Faculty of Health University of Applied Sciences, Leiden, the Netherlands
| | - Susanne van Hooft
- Department of Nursing and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - AnneLoes van Staa
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
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Levy T, Huxley K, Vuu S, Lewis LK. Physical activity for people with chronic conditions: a systematic review of toolkits to promote adherence. Disabil Rehabil 2023:1-14. [PMID: 38131330 DOI: 10.1080/09638288.2023.2296525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE The World Health Organisation (WHO) recommends that health professionals develop and implement "adherence counselling toolkits" to promote adherence to long-term therapies in people with chronic conditions. This prospectively registered review aimed to systematically identify and evaluate existing toolkits developed to promote adherence to physical activity in people with chronic conditions. MATERIALS AND METHODS Grey literature and six e-databases were searched for studies investigating the use of "toolkits" to promote adherence to physical activity or exercise recommendations in people with chronic conditions (Medline, PsycInfo, EmCare, Cochrane, CINAHL Plus, Pedro). A two-stage screening process was completed by two independent reviewers. RESULTS Five studies describing five toolkits were included. Three toolkits displayed all WHO recommended features, including information on adherence, a clinically useful way of using this information, and behavioural tools for maintaining habits. The included toolkits featured "adherence" to the intervention; however, this was not their primary aim. There were trends towards improved physical activity with some of the included toolkits. CONCLUSIONS There are a lack of rigorously developed toolkits that focus on adherence to physical activity in people with chronic conditions. Toolkits should be developed, tested, and implemented to improve adherence and outcomes for people with chronic conditions.
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Affiliation(s)
- Tamina Levy
- Caring Futures Institute, Flinders University, Adelaide, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Flinders Medical Centre, Rehabilitation and Palliative Services, Adelaide, Australia
| | - Kelly Huxley
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Flinders Medical Centre, Rehabilitation and Palliative Services, Adelaide, Australia
| | - Sally Vuu
- Caring Futures Institute, Flinders University, Adelaide, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lucy K Lewis
- Caring Futures Institute, Flinders University, Adelaide, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Arensman RM, Heymans MW, Kloek CJJ, Ostelo RJWG, Veenhof C, Koppenaal T, Pisters MF. Trajectories of Adherence to Home-Based Exercise Recommendations Among People With Low Back Pain: A Longitudinal Analysis. Phys Ther 2023; 103:pzad091. [PMID: 37669137 PMCID: PMC10740005 DOI: 10.1093/ptj/pzad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/04/2023] [Accepted: 06/12/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE This study aimed to examine the presence of distinct trajectories of adherence to home-based exercise recommendations among people with low back pain (LBP). This study also aimed to identify differences in baseline characteristics among groups. METHODS This study was a secondary analysis of a prospective, multicenter cluster randomized controlled trial investigating the cost-effectiveness of a stratified blended physical therapist intervention compared to usual care physical therapy in patients with LBP. The intervention group received usual care with integrated support via a smartphone app. A total of 208 patients were recruited from 58 primary care physical therapist practices. Baseline data included patient characteristics, physical functioning, pain intensity, physical activity, fear avoidance, pain catastrophizing, self-efficacy, self-management ability, and health-related quality of life. The Exercise Adherence Scale (score range = 0-100) was used to measure adherence during each treatment session. Latent class growth analysis was used to estimate trajectories of adherence. RESULTS Adherence data were available from 173 out of 208 patients (83%). Data were collected during an average of 5.1 (standard deviation [SD] = 2.5) treatment sessions, with total treatment duration of 51 (SD = 41.7) days. Three trajectory classes were identified: "declining adherence" (12%), "stable adherence" (45%), and "increasing adherence" (43%). No differences in baseline characteristic were found between groups. CONCLUSION Three adherence trajectories to exercise recommendations were identified in patients with LBP. However, baseline characteristics cannot identify a patient's trajectory group. IMPACT Despite the presence of distinct trajectories of adherence in patients with LBP, physical therapists should not attempt to place a patient in a trajectory group at the start of treatment. Instead, adherence should be closely monitored as treatment progresses and supported when required as part of an ongoing process.
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Affiliation(s)
- Remco M Arensman
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martijn W Heymans
- Department of Data Science and Bio-Statistics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre, Location VUmc, North-Holland, Amsterdam, The Netherlands
| | - Corelien J J Kloek
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Raymond J W G Ostelo
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences Research Institute Amsterdam, North-Holland, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Location VUmc, North-Holland, Amsterdam, The Netherlands
| | - Cindy Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Tjarco Koppenaal
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, North-Brabant, Eindhoven, The Netherlands
| | - Martijn F Pisters
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, North-Brabant, Eindhoven, The Netherlands
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Ng YK, Shah NM, Chen TF, Loganadan NK, Kong SH, Cheng YY, Sharifudin SSM, Chong WW. Impact of a training program on hospital pharmacists' patient-centered communication attitudes and behaviors. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100325. [PMID: 37694168 PMCID: PMC10485631 DOI: 10.1016/j.rcsop.2023.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023] Open
Abstract
Background Effective communication that integrates the value of patient-centered care is important in healthcare encounters. Communication skills training (CST) has been indicated as effective in improving patient-centered communication behaviors. However, there is a paucity of studies on the impact of CST among Malaysian hospital pharmacists. Objective This study aimed to evaluate the effects of a patient-centered CST program on patient-centered communication scores, communication self-efficacy, and attitudes toward concordance among pharmacists in public hospitals. Methods A communication skills training (CST) program was conducted among hospital pharmacists. This training intervention was developed based on patient-centered communication frameworks and techniques, namely the Four Habits Model and motivational interviewing. A pre-test/post-test quasi-experimental design was implemented for the evaluation. Pharmacists underwent pre-test/post-test audiotaped simulated consultations and completed questionnaires, including the Revised United States-Leeds Attitudes Toward Concordance scale (RUS-LATCon) and Communication Self-Efficacy scale. The Four Habits Coding Scheme (FHCS) was used to evaluate patient-centered communication scores from the audiotapes, and the Wilcoxon signed-rank test was used to analyze for differences in the pre- and post-intervention scores. Results A total of 38 pharmacists from four tertiary hospitals participated in this study and completed the pre-test. However, due to the impact of COVID-19, only 23 pharmacists completed the post-test data collection. Improvements were noted in the FHCS scores post-training, including items related to exploring patients' concerns, acceptability, and barriers to treatment. Based on the questionnaire, there was an improvement in recognizing patients' needs and potential medication uncertainty and an increase in the overall communication self-efficacy scores after the training. Conclusions CST may help improve the adoption of patient-centered communication in pharmacists' consultations with patients.
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Affiliation(s)
- Yew Keong Ng
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Timothy F. Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Navin Kumar Loganadan
- Department of Pharmacy, Hospital Putrajaya, Ministry of Health, Pusat Pentadbiran Kerajaan Persekutuan Presint 7, 62250 Putrajaya, Malaysia
| | - Shue Hong Kong
- Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Yi Yun Cheng
- Department of Pharmacy, Hospital Ampang, Ministry of Health, Jalan Mewah Utara, Taman Pandan Mewah, 68000 Ampang Jaya, Selangor, Malaysia
| | - Siti Shahida Md Sharifudin
- Department of Pharmacy, Hospital Kuala Lumpur, Ministry of Health, Jalan Pahang 50586, Kuala Lumpur, Malaysia
| | - Wei Wen Chong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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10
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Alt A, Luomajoki H, Luedtke K. Which aspects facilitate the adherence of patients with low back pain to physiotherapy? A Delphi study. BMC Musculoskelet Disord 2023; 24:615. [PMID: 37501088 PMCID: PMC10375614 DOI: 10.1186/s12891-023-06724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The effectiveness of physiotherapy to reduce low back pain depends on patient adherence to treatment. Facilitators and barriers to patient adherence are multifactorial and include patient and therapist-related factors. This Delphi study aimed to identify an expert consensus on aspects facilitating the adherence of patients with back pain to physiotherapy. METHOD International experts were invited to participate in a three-round standard Delphi survey. The survey contained 49 items (32 original and 17 suggested by experts) which were rated on 5-point Likert scales. The items were assigned to six domains. The consensus level was defined as 60%. RESULTS Of 38 invited experts, 15 followed the invitation and completed all three rounds. A positive consensus was reached on 62% of the 49 proposed items to facilitate adherence. The highest consensus was achieved in the domains "Influence of biopsychosocial factors" (89%) and "Influence of cooperation between physiotherapists and patients" (79%). Additional important domains were the "Influence of competencies of physiotherapists" (71%) and "Interdisciplinary congruence" (78%). "Administration aspects" and the "Use of digital tools" did not reach expert consensus. CONCLUSIONS Biopsychosocial factors, therapeutic skills, and patient-physiotherapist collaboration should be considered in physiotherapy practice to facilitate adherence in patients with LBP. Future studies should prospectively evaluate the effectiveness of individual or combined identified aspects for their influence on patient adherence in longitudinal study designs.
