Limits...
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.

Show MeSH

Related in: MedlinePlus

Self-Determination Theory Model of Behavior Change.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3475041&req=5

Figure 2: Self-Determination Theory Model of Behavior Change.

Mentions: In line with the SDT-based model of health behavior change [30,31], the relationship between the healthcare provider’s autonomy support and the patient’s behavior change via autonomous motivation and perceived competence has been supported in numerous health settings including smoking cessation [30], physical activity [32], medication adherence [33], and dental hygiene [34]. Evidence from cohort studies in physiotherapy settings has supported the positive relationship between autonomy support and adherence outcomes, such as attendance at clinic-based rehabilitation settings [35] and adherence to home-based exercise programs [26], However, no study has been conducted to test the effect of an intervention designed to enable physiotherapists to act in a more autonomy supportive manner during the therapeutic scenario. This type of intervention could increase CLBP patients’ autonomous motivation and competence leading to improved adherence to prescribed home-based treatment and improved LBP outcomes. A diagram presenting the proposed theoretical model of behavior change is presented in Figure 2.


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)

Self-Determination Theory Model of Behavior Change.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Self-Determination Theory Model of Behavior Change.
Mentions: In line with the SDT-based model of health behavior change [30,31], the relationship between the healthcare provider’s autonomy support and the patient’s behavior change via autonomous motivation and perceived competence has been supported in numerous health settings including smoking cessation [30], physical activity [32], medication adherence [33], and dental hygiene [34]. Evidence from cohort studies in physiotherapy settings has supported the positive relationship between autonomy support and adherence outcomes, such as attendance at clinic-based rehabilitation settings [35] and adherence to home-based exercise programs [26], However, no study has been conducted to test the effect of an intervention designed to enable physiotherapists to act in a more autonomy supportive manner during the therapeutic scenario. This type of intervention could increase CLBP patients’ autonomous motivation and competence leading to improved adherence to prescribed home-based treatment and improved LBP outcomes. A diagram presenting the proposed theoretical model of behavior change is presented in Figure 2.

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