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Communication style and exercise compliance in physiotherapy (CONNECT): a cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients' adherence to physiotherapists' recommendations: study rationale, design, and methods.

Lonsdale C, Hall AM, Williams GC, McDonough SM, Ntoumanis N, Murray A, Hurley DA - BMC Musculoskelet Disord (2012)

Bottom Line: Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises.According to self-determination theory, support from health care practitioners can promote patients' autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists' recommendations).We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Science and Health, University of Western Sydney, Penrith, NSW, Australia. c.lonsdale@uws.edu.au

ABSTRACT

Background: Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist's recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients' autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists' recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists' autonomy-supportive communication on low back pain patients' adherence to physical activity and exercise therapy recommendations.

Methods/design: This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded.We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects.

Discussion: This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients' adherence to rehabilitation recommendations.

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Related in: MedlinePlus

The Self-Determination Continuum of Motivation (with examples quotes to illustrate motives for following a physiotherapist’s recommendations).
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Figure 1: The Self-Determination Continuum of Motivation (with examples quotes to illustrate motives for following a physiotherapist’s recommendations).

Mentions: According to SDT [27], humans have basic psychological needs for autonomy (feeling fully volitional or free to engage in a behavior), perceived competence (feeling effective in one’s actions), and relatedness (feeling safe and cared for in one’s interpersonal relationships). When these needs are supported, patients’ participation in treatment will be more autonomous and less controlled. Autonomous motivation is characterized by perceptions of valued benefits and a willingness to participate. In contrast, controlled motivation in the healthcare domain typically involves patient engagement in treatment due to external pressure, coercion, or feelings of guilt. This distinction between autonomous and controlled motivation represents a continuum rather than a dichotomy (see Figure 1 for details), with more autonomously motivated behaviors leading to greater psychological well-being and long-term behavioral persistence [28].


Communication style and exercise compliance in physiotherapy (CONNECT): a cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients' adherence to physiotherapists' recommendations: study rationale, design, and methods.

Lonsdale C, Hall AM, Williams GC, McDonough SM, Ntoumanis N, Murray A, Hurley DA - BMC Musculoskelet Disord (2012)

The Self-Determination Continuum of Motivation (with examples quotes to illustrate motives for following a physiotherapist’s recommendations).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475041&req=5

Figure 1: The Self-Determination Continuum of Motivation (with examples quotes to illustrate motives for following a physiotherapist’s recommendations).
Mentions: According to SDT [27], humans have basic psychological needs for autonomy (feeling fully volitional or free to engage in a behavior), perceived competence (feeling effective in one’s actions), and relatedness (feeling safe and cared for in one’s interpersonal relationships). When these needs are supported, patients’ participation in treatment will be more autonomous and less controlled. Autonomous motivation is characterized by perceptions of valued benefits and a willingness to participate. In contrast, controlled motivation in the healthcare domain typically involves patient engagement in treatment due to external pressure, coercion, or feelings of guilt. This distinction between autonomous and controlled motivation represents a continuum rather than a dichotomy (see Figure 1 for details), with more autonomously motivated behaviors leading to greater psychological well-being and long-term behavioral persistence [28].

Bottom Line: Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises.According to self-determination theory, support from health care practitioners can promote patients' autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists' recommendations).We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Science and Health, University of Western Sydney, Penrith, NSW, Australia. c.lonsdale@uws.edu.au

ABSTRACT

Background: Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist's recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients' autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists' recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists' autonomy-supportive communication on low back pain patients' adherence to physical activity and exercise therapy recommendations.

Methods/design: This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded.We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects.

Discussion: This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients' adherence to rehabilitation recommendations.

Show MeSH
Related in: MedlinePlus