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Affiliation(s)
- Andreas Alt
- Institute of Health Sciences, Department of Physiotherapy, Universität zu Lübeck, Lübeck, Germany
| | - Hannu Luomajoki
- Institute of physiotherapy, Zürich University of applied Sciences (ZHAW), Katharina-Sulzer-Platz 9, Winterthur, CH-8401, Switzerland.
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Universität zu Lübeck, Lübeck, Germany
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Alt A, Luomajoki H, Lüdtke K. Strategies to facilitate and tools to measure non-specific low back pain patients' adherence to physiotherapy - A two-stage systematic review. J Bodyw Mov Ther 2023; 35:208-219. [PMID: 37330771 DOI: 10.1016/j.jbmt.2023.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Sustainable management for non-specific low back pain relies on adherence. This requires effective strategies to facilitate but also tools to measure adherence to physiotherapy. OBJECTIVE This two-stage systematic review aims to identify (1) tools to measure non-specific back pain patients' adherence to physiotherapy and (2) the most effective strategy to facilitate patients' adherence to physiotherapy. METHOD PubMed, Cochrane, PEDro, and Web of Science were searched for English language studies measuring adherence in adults with low back pain. Following PRISMA recommendations, scoping review methods were used to identify measurement tools (stage 1). The effectiveness of interventions (stage 2), followed a predefined systematic search strategy. Two independent reviewers selected eligible studies (software Rayyan), analyzed these for risk of bias using the Downs and Black checklist. Data relevant to assess adherence were collected in a predesigned data extraction table. Results were heterogeneous and hence summarized narratively. RESULTS Twenty-one studies were included for stage 1 and 16 for stage 2. Identified were 6 different tools to measure adherence. The most used tool was an exercise diary; the most common more multidimensional tool was the Sports Injury Rehabilitation Adherence Scale. Most included studies were not designed to improve or measure adherence but used adherence as a secondary outcome for new exercise programs. The most promising strategies for facilitating adherence were based on cognitive behavioral principles. CONCLUSION Future studies should focus on the development of multidimensional strategies to facilitate adherence to physiotherapy and appropriate tools to measure all aspects of adherence.
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Affiliation(s)
- A Alt
- Universität zu Lübeck, Institute of Health Sciences, Department of Physiotherapy, Ratzeburger Allee 160, Germany.
| | - H Luomajoki
- Zürich University of Applied Sciences, Institute of Physiotherapy, Katharina Sulzer Platz 95, 8401, Winterthur, Switzerland
| | - K Lüdtke
- Universität zu Lübeck, Institute of Health Sciences, Department of Physiotherapy, Ratzeburger Allee 160, Germany
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Windfeld-Lund C, Sturt R, Pham C, Lannin NA, Graco M. Systematic Review of the Effectiveness of Allied Health Clinical Education Programs. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:109-116. [PMID: 36988438 DOI: 10.1097/ceh.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Continuing allied health professional (AHP) clinical education is essential to ensure high-quality patient care; however, the effectiveness of current education programs is unclear. This review aimed to determine whether AHP education programs improve the knowledge of AHPs, change their clinical practice behavior, and/or improve patient-related clinical outcome and to identify important components of these programs. METHODS Four electronic databases were searched. Controlled clinical trials investigating the effectiveness of clinical education programs were included. Education programs were diverse, varying in design, delivery mode, and intensity. Only therapy-specific AHPs were included. Effectiveness was determined by differences in group outcomes in the domains of AHP knowledge, AHP clinical practice behavior, and patient-related clinical outcomes. RESULTS Forty-four studies were identified, of which 26 included physiotherapists only. Most control groups were waitlist, passive dissemination of information, or usual care, limiting comparisons between programs. Changes in AHP knowledge was investigated in 20 trials, with 13 showing an improvement. Thirty studies investigated changes in AHP clinical practice behavior, with half demonstrating a difference between groups. Seventeen studies investigated a patient-related clinical outcome, with five finding a difference between groups. Where improvements in outcomes were demonstrated, programs tended to incorporate self-selection and cater to the learner's contextual needs. DISCUSSION AHP knowledge is effectively improved through targeted education programs. To change AHP behavior and patient outcomes, it seems important to incorporate self-selection for the program and consider the learner's individual needs and contexts through mentoring, outreach visits, reflection, and incorporating patient participation in the learning.
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Affiliation(s)
- Cristie Windfeld-Lund
- Ms Windfeld-Lund: Senior Physiotherapist, Alfred Health, Melbourne, Australia, Mr Sturt : Allied Health Clinical Education Lead, Alfred Health, Melbourne, Australia. Ms Pham: Senior Physiotherapist, Alfred Health, Melbourne, Australia. Dr. Lannin: Professor, Department of Neuroscience, Monash University, Melbourne, Australia; and Clinical Chair (Occupational Therapy), Alfred Health, Melbourne, Australia. Dr Graco: Implementation Scientist, Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
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Lee GT, Himler P, Rhon DI, Young JL. Home Exercise Programs Are Infrequently Prescribed in Trials of Supervised Exercise for Individuals With Low Back Pain: A Scoping Review of 292 Randomized Controlled Trials. J Orthop Sports Phys Ther 2023; 53:120-142. [PMID: 36645192 DOI: 10.2519/jospt.2023.11448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES: To (1) determine how often home exercise programs (HEPs) are prescribed in supervised exercise trials for low back pain (LBP) and (2) describe characteristics of the HEP programs (design, purpose, dose, and adherence). DESIGN: Scoping review. LITERATURE SEARCH: PubMed, CINAHL, and Ovid MEDLINE were searched from January 1, 2010, to August 17, 2021. STUDY SELECTION CRITERIA: Randomized controlled trials that included adults with LBP who received exercise interventions. DATA SYNTHESIS: The presence or absence of a prescribed HEP and any details of the HEP including design, dose, and adherence were extracted and summarized. RESULTS: Of 2689 potentially relevant trials, 292 were eligible for inclusion. Ninety-four trials (32%) included a HEP. The most commonly prescribed home exercises were core stability, trunk strengthening, and motor control exercises. There was great variation in the frequency and duration with which HEPs were prescribed. Adherence to HEPs was measured in fewer than half of the trials, and the methods for measuring adherence were inconsistent. Adherence to HEPs ranged from 29% to 82% in the 21 trials that reported adherence. CONCLUSION: Home exercise programs are not regularly prescribed in supervised exercise trials for LBP. There was considerable variation in prescribing HEPs and monitoring exercise adherence in trials of exercise-based treatments for adults with LBP. There is no consistent method used to measure participants' adherence to HEPs, and adherence percentages vary widely. J Orthop Sports Phys Ther 2023;53(3):120-142. Epub: 16 January 2023. doi:10.2519/jospt.2023.11448.
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Prior JL, Vesentini G, Michell De Gregorio JA, Ferreira PH, Hunter DJ, Ferreira ML. Health Coaching for Low Back Pain and Hip and Knee Osteoarthritis: A Systematic Review with Meta-Analysis. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:32-51. [PMID: 35775931 PMCID: PMC9825146 DOI: 10.1093/pm/pnac099] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/12/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Health coaching aims to empower people to reach their goals and is increasingly used in health care settings. Whether health coaching improves pain and disability for people with hip or knee osteoarthritis (OA) or low back pain (LBP) is unknown. METHODS Six databases were searched for randomized controlled trials assessing health coaching or motivational programs in adults with hip or knee OA or LBP, with each condition investigated independently. Meta-analyses were performed with random-effects models in the Cochrane Collaboration Review Manager 5.3 program. RESULTS Seventeen eligible studies were found. No studies analyzing hip OA alone were found. Pooled analyses found statistically significant decreases in mid-term pain (mean difference [MD]: -7.57; 95% confidence interval [CI]: -10.08 to -5.07; P < 0.001, I2 = 0%), short-term disability (standard mean difference [SMD]: -0.22; 95% CI: -0.41 to -0.03; P = 0.02, z = 2.32, I2 = 0%), and mid-term disability (SMD: -0.42; 95% CI: -0.75 to -0.09; P = 0.01, z = 2.49, I2 = 60%), favoring the intervention for chronic LBP. There were significant improvements in knee OA long-term functional disability (MD: -3.04; 95% CI: -5.70 to -0.38; P = 0.03; z = 2.24; I2 = 0%). CONCLUSION Meta-analyses provide evidence that health coaching reduces both disability and pain in people with chronic LBP and reduces disability in people with knee OA, though the clinical significance is unknown. There is currently no evidence supporting or refuting the use of health coaching for hip OA.
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Affiliation(s)
- Joanna Louise Prior
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Giovana Vesentini
- Department of Gynaecology and Obstetrics, Botucatu Medical School, UNESP—Univ Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Jose Antonio Michell De Gregorio
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David J Hunter
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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Rivera E, Clark-Cutaia MN, Schrauben SJ, Townsend RR, Lash JP, Hannan M, Jaar BG, Rincon-Choles H, Kansal S, He J, Chen J, Hirschman KB. Treatment Adherence in CKD and Support From Health care Providers: A Qualitative Study. Kidney Med 2022; 4:100545. [PMID: 36339664 PMCID: PMC9630784 DOI: 10.1016/j.xkme.2022.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Rationale & Objective Adherence to recommended medical treatment is critical in chronic kidney disease (CKD) to prevent complications and progression to kidney failure. Overall adherence to treatment is low in CKD, and as few as 40% of patients with kidney failure receive any documented CKD-related care. The purpose of this study was to explore the experiences of patients with CKD and their adherence to CKD treatment plans, and the role their health care providers played in supporting their adherence. Study Design One-on-one interviews were conducted in 2019-2020 using a semi-structured interview guide. Participants described experiences with adherence to treatment plans and what they did when experiencing difficulty. Setting & Participants Participants were recruited from the Chronic Renal Insufficiency Cohort (CRIC) study. All CRIC participants were older than 21 years with CKD stages 2-4; this sample consisted of participants from the University of Pennsylvania CRIC site. Analytical Approach Interviews were recorded, transcribed, and coded using conventional content analysis. Data were organized into themes using NVivo 12. Results The sample (n = 32) had a mean age of 67 years, 53% were women, 59% were non-White, with a mean estimated glomerular filtration rate of 56.6 mL/min/1.73 m2. From analysis of factors relevant to treatment planning and adherence, following 4 major themes emerged: patient factors (multiple chronic conditions, motivation, outlook), provider factors (attentiveness, availability/accessibility, communication), treatment planning factors (lack of plan, proactive research, provider-focused treatment goals, and shared decision making), and treatment plan responses (disagreeing with treatment, perceived capability deficit, lack of information, and positive feedback). Limitations The sample was drawn from the CRIC study, which may not be representative of the general population with CKD. Conclusions These themes align with Behavioral Learning Theory, which includes concepts of internal antecedents (patient factors), external antecedents (provider factors), behavior (treatment planning factors), and consequences (treatment plan responses). In particular, the treatment plan responses point to innovative potential intervention approaches to support treatment adherence in CKD.
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Affiliation(s)
- Eleanor Rivera
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL
| | | | - Sarah J. Schrauben
- Division of Renal Electrolyte and Hypertension, School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Raymond R. Townsend
- Division of Renal Electrolyte and Hypertension, School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - James P. Lash
- Division of Nephrology, College of Medicine, University of Illinois Chicago, Chicago, IL
| | - Mary Hannan
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL
| | - Bernard G. Jaar
- Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Sheru Kansal
- Division of Nephrology and Hypertension, University Hospital Cleveland Medical Center, University Hospitals, Cleveland, OH
| | - Jiang He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Jing Chen
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA
| | - Karen B. Hirschman
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA
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McLeod G, Morgan E, McMillan S, McCahon S, Sanna N. Why Are Patients Not Doing Their Prescribed Home-Based Exercises? An Updated Review of the Factors Affecting Adherence to Prescribed Home-Based Exercise in Patients With Chronic Low Back Pain. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221116143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prescribed home-based exercise programs have been found to be an effective non-pharmacological treatment for the management of chronic low back pain. However, such programs rely on continued patient adherence to performing the exercises. The purpose of this integrative review is to present the key factors that influence adherence to prescribed home-based exercise for individuals with chronic low back pain. Searches of AMED, SPORTDiscus, CINAHL, MEDLINE, ScienceDirect, and Cochrane Library databases were performed for the period 2015 to 2021, using the following key search terms: exercise adherence, exercise compliance, exercise therapy, home-based exercise, chronic low back pain, and enabler, barrier or factor. Eight studies met the inclusion criteria and included Qualitative, Prospective Observation, Feasibility, Case Series and Randomised Controlled Trial studies. All participants were adults ranging from 18 to 85 years old with chronic low back pain and there was an overall female representation of 53.4%. Studies were assessed for methodological quality using the Critical Appraisal Skills Programme (CASP) checklist. The findings highlighted 2 key factors influencing adherence to home-based exercise programs for individuals with chronic low back pain: (1) the need for practitioners to develop effective communication skills that focus on the individual’s needs, including personalisation of exercise programs aimed at an individual’s symptoms, lifestyle and treatment goals; and (2) follow-up feedback and support strategies via electronic (virtual) or face to face in-clinic and home visits. Adherence to home-based exercise programs requires effective practitioner communication and targeted follow-up support and feedback.
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Affiliation(s)
- Gopi McLeod
- Southern Cross University, Lismore, NSW, Australia
| | - Eva Morgan
- Southern Cross University, Lismore, NSW, Australia
| | | | | | - Niribi Sanna
- Southern Cross University, Lismore, NSW, Australia
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Sherriff B, Clark C, Killingback C, Newell D. Impact of contextual factors on patient outcomes following conservative low back pain treatment: systematic review. Chiropr Man Therap 2022; 30:20. [PMID: 35449074 PMCID: PMC9028033 DOI: 10.1186/s12998-022-00430-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/11/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Chronic low back pain is pervasive, societally impactful, and current treatments only provide moderate relief. Exploring whether therapeutic elements, either unrecognised or perceived as implicit within clinical encounters, are acknowledged and deliberately targeted may improve treatment efficacy. Contextual factors (specifically, patient's and practitioner's beliefs/characteristics; patient-practitioner relationships; the therapeutic setting/environment; and treatment characteristics) could be important, but there is limited evidence regarding their influence. This research aims to review the impact of interventions modifying contextual factors during conservative care on patient's pain and physical functioning. DATABASES AND DATA TREATMENT Four electronic databases (Medline, CINAHL, PsycINFO and AMED) were searched from 2009 until 15th February 2022, using tailored search strategies, and resulted in 3476 unique citations. After initial screening, 170 full-text records were potentially eligible and assessed against the inclusion-exclusion criteria. Thereafter, studies were assessed for methodological quality using a modified Downs and Black scale, data extracted, and synthesised using a narrative approach. RESULTS Twenty-one primary studies (N = 3075 participants), were included in this review. Eight studies reported significant improvements in pain intensity, and seven in physical functioning, in favour of the contextual factor intervention(s). Notable contextual factors included: addressing maladaptive illness beliefs; verbal suggestions to influence symptom change expectations; visual or physical cues to suggest pain-relieving treatment properties; and positive communication such as empathy to enhance the therapeutic alliance. CONCLUSION This review identified influential contextual factors which may augment conservative chronic low back pain care. The heterogeneity of interventions suggests modifying more than one contextual factor may be more impactful on patients' clinical outcomes, although these findings require judicious interpretation.
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Affiliation(s)
- Bronwyn Sherriff
- Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, England.
- AECC University College, Bournemouth, England.
| | - Carol Clark
- Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, England
| | - Clare Killingback
- Department of Sport, Health and Exercise Sciences, Faculty of Health Sciences, University of Hull, Hull, England
| | - Dave Newell
- AECC University College, Bournemouth, England
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18
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Zheng F, Liu S, Zhang S, Yu Q, Lo WLA, Li T, Wang CH. Does m-health-based exercise (guidance plus education) improve efficacy in patients with chronic low-back pain? A preliminary report on the intervention's significance. Trials 2022; 23:190. [PMID: 35241140 PMCID: PMC8892411 DOI: 10.1186/s13063-022-06116-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/15/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The utilization of mobile health (m-health) has rapidly expanded during the COVID-19 pandemic, and there is still a lack of relevant clinical data pertaining to chronic low-back pain (CLBP) management. This study was designed to compare the effectiveness of m-health-based exercise (via guidance plus education) versus exercise (via guidance) during CLBP management. METHODS Participants (n = 40) were randomly assigned to intervention and control groups. The intervention group received m-health-based exercise (via guidance plus education), whereas the control group received m-health-based exercise (via guidance). The exercise prescription video and educational content were sent to participants by the application (app), Ding Talk. Repeated-measures analysis of variance was used to test the baseline's intervention effects, 6-week follow-up, and 18-week follow-up. We selected function (Roland and Morris Disability Questionnaire) and pain intensity (current, mean, and most severe Numeric Rating Scale in the last 2 weeks) as the primary outcomes, changes of negative emotion (depression, anxious), and quality of life as the secondary outcomes. RESULTS Time's significant effect was found in pain, function, and health-related quality of life in both groups, but time did not show significant interaction effects. Participants were able to use m-based education with their anxiety and depression after treatment, but the relief only lasted until week 6. No differences were found on the aspect of mental health-related quality of life. CONCLUSION Preliminary findings suggest that m-health-based exercise (via guidance) may be a convenient and effective method to treat CLBP. However, additional health education didn't help more. More rigorous controlled trials are needed to improve the therapeutic effect in future studies. TRIAL REGISTRATION Chinese Clinical Trials Registry Number ChiCTR2000041459 . Registered on December 26, 2020.
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Affiliation(s)
- Fuming Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Shufeng Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Shanshan Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Tingni Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Chu Huai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
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Ashton-James CE, Anderson SR, Mackey SC, Darnall BD. Beyond pain, distress, and disability: the importance of social outcomes in pain management research and practice. Pain 2022; 163:e426-e431. [PMID: 34252908 PMCID: PMC8742845 DOI: 10.1097/j.pain.0000000000002404] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Claire E Ashton-James
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Steven R Anderson
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States
| | - Sean C Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States
| | - Beth D Darnall
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States
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20
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Deng B, Chen Y, Meng Y, Zhang Y, Tan X, Zhou X, Zhang M. A self-efficacy-enhancing intervention for Chinese patients after total hip arthroplasty: study protocol for a randomized controlled trial with 6-month follow-up. J Orthop Surg Res 2022; 17:1. [PMID: 34983553 PMCID: PMC8725334 DOI: 10.1186/s13018-021-02689-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/23/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a common and effective surgical method for advanced hip arthritis. Rehabilitation exercises are important to improve joint function after THA and are usually conducted in a home-based program. Poor patient adherence limits improvements in pain and function, affecting quality of life. The increasing use of THA in the aging Chinese population underscores the need to develop strategies that maximize functional outcomes. The purpose of this pilot study is to develop and assess the feasibility of a self-efficacy-enhancing intervention (SEEI) to improve exercise adherence in patients undergoing THA. METHODS This single-blinded, parallel, randomized control trial will recruit 150 patients after THA and randomly assign them to an intervention or control group using computer-generated block randomization. The control group will receive usual care using evidence-based guidelines. The intervention group will receive the 6-month SEEI comprising personalized exercise guidance and self-efficacy education delivered using one face-to-face education session and four telephone consultations, supplemented by written materials. Participants are encouraged to build confidence in their own abilities, set rehabilitation goals, and self-monitor their physical exercise. RESULTS Assessments will be conducted at baseline and 1, 3, and 6 months postsurgery. The outcome indicators are exercise adherence, physical function, anxiety and depression, self-efficacy of rehabilitation, joint function, and quality of life. CONCLUSIONS This study will test a theory-based intervention program to improve self-efficacy in rehabilitation, which may significantly impact out-of-hospital rehabilitation. The results will provide evidence to inform the postoperative recovery of patients undergoing THA or similar procedures. TRIAL REGISTRATION Chinese Clinical Trials Registry, ChiCTR2000029422 , registered on 31 January 2020.
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Affiliation(s)
- Bo Deng
- Nursing Department, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yumei Chen
- Nursing Department, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Ya Meng
- School of Nursing, Sun Yat-sen University, 74, Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, China
| | - Yiheng Zhang
- School of Nursing, Sun Yat-sen University, 74, Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, China
| | - Xingxian Tan
- Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Xiaohong Zhou
- Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Meifen Zhang
- School of Nursing, Sun Yat-sen University, 74, Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, China.
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Singh S, Orlando JM, Alghamdi ZS, Franklin KA, Lobo MA. Reframing Clinical Paradigms: Strategies for Improving Patient Care Relationships. Phys Ther 2021; 101:6178887. [PMID: 33742681 DOI: 10.1093/ptj/pzab095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/17/2020] [Accepted: 02/11/2021] [Indexed: 12/21/2022]
Abstract
This article presents strategies for reframing clinical paradigms to build better therapeutic relationships with patients and the members of their support network from the unique and important lens of a parent and disability researcher. First, a brief history of the evolution of models of care is presented, and implementation of the current biopsychosocial model is discussed. Then, evidence-based practice and the role of the patient perspective is considered. Next, specific examples, tools, techniques, guidelines, and resources to foster the demonstration of patient-informed respect and patient-centered communication in clinical practice are provided. Examples and resources are presented that can be accessed and implemented immediately, without cost to the practitioner and with the vast potential to improve care, therapeutic relationships, and patient outcomes. It is important for health care providers and researchers in all practice areas and across all experience levels to regularly evaluate their psychosocial skills. It is critical that the voices of patients and the members of their support network are central in this process. This can enable health care providers to acknowledge areas for growth and to implement changes effectively and efficiently at the individual level to facilitate changes across the broader spectrum of health care practice.
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Affiliation(s)
- Shailen Singh
- Department of Organization, Workforce, and Leadership Studies, Texas State University, Round Rock, Texas, USA
| | - Julie M Orlando
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Zainab S Alghamdi
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | | | - Michele A Lobo
- Department of Physical Therapy and Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
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Areerak K, Waongenngarm P, Janwantanakul P. Factors associated with exercise adherence to prevent or treat neck and low back pain: A systematic review. Musculoskelet Sci Pract 2021; 52:102333. [PMID: 33529988 DOI: 10.1016/j.msksp.2021.102333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/10/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Much attention has been paid to the evaluation of the efficacy of exercise therapy or increasing physical activity with the aim to prevent or alleviate neck and low back pain. However, exercise adherence is necessary for the effective management of neck and low back pain. OBJECTIVE We aimed to systematically review randomized controlled trials and cohort studies to gain insights into the factors associated with adherence to exercise or physical activity programs to prevent or treat neck pain and low back pain. METHOD Publications were systematically searched from 1980-December 2019 in several databases. The following key words were used: neck pain or low back pain paired with exercise or physical activity and adherence or compliance. Relevant studies were retrieved and assessed for methodological quality by two independent reviewers. Quality of evidence was assessed and rated according to GRADE guidelines. RESULTS Nine randomized controlled trials and eight cohort studies were included in this review. Randomized controlled trials indicated moderate-quality evidence for the association between exercise adherence and self-efficacy. Cohort studies showed moderate-quality evidence for the association between exercise adherence and education level. CONCLUSIONS Literature investigating factors associated with exercise adherence to prevent or treat neck and low back pain was heterogeneous. Few factors were found to be associated with exercise adherence. More studies are needed before any firm conclusions can be reached.
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Affiliation(s)
- Kantheera Areerak
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand.
| | - Pooriput Waongenngarm
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Prawit Janwantanakul
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
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Montesinos F, Páez M, McCracken LM, Rodríguez-Rey R, Núñez S, González C, Díaz-Meco R, Hernando A. Communication skills in the context of psychological flexibility: training is associated with changes in responses to chronic pain in physiotherapy students in Spain. Br J Pain 2021; 15:54-63. [PMID: 33633852 DOI: 10.1177/2049463719884589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The aim of this study is to explore the effectiveness of a training programme aimed at managing patients' chronic pain in physiotherapy students in Spain. The programme addressed providing them with efficient skills to manage patients' chronic pain from psychological flexibility (PF) perspective. Methods The programme integrates communication skills training into PF-based training. It sought to contribute to better recognise the role of psychosocial factors in chronic pain and to better promote adherence to treatment. This is an observational study with a pre- and post-training programme design and a 2-month follow-up. A total of 35 physiotherapy students, divided into three groups, participated in a 10-hour training course. Training focused on three areas: (1) communication skills, (2) therapeutic adherence and (3) managing distress and pain. The three areas were addressed from the PF point of view. Impact of training was measured through standardised questionnaires that assessed attitudes towards chronic pain, an ad hoc questionnaire that assessed responses to difficult communicative situations and a training satisfaction scale. Results Final analyses showed that attitudes changed significantly after training, biomedical attitude scores decreased and biopsychosocial attitude increased, while pain was considered less disabling, and informed empathic responses in communication situations increased. These changes were maintained at 2-month follow-up. Satisfaction with the training was high. Conclusion We conclude that a brief training programme based on the PF model may help students develop a more comprehensive approach and improve their skills for managing chronic pain.
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Affiliation(s)
- Francisco Montesinos
- Department of Psychology, The School of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain.,Instituto ACT, Madrid, Spain
| | | | | | - Rocío Rodríguez-Rey
- Department of Psychology, The School of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | | | - Cristina González
- Department of physiotherapy, Faculty of Health and Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Raquel Díaz-Meco
- Department of physiotherapy, Faculty of Health and Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Asunción Hernando
- Department of Medicine, School of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
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Söderlund A, von Heideken Wågert P. Adherence to and the Maintenance of Self-Management Behaviour in Older People with Musculoskeletal Pain-A Scoping Review and Theoretical Models. J Clin Med 2021; 10:jcm10020303. [PMID: 33467552 PMCID: PMC7830780 DOI: 10.3390/jcm10020303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Adherence to and the maintenance of treatment regimens are fundamental for pain self-management and sustainable behavioural changes. The first aim was to study older adults’ (>65 years) levels of adherence to and maintenance of musculoskeletal pain self-management programmes in randomized controlled trials. The second aim was to suggest theoretical models of adherence to and maintenance of a behaviour. (2) Methods: The study was conducted in accordance with the recommendations for a scoping review and the PRISMA-ScR checklist. Capability, motivation and opportunity were used to categorize the behavioural change components in the theoretical models. (3) Results: Among the four studies included, components targeting adherence were reported in one study, and maintenance was reported in two studies. Adherence was assessed by the treatment attendance rates, and maintenance was assessed by the follow-up data of outcome measures. For adherence, the capability components were mostly about education and the supervision, grading and mastery of exercise to increase self-efficacy. The motivation components included the readiness to change, self-monitoring and goal setting; and the opportunity components included booster sessions, feedback and social support. For maintenance, the capability components consisted of identifying high-risk situations for relapse and problem-solving skills. The motivation components included self-regulation and self-efficacy for problem solving, and the opportunity components included environmental triggers and problem solving by using social support. (4) Conclusion: There are several behavioural change components that should be used to increase older adults’ levels of adherence to and maintenance of a pain self-management behaviour.
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Eisele A, Schagg D, Krämer LV, Küffner R, Reusch A, Göhner W. Supporting patient adherence to physical activity and exercise: evaluation of a behavior change counseling training program for physiotherapists. Physiother Theory Pract 2021; 38:1426-1437. [PMID: 33444086 DOI: 10.1080/09593985.2021.1872128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background:Physiotherapists promote physical activity and exercise, yet patient adherence is often poor. To support patient adherence, behavior change techniques (BCTs) should be applied. These are insufficiently covered in physiotherapy curricula.Objective:The aim of this study was to evaluate a behavior change counseling training program for physiotherapists. The specific aims were to investigate: (1) physiotherapists' satisfaction with the training; (2) changes in physiotherapists' knowledge of BCTs and communication techniques immediately after the training and 6 weeks later; and (3) changes in physiotherapists' self-reported use of these techniques 6 weeks after the training.Methods:We conducted a single-group pre-post intervention study. Data of 56 physiotherapists (47 female, mean age 48.0 years) who participated in the training program "BeFo" (German: "Bewegungstherapie-Fortbildungen") were analyzed. Knowledge of BCTs and communication techniques, intention to apply these techniques, action and coping planning were assessed at baseline (t1), after the training (t2), and 6 weeks later (t3) using questionnaires. Participants' satisfaction was evaluated at t2, their use of BCTs and communication techniques at t1 and t3.Results:Fifty-four participants (96.4%) were satisfied with BeFo. One-way repeated-measures ANOVAs and Friedman's ANOVA revealed increased knowledge (Chi2(2) = 28.12, p < .001) and improved action planning (F(2, 98) = 22.65; p < .001) and coping planning (F(2, 100) = 19.28, p < .001) at t2 and t3. Higher use of BCTs and communication techniques at t3 was identified when participants with high baseline values were excluded.Conclusion:BeFo could be successfully implemented for physiotherapists. Our results imply that BeFo is a promising approach to improve physiotherapists' behavior change counseling skills.
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Affiliation(s)
- Angelika Eisele
- Catholic University of Applied Sciences Freiburg, Freiburg, Germany
| | - Daniela Schagg
- Catholic University of Applied Sciences Freiburg, Freiburg, Germany
| | - Lena Violetta Krämer
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Roland Küffner
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Andrea Reusch
- Zentrum Patientenschulung und Gesundheitsförderung (ZePG e. V.), Geschäftsstelle und Wissenschaftsreferat, Würzburg, Germany
| | - Wiebke Göhner
- Catholic University of Applied Sciences Freiburg, Freiburg, Germany
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van Koppen B, Zandwijk P, de Vries J, van Mameren H, de Bie R. Adherence to home-based exercises and/or activity advice in low back pain patients: a systematic review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1846783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Ben van Koppen
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Caphri Research Institute for Care and Public Health, Maastricht University, Maastricht, The Netherlands
| | - Pim Zandwijk
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Caphri Research Institute for Care and Public Health, Maastricht University, Maastricht, The Netherlands
| | - Jurryt de Vries
- Department of Orthopaedic Manipulative Physical Therapy, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Henk van Mameren
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Caphri Research Institute for Care and Public Health, Maastricht University, Maastricht, The Netherlands
| | - Rob de Bie
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Caphri Research Institute for Care and Public Health, Maastricht University, Maastricht, The Netherlands
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Matthews J, Hall AM, Keogh A. Evaluating the effects of behavior change training on the knowledge, confidence and skills of sport and exercise science students. BMC Sports Sci Med Rehabil 2020; 12:62. [PMID: 33042551 PMCID: PMC7539374 DOI: 10.1186/s13102-020-00209-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/24/2020] [Indexed: 12/02/2022]
Abstract
Background Behavior change interventions have the potential to have a transformative effect on the health of populations. Allied health professionals have a key role to play in delivering these interventions. However, traditionally undergraduate allied health professional programs have not had a behavior change focus. The aim of this study was to assess the effectiveness of a training program on sport and exercise science students’ knowledge, confidence and skills in the provision of behavior change support. Method A mixed method convergent design was used to address the research question. Fifteen sport and exercise science students took part in a training program consisting of seven 90-min weekly face to face group sessions. Student satisfaction with training methods was assessed. Pre-to-post training changes in students’ confidence and knowledge in the provision of behavior change support was evaluated. Delivery of behavior change support was assessed by an audio recorded role-play rated by an expert using the Health Care Climate Questionnaire, and an adapted version of the Communication Evaluation in Rehabilitation Tool. Students also completed a reflective assignment. Results Students were satisfied with the training. There were increases in students’ confidence and knowledge of certain behavior change components post-training but not behavior change techniques. Students delivered behavior change support in a broadly needs supportive manner. The reflective assignment showed that students found particular behavior change strategies difficult to implement. Conclusion It is feasible to train undergraduate students in particular components of behavior change support. Academic institutions should embed behavior change training into the allied health professional curriculum to ensure graduates are job ready with the knowledge, confidence and skills to support health related behavior change within the wider health system.
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Affiliation(s)
- James Matthews
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland.,Institute of Sport and Health, University College Dublin, Dublin, Ireland
| | - Amanda M Hall
- Faculty of Medicine, Memorial University, Newfoundland, Canada
| | - Alison Keogh
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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Pain Neuroscience Education as the Foundation of Interdisciplinary Pain Treatment. Phys Med Rehabil Clin N Am 2020; 31:541-551. [PMID: 32981577 DOI: 10.1016/j.pmr.2020.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Pain neuroscience education (PNE) can be applied as the foundational core of an interdisciplinary biopsychosocial approach to persistent pain. This article outlines a noninvasive, nonpharmaceutical, and collaborative approach to providing comprehensive pain care, applying evidence-based biopsychosocial treatment strategies within the framework of PNE. Through consistent messaging across all interdisciplinary team members, persistent pain patients can sustain a deeper level of understanding and empowerment, with goals of sustainable improvement and self-management. The application of adult learning theory by patient educators also is discussed.
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Hurley DA, Jeffares I, Hall AM, Keogh A, Toomey E, McArdle D, McDonough SM, Guerin S, Segurado R, Matthews J. Feasibility cluster randomised controlled trial evaluating a theory-driven group-based complex intervention versus usual physiotherapy to support self-management of osteoarthritis and low back pain (SOLAS). Trials 2020; 21:807. [PMID: 32967713 PMCID: PMC7510107 DOI: 10.1186/s13063-020-04671-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/12/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The self-management of osteoarthritis (OA) and low back pain (LBP) through activity and skills (SOLAS) theory-driven group-based complex intervention was developed primarily for the evaluation of its acceptability to patients and physiotherapists and the feasibility of trial procedures, to inform the potential for a definitive trial. METHODS This assessor-blinded multicentre two-arm parallel cluster randomised controlled feasibility trial compared the SOLAS intervention to usual individual physiotherapy (UP; pragmatic control group). Patients with OA of the hip, knee, lumbar spine and/or chronic LBP were recruited in primary care physiotherapy clinics (i.e. clusters) in Dublin, Ireland, between September 2014 and November 2015. The primary feasibility objectives were evaluated using quantitative methods and individual telephone interviews with purposive samples of participants and physiotherapists. A range of secondary outcomes were collected at baseline, 6 weeks (behaviour change only), 2 months and 6 months to explore the preliminary effects of the intervention. Analysis was by intention-to-treat according to participants' cluster allocation and involved descriptive analysis of the quantitative data and inductive thematic analysis of the qualitative interviews. A linear mixed model was used to contrast change over time in participant secondary outcomes between treatment arms, while adjusting for study waves and clusters. RESULTS Fourteen clusters were recruited (7 per trial arm), each cluster participated in two waves of recruitment, with the average cluster size below the target of six participants (intervention: mean (SD) = 4.92 (1.31), range 2-7; UP: mean (SD) = 5.08 (2.43), range 1-9). One hundred twenty participants (83.3% of n = 144 expected) were recruited (intervention n = 59; UP n = 61), with follow-up data obtained from 80.8% (n = 97) at 6 weeks, 84.2% (n = 101) at 2 months and 71.7% (n = 86) at 6 months. Most participants received treatment as allocated (intervention n = 49; UP n = 54). The qualitative interviews (12 participants; 10 physiotherapists (PTs) found the intervention and trial procedures acceptable and appropriate, with minimal feasible adaptations required. Linear mixed methods showed improvements in most secondary outcomes at 2 and 6 months with small between-group effects. CONCLUSIONS While the SOLAS intervention and trial procedures were acceptable to participants and PTs, the recruitment of enough participants is the biggest obstacle to a definitive trial. TRIAL REGISTRATION ISRCTN ISRCTN49875385 . Registered on 26 March 2014.
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Affiliation(s)
- Deirdre A. Hurley
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Room A302, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - Isabelle Jeffares
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin 2, Ireland
| | - Amanda M. Hall
- Faculty of Medicine, Memorial University, St Johns, Newfoundland Canada
| | - Alison Keogh
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Room A302, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Danielle McArdle
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Room A302, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - Suzanne M. McDonough
- School of Physiotherapy, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin 2, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Room A302, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - James Matthews
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Room A302, Health Sciences Centre, Belfield, Dublin 4, Ireland
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Mendi O, Yildirim N, Mendi B. Cross-cultural Adaptation, Reliability, and Validity of the Turkish Version of the Health Professionals Communication Skills Scale. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:312-319. [PMID: 32937201 DOI: 10.1016/j.anr.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the psychometric properties of the Turkish version of the Health Professionals Communication Skills Scale (HP-CSS). METHODS The HP-CSS was translated into Turkish following an international instrument translation guideline. A convenience sample of 394 health professionals participated in this study. Internal consistency reliability, content validity, test-retest reliability, and convergent validity were assessed. A confirmatory factor analysis was conducted to evaluate the construct validity. RESULTS The Turkish version of HP-CSS comprised four factors (empathy, informative communication, respect, and social skill). The HP-CSS-TR demonstrated adequate internal consistency (Cronbach's α values .72-.79). In terms of the content validity, the scale-level content validity index (CVI) was .94, and the item-level CVI ranged from .83 to 1.00. The HP-CSS-TR showed good test-retest reliability (intraclass correlation coefficients were above .82). No statistically significant difference was found between the applications. There was a good agreement between the HP-CSS-TR and communication skills inventory (CSI) scales. Confirmatory factor analysis results (χ2/df, GFI, AGFI, IFI, TLI, CFI, RMSEA, and SRMR) showed a good fit for the original four-factor model. CONCLUSION Results showed that the Turkish version of the HP-CSS is a valid and reliable tool for the assessment of communication skills of health professionals in Turkey. The use of the HP-CSS-TR measure in clinical settings could be useful in enhancing the quality of care by identifying inadequacies and improving communication skills.
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Affiliation(s)
- Onur Mendi
- Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey.
| | - Nurdan Yildirim
- Florence Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey.
| | - Basak Mendi
- Faculty of Health Sciences, Demiroglu Bilim University, Istanbul, Turkey.
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Leahy E, Chipchase L, Calo M, Blackstock FC. Which Learning Activities Enhance Physical Therapist Practice? Part 1: Systematic Review and Meta-analysis of Quantitative Studies. Phys Ther 2020; 100:1469-1483. [PMID: 32529249 DOI: 10.1093/ptj/pzaa107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/26/2019] [Accepted: 04/15/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Following graduation from professional education, the development of clinical expertise requires career-long participation in learning activities. The purpose of this study was to evaluate which learning activities enhanced physical therapist practice. METHODS Eight databases were searched for studies published from inception through December 2018. Articles reporting quantitative data evaluating the effectiveness of learning activities completed by qualified physical therapists were included. Study characteristics and results were extracted from the 26 randomized controlled trials that met the inclusion criteria. Clinician (knowledge, affective attributes, and behavior) and patient-related outcomes were extracted. RESULTS There was limited evidence that professional development courses improved physical therapist knowledge. There was low-level evidence that peer assessment and feedback were more effective than case discussion at improving knowledge (standardized mean difference = 0.35, 95% CI = 0.09-0.62). Results were inconsistent for the effect of learning activities on affective attributes. Courses with active learning components appeared more effective at changing physical therapist behavior. The completion of courses by physical therapists did not improve patient outcomes; however, the addition of a mentored patient interaction appeared impactful. CONCLUSION Current evidence suggests active approaches, such as peer assessment and mentored patient interactions, should be used when designing learning activities for physical therapists. Further high-quality research focused on evaluating the impact of active learning interventions on physical therapist practice and patient outcomes is now needed. IMPACT This study is a first step in determining which learning activities enhance clinical expertise and practice would enable the physical therapy profession to make informed decisions about the allocation of professional development resources.
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Affiliation(s)
- Edmund Leahy
- BPhysio, MPhty(Musc), Department of Physiotherapy, School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia; Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia; and Physiotherapy Department, Northern Health, Epping, Victoria, Australia
| | - Lucy Chipchase
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Marlena Calo
- BPhysio, PGCert(PFPhysio), Department of Physiotherapy, School of Science and Health, Western Sydney University; and Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, La Trobe University
| | - Felicity C Blackstock
- Department of Physiotherapy, School of Science and Health, Western Sydney University
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Hall MS, Podlog L, Newton M, Galli N, Fritz J, Butner J, Greviskes L, Hammer C. Patient and practitioner perspectives of psychological need support in physical therapy. Physiother Theory Pract 2020; 38:670-685. [PMID: 32627632 DOI: 10.1080/09593985.2020.1780654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine strategies utilized by physical therapists that contributed to patient perceptions of basic psychological needs support articulated within Self-Determination Theory (SDT). METHODS Semi-structured interviews were conducted with physical therapists (n = 9) and physical therapy patients (n = 9) undergoing rehabilitation for a variety of musculoskeletal injuries. RESULTS Both patients and practitioners articulated the value of specific competence (e.g. matching rehabilitation challenges with patient abilities) and autonomy support strategies (e.g. active decision-making). Interestingly, both patients and therapists emphasized the salience of relatedness need support, a finding indicative of the potential importance of this need in a rehabilitation environment. The possibility that relatedness need support may be of equal - or potentially greater - importance than the other two needs in a rehabilitation setting, is however, antithetical to SDT contentions. Whether the primacy of relatedness need support is an artifact of the sample used in the current study or a reflection of a broader rehabilitation trend, is uncertain and remains a topic for further investigation. CONCLUSIONS Understanding the strategies physical therapists use to support patients' psychological needs may have substantial implications for patient motivation and rehabilitation adherence, such as, improved psychological well-being, enhanced function, and increased adherence to physical therapists' recommendations.
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Affiliation(s)
- Morgan S Hall
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Leslie Podlog
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Maria Newton
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Nick Galli
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Jonathan Butner
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Lindsey Greviskes
- Department of Health, Physical Education, Recreation, and Coaching, University of Wisconsin-Whitewater, Whitewater, WI, USA
| | - Chris Hammer
- Athletics Department, Davis & Elkins College, Elkins, WV, USA
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Haverfield MC, Tierney A, Schwartz R, Bass MB, Brown-Johnson C, Zionts DL, Safaeinili N, Fischer M, Shaw JG, Thadaney S, Piccininni G, Lorenz KA, Asch SM, Verghese A, Zulman DM. Can Patient-Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review. J Gen Intern Med 2020; 35:2107-2117. [PMID: 31919725 PMCID: PMC7351919 DOI: 10.1007/s11606-019-05525-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Human connection is at the heart of medical care, but questions remain as to the effectiveness of interpersonal interventions. The purpose of this review was to characterize the associations between patient-provider interpersonal interventions and the quadruple aim outcomes (population health, patient experience, cost, and provider experience). METHODS We sourced data from PubMed, EMBASE, and PsycInfo (January 1997-August 2017). Selected studies included randomized controlled trials and controlled observational studies that examined the association between patient-provider interpersonal interventions and at least one outcome measure of the quadruple aim. Two abstractors independently extracted information about study design, methods, and quality. We characterized evidence related to the objective of the intervention, type and duration of intervention training, target recipient (provider-only vs. provider-patient dyad), and quadruple aim outcomes. RESULTS Seventy-three out of 21,835 studies met the design and outcome inclusion criteria. The methodological quality of research was moderate to high for most included studies; 67% of interventions targeted the provider. Most studies measured impact on patient experience; improvements in experience (e.g., satisfaction, patient-centeredness, reduced unmet needs) often corresponded with a positive impact on other patient health outcomes (e.g., quality of life, depression, adherence). Enhanced interpersonal interactions improved provider well-being, burnout, stress, and confidence in communicating with difficult patients. Roughly a quarter of studies evaluated cost, but the majority reported no significant differences between intervention and control groups. Among studies that measured time in the clinical encounter, intervention effects varied. Interventions with lower demands on provider time and effort were often as effective as those with higher demands. DISCUSSION Simple, low-demand patient-provider interpersonal interventions may have the potential to improve patient health and patient and provider experience, but there is limited evidence that these interventions influence cost-related outcomes.
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Affiliation(s)
- Marie C Haverfield
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA. .,Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Research and Policy (CHRP), Stanford, CA, USA.
| | - Aaron Tierney
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Rachel Schwartz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Research and Policy (CHRP), Stanford, CA, USA
| | | | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Dani L Zionts
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Meredith Fischer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sonoo Thadaney
- School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Karl A Lorenz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven M Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Donna M Zulman
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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MacDonald CW, Osmotherly PG, Rivett DA. COVID-19 wash your hands but don't erase them from our profession - considerations on manual therapy past and present. J Man Manip Ther 2020; 28:127-131. [PMID: 32666913 PMCID: PMC7480463 DOI: 10.1080/10669817.2020.1766845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
| | - Peter G Osmotherly
- Senior Lecturer, School of Health Sciences (Physiotherapy), University of Newcastle, Australia
| | - Darren a Rivett
- Professor of Physiotherapy, The University of Newcastle, Australia
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Does a Web-Based Exercise Programming System Improve Home Exercise Adherence for People With Musculoskeletal Conditions?: A Randomized Controlled Trial. Am J Phys Med Rehabil 2020; 98:850-858. [PMID: 31021823 DOI: 10.1097/phm.0000000000001204] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate whether a web-based exercise programming system improves adherence to a home exercise program for people with musculoskeletal conditions. DESIGN Eligible patients with a musculoskeletal condition presenting to a physical therapist in private practice were randomized to the following: (a) control (home exercise prescribed by therapist's usual methods) or (b) intervention (home exercise prescribed using a web-based exercise programming system). The primary outcome was self-rated exercise adherence measured at week 3 via 11-point Numeric Rating Scales. Secondary outcomes were satisfaction with exercise delivery and confidence in ability to undertake prescribed exercise. Process measures were also included. RESULTS We enrolled 305 participants, with loss to follow-up of 14.5% (22/152) and 13.7% (21/153) in intervention and control groups, respectively. Compared with controls, the intervention group reported higher exercise adherence (mean difference Numeric Rating Scale units (95% confidence intervals): adherence overall -1.0 [-1.6 to -0.3] and regarding number of exercises in session -0.7 [-1.3 to -0.1], number of repetitions -0.8 [-1.4 to -0.2], and number of sessions -1.0 [-1.6 to -0.3]). The intervention group showed greater confidence to exercise than control, with no difference in satisfaction. CONCLUSIONS A web-based exercise programming system improved home exercise adherence and confidence in ability to undertake exercise, although the clinical relevance of the results needs to be established.
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Martin ES, Dobson F, Hall M, Marshall C, Egerton T. The effects of behavioural counselling on the determinants of health behaviour change in adults with chronic musculoskeletal conditions making lifestyle changes: A systematic review and meta-analysis. Musculoskeletal Care 2019; 17:170-197. [PMID: 31373435 DOI: 10.1002/msc.1410] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE A systematic review and meta-analysis of controlled trials was carried out to examine the effect of behavioural counselling on determinants of behaviour change in adults with chronic, painful musculoskeletal conditions. METHODS Seven databases were searched up to January 2019. Two reviewers independently screened title/abstracts and full texts. Eligible trials included those including participants over 18 years of age with a chronic, painful musculoskeletal condition, a measurement of at least one behavioural determinant and lifestyle behaviour, and where behavioural counselling was the distinguishing intervention. Two reviewers independently extracted data and assessed for risk of bias using the Cochrane Risk of Bias Tool. Meta-analyses were conducted, using standardized mean differences and 95% confidence intervals (CIs) when at least two trials examined the same outcome. The quality of the evidence was evaluated using the Grades of Recommendation, Assessment, Development and Evaluation approach. RESULTS Fourteen unique trials, reported in 16 publications, were included. Low-quality evidence showed that behavioural counselling has a small effect on increasing self-reported physical activity (standardized mean difference 0.26; 95% CI 0.00, 0.53). Very-low-quality evidence showed that behavioural counselling has a moderate effect on self-efficacy related to physical activity (standardized mean difference 0.69; 95% CI 0.19, 1.18). Low-quality evidence suggested that behavioural counselling has no effect on symptoms of depression and anxiety. CONCLUSIONS Behavioural counselling may help to increase self-reported physical activity levels in adults with chronic painful musculoskeletal conditions. Self-efficacy may be a behavioural determinant in an underlying causal pathway explaining positive lifestyle change.
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Affiliation(s)
- Emma S Martin
- Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia
- St Vincent's Hospital, Melbourne, VIC, Australia
| | - Fiona Dobson
- Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia
- Centre for Health Exercise & Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Michelle Hall
- Centre for Health Exercise & Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Charlotte Marshall
- Centre for Health Exercise & Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Thorlene Egerton
- Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia
- Centre for Health Exercise & Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
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Ware ME, deMarrais KB, McCully KK. Adherence and Continued Participation in a Wellness Class for Individuals with Disabilities. Rehabil Process Outcome 2019; 8:1179572719843257. [PMID: 34497459 PMCID: PMC8282129 DOI: 10.1177/1179572719843257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background: For individuals with disabilities, adherence and participation in wellness programs is a challenge. Adherence and participation were explored in a wellness class for people with disabilities. Objective: Understand what factors impact participant adherence and participation in the wellness class. Methods: Eight wellness class participants, who have been in the class for 6 to 36 months, were chosen for qualitative interviews. Interview responses were coded and analyzed for overarching themes. Results: A total of 77 codes were obtained from interview data. The primary theme identified from the codes was related to social interaction with the student-trainers, divided into subthemes of social accountability, motivation, supporting classroom environment, and participant-student interaction. Conclusion: The primary factor influencing adherence and participation was related to social interaction with student-trainers. These results suggest that social interaction can play a major role in continued participation in exercise as well as exercise adherence.
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Affiliation(s)
| | - Kathleen B deMarrais
- Department of Lifelong Education, Administration, and Policy, University of Georgia, Athens, GA, USA
| | - Kevin K McCully
- Department of Kinesiology, University of Georgia, Athens, GA, USA
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Stuge B. Evidence of stabilizing exercises for low back- and pelvic girdle pain - a critical review. Braz J Phys Ther 2019; 23:181-186. [PMID: 30471967 PMCID: PMC6428920 DOI: 10.1016/j.bjpt.2018.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) have been associated with an alteration in the strategy for lumbopelvic stabilization. Different core stabilization approaches exist, the evidence is however controversial. METHODS This paper discusses how to improve the evidence of exercises for women suffering from LBP and PGP during and after pregnancy. Exercises should be understood in a context, where the bio-psycho-social perspective directs the prescription of exercises, targeting both psychological and physical factors. The type of exercise probably should be individually tailored to the needs and capability of the individual and it is not only about the most appropriate exercise, it is about dosage and delivery of the exercises, and it is about performance. To promote adherence the use of patient preferences, with self-defined movement goals, may be a motivational basis for behavior change. Communication skills may facilitate positive beliefs and provide a motivational foundation for empowerment, self-efficacy and for self-management. To learn by discovery where the patient learns through their own experiences, might motivate the patients to active engagement and to behavioral change. Adherence probably will increase when the patients understand the aim and the rationale behind the exercises they are prescribed. However, with high adherence to exercises that maintains an inappropriate motor pattern, LBP and PGP possibly could proceed into chronicity. CONCLUSION Exercises need to be meaningful to the patient, relevant for daily activities, individualized according to patient preferences, guided and supervised to secure performance and quality.
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Affiliation(s)
- Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
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Kinney M, Seider J, Beaty AF, Coughlin K, Dyal M, Clewley D. The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract 2018; 36:886-898. [PMID: 30265840 DOI: 10.1080/09593985.2018.1516015] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To systematically determine the specific impact of therapeutic alliance (TA) on chronic musculoskeletal pain, identify factors influencing TA between physical therapists and patients with chronic musculoskeletal pain, and determine the working definition of TA across studies. Data Sources: Databases, including PubMed, CINHAL, and Embase, were searched from inception to January 2017. Study Selection: The initial search resulted in 451 papers. After screening, seven studies were identified that examined the role of TA on chronic pain (> 12 weeks) management in physical therapy settings. Data Extraction: Authors extracted data into tables. Risk of bias was assessed using Cochrane Collaboration methodology. Data Synthesis: Three studies examined the influence of a strong TA coupled with physical therapy on pain outcomes. Four studies identified factors that positively and negatively influenced TA. The working definition of TA was identified in each study. Conclusions: Emerging evidence suggests that for individuals participating in physical therapy for chronic musculoskeletal pain, a strong TA may improve pain outcomes. In order to facilitate a strong TA, physical therapists must understand factors that positively and negatively influence the relationship. Studies demonstrate that the definition of TA remains consistent as it transitions to the physical therapy setting.
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Affiliation(s)
- Meredith Kinney
- Outpatient Physical Therapy Department, BreakThrough Physical Therapy , Wake Forest, NC, USA
| | - Jasmine Seider
- Outpatient Physical Therapy Department, Select Physical Therapy , Arlington, VA, USA
| | - Amanda Floyd Beaty
- Department of Physical Therapy and Occupational Therapy, Adult Ambulatory Division, Duke University Health System , Durham, NC, USA
| | - Kaitlin Coughlin
- Outpatient Physical Therapy Department, Back to Work Physical Therapy , Tampa, FL, USA
| | - Maximilian Dyal
- Outpatient Physical Therapy Department, Korunda Medical LLC , Naples, FL, USA
| | - Derek Clewley
- Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University , Durham, NC, USA
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Hart T, Dijkers MP, Whyte J, Turkstra LS, Zanca JM, Packel A, Van Stan JH, Ferraro M, Chen C. A Theory-Driven System for the Specification of Rehabilitation Treatments. Arch Phys Med Rehabil 2018; 100:172-180. [PMID: 30267669 DOI: 10.1016/j.apmr.2018.09.109] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/27/2018] [Accepted: 09/12/2018] [Indexed: 11/20/2022]
Abstract
The field of rehabilitation remains captive to the black-box problem: our inability to characterize treatments in a systematic fashion across diagnoses, settings, and disciplines, so as to identify and disseminate the active ingredients of those treatments. In this article, we describe the Rehabilitation Treatment Specification System (RTSS), by which any treatment employed in rehabilitation may be characterized, and ultimately classified according to shared properties, via the 3 elements of treatment theory: targets, ingredients, and (hypothesized) mechanisms of action. We discuss important concepts in the RTSS such as the distinction between treatments and treatment components, which consist of 1 target and its associated ingredients; and the distinction between targets, which are the direct effects of treatment, and aims, which are downstream or distal effects. The RTSS includes 3 groups of mutually exclusive treatment components: Organ Functions, Skills and Habits, and Representations. The last of these comprises not only thoughts and feelings, but also internal representations underlying volitional action; the RTSS addresses the concept of volition (effort) as a critical element for many rehabilitation treatments. We have developed an algorithm for treatment specification which is illustrated and described in brief. The RTSS stands to benefit the field in numerous ways by supplying a coherent, theory-based framework encompassing all rehabilitation treatments. Using a common framework, researchers will be able to test systematically the effects of specific ingredients on specific targets; and their work will be more readily replicated and translated into clinical practice.
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Affiliation(s)
- Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, PA.
| | - Marcel P Dijkers
- Wayne State University, Detroit, MI; Icahn School of Medicine at Mount Sinai, New York, NY
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA
| | | | | | - Andrew Packel
- Moss Rehabilitation Research Institute, Elkins Park, PA
| | - Jarrad H Van Stan
- Harvard Medical School, Boston, MA; Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston, MA; MGH Institute of Health Professions, Charlestown, MA
| | - Mary Ferraro
- Moss Rehabilitation Research Institute, Elkins Park, PA
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Murray A, Hall A, Williams GC, McDonough SM, Ntoumanis N, Taylor I, Jackson B, Copsey B, Hurley DA, Matthews J. Assessing physiotherapists' communication skills for promoting patient autonomy for self-management: reliability and validity of the communication evaluation in rehabilitation tool. Disabil Rehabil 2018; 41:1699-1705. [PMID: 29485325 DOI: 10.1080/09638288.2018.1443159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To assess the inter-rater reliability and concurrent validity of the Communication Evaluation in Rehabilitation Tool, which aims to externally assess physiotherapists competency in using Self-Determination Theory-based communication strategies in practice. MATERIALS AND METHODS Audio recordings of initial consultations between 24 physiotherapists and 24 patients with chronic low back pain in four hospitals in Ireland were obtained as part of a larger randomised controlled trial. Three raters, all of whom had Ph.Ds in psychology and expertise in motivation and physical activity, independently listened to the 24 audio recordings and completed the 18-item Communication Evaluation in Rehabilitation Tool. Inter-rater reliability between all three raters was assessed using intraclass correlation coefficients. Concurrent validity was assessed using Pearson's r correlations with a reference standard, the Health Care Climate Questionnaire. RESULTS The total score for the Communication Evaluation in Rehabilitation Tool is an average of all 18 items. Total scores demonstrated good inter-rater reliability (Intraclass Correlation Coefficient (ICC) = 0.8) and concurrent validity with the Health Care Climate Questionnaire total score (range: r = 0.7-0.88). Item-level scores of the Communication Evaluation in Rehabilitation Tool identified five items that need improvement. CONCLUSION Results provide preliminary evidence to support future use and testing of the Communication Evaluation in Rehabilitation Tool. Implications for Rehabilitation Promoting patient autonomy is a learned skill and while interventions exist to train clinicians in these skills there are no tools to assess how well clinicians use these skills when interacting with a patient. The lack of robust assessment has severe implications regarding both the fidelity of clinician training packages and resulting outcomes for promoting patient autonomy. This study has developed a novel measurement tool Communication Evaluation in Rehabilitation Tool and a comprehensive user manual to assess how well health care providers use autonomy-supportive communication strategies in real world-clinical settings. This tool has demonstrated good inter-rater reliability and concurrent validity in its initial testing phase. The Communication Evaluation in Rehabilitation Tool can be used in future studies to assess autonomy-supportive communication and undergo further measurement property testing as per our recommendations.
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Affiliation(s)
- Aileen Murray
- a School of Public Health, Physiotherapy and Sports Science , University College Dublin , Dublin , Ireland
| | - Amanda Hall
- b Faculty of Medicine , Memorial University of Newfoundland , St. John's , Canada
| | | | | | - Nikos Ntoumanis
- e School of Psychology and Speech Pathology , Curtin University , Perth , Australia
| | - Ian Taylor
- f School of Sport, Exercise and Health Sciences , Loughborough University , Leicestershire , UK
| | - Ben Jackson
- g Exercise, Health and Sport Psychology , University of Western Australia , Crawley , Australia
| | - Bethan Copsey
- h Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford , UK
| | - Deirdre A Hurley
- a School of Public Health, Physiotherapy and Sports Science , University College Dublin , Dublin , Ireland
| | - James Matthews
- a School of Public Health, Physiotherapy and Sports Science , University College Dublin , Dublin , Ireland
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Keogh A, Matthews J, Segurado R, Hurley DA. Feasibility of Training Physical Therapists to Deliver the Theory-Based Self-Management of Osteoarthritis and Low Back Pain Through Activity and Skills (SOLAS) Intervention Within a Trial. Phys Ther 2018; 98:95-107. [PMID: 29088437 DOI: 10.1093/ptj/pzx105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 10/12/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Provider training programs are frequently underevaluated, leading to ambiguity surrounding effective intervention components. OBJECTIVE The purpose of this study was to assess the effectiveness of a training program in guiding physical therapists to deliver the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) group education and exercise intervention (ISRCTN49875385), using a communication style underpinned by self-determination theory (SDT). DESIGN This was an assessment of the intervention arm training program using quantitative methods. METHODS Thirteen physical therapists were trained using mixed methods to deliver the SOLAS intervention. Training was evaluated using the Kirkpatrick model: (1) Reaction-physical therapists' satisfaction with training, (2) Learning-therapists' confidence in and knowledge of the SDT-based communication strategies and intervention content and their skills in applying the strategies during training, and (3) Behavior-8 therapists were audio-recorded delivering all 6 SOLAS intervention classes (n = 48), and 2 raters independently coded 50% of recordings (n = 24) using the Health Care Climate Questionnaire (HCCQ), the Controlling Coach Behavior Scale (CCBS), and an intervention-specific measure. RESULTS Reaction: Physical therapists reacted well to training (median [IRQ]; min-max = 4.7; [0.5]; 3.7-5.0). Learning: Physical therapists' confidence in the SDT-based communication strategies and knowledge of some intervention content components significantly improved. Behavior: Therapists delivered the intervention in a needs-supportive manner (median HCCQ = 5.3 [1.4]; 3.9-6.0; median CCBS = 6.6 ([0.5]; 6.1-6.8; median intervention specific measure = 4.0 [1.2]; 3.2-4.9). However, "goal setting" was delivered below acceptable levels by all therapists (median 2.9 [0.9]; 2.0-4.0). LIMITATIONS The intervention group only was assessed as part of the process evaluation of the feasibility trial. CONCLUSIONS Training effectively guided physical therapists to be needs-supportive during delivery of the SOLAS intervention. Refinements were outlined to improve future similar training programs, including greater emphasis on goal setting.
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Affiliation(s)
- Alison Keogh
- UCD School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - James Matthews
- UCD School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin
| | - Ricardo Segurado
- CSTAR and UCD School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin
| | - Deirdre A Hurley
- UCD School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin
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Maiorana A, Ntoumanis N. Physical Activity in Patients with Cardiovascular Disease: Challenges in Measurement and Motivation. Heart Lung Circ 2017; 26:1001-1003. [PMID: 28867025 DOI: 10.1016/j.hlc.2017.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew Maiorana
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia; Allied Health Department and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, WA, Australia.
| | - Nikos Ntoumanis
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, WA, Australia
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