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

BMC Musculoskeletal Disorders

Deirdre A Hurley³  Aileen Murray³  Nikos Ntoumanis⁵  Suzanne M McDonough⁴  Geoffrey C Williams¹  Amanda M Hall³  Chris Lonsdale² 

[1] Departments of Medicine, Clinical and Social Sciences in Psychology, Psychiatry, Center of Community Health, University of Rochester, 46 Prince St Suite 3001, Rochester, NY, 14607, USA;School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia;School of Public Health, Physiotherapy, and Population Science, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland;Health and Rehabilitation Sciences Research Centre, School of Health Sciences, University of Ulster, Ulster, BT37 0QB, UK;School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK

关键词: Physiotherapy;    Physical therapy;    Compliance;    Adherence;    Well-being;    Disability;    Low back pain;    Patient;    Motivation;    Communication;   

Others  :  1149415
DOI  :  10.1186/1471-2474-13-104

 received in 2012-05-09, accepted in 2012-05-29,  发布年份 2012

【 摘 要 】

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.

Trial Registration

Current Controlled Trials ISRCTN63723433

【 授权许可】

   
2012 Lonsdale et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 .

Figure 2 .

Figure 1.

【 参考文献 】

• [1]Walker BF, Muller R, Grant WD: Low back pain in Australian adults Health provider utilization and care seeking. J Manip Physiol Ther 2004, 27(5):327-335.
• [2]Airaksinen O, Brox J, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion A, Reis S, Staal J, Ursin H, et al.: Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006, 15(S2):192-300.
• [3]Higgins JPT, Sally Green P: Cochrane handbook for systematic reviews of interventions, vol. 4. John Wiley & Sons, Chichester; 2011.
• [4]Bogduk N: Management of chronic low back pain. Medical Journal of Australia 2004, 181:55-55.
• [5]Lin CW, Haas M, Maher CG, Machado LA, van Tulder MW: Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review. European Spine Journal 2011, 20(7):1024-1038.
• [6]Chartered Institute of Personnel and Development: Annual survey report. In Accessed March 29, 2011 from. 2011. http://wwwcipdcouk/NR/rdonlyres/E0CD22D4-0BA8-4A7A-A9E1-DAFC7B8550D1/0/5343_AbsenceManagementsurveyreport2010pdf webcite
• [7]Hayden JA, Tulder MWv, Malmivaara A, Koes BW: Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, (3):CD000335.pub2.
• [8]Hurwitz E, Morgenstern H, Chiao C: Effects of recreational physical activity and back exercises on low back pain and psychological distress: findings from the UCLA Low Back Pain Study. Am J Public Health 2005, 95(10):1817.
• [9]Frih Z, Fendri Y, Jellad A, Boudoukhane S, Rejeb N: Efficacy and treatment compliance of a home-based rehabilitation programme for chronic low back pain: A randomized, controlled study. Annals of Physical and Rehabilitation Medicine 2009, 52(6):485-496.
• [10]Kolt GS, McEvoy JF: Adherence to rehabilitation in patients with low back pain. Man Ther 2003, 8(2):110-116.
• [11]Taimela S, Diederich C, Hubsch M, Heinricy M: The role of physical exercise and inactivity in pain recurrence and absenteeism from work after active outpatient rehabilitation for recurrent or chronic low back pain: a follow-up study. Spine 2000, 25(14):1809.
• [12]WHO: Adherence to long-term therapies: Evidence for action. In WHO Library. World Health Organization, Geneva, Switzerland; 2003. ISBN 92 4 154599 2 (NLM classification: W 85)
• [13]Michie S, Johnston M, Francis J, Hardeman W, Eccles M: From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol 2008, 57(4):660-680.
• [14]Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008, 337(7676):979-983.
• [15]Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P: Framework for design and evaluation of complex interventions to improve health. British Medical Journal 2000, 321:694-696.
• [16]Jordan J, Holden M, Mason E, Foster N: Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. The Cochrane Library 2010, (1):CD005956.
• [17]Hughes SL, Seymour RB, Campbell R, Pollak N, Huber G, Sharma L: Impact of the fit and strong intervention on older adults with osteoarthritis. Gerontologist 2004, 44(2):217.
• [18]Basler H-D, Bertalanffy H, Quint S, Wilke A, Wolf U: TTM-based counselling in physiotherapy does not contribute to an increase of adherence to activity recommendations in older adults with chronic low back pain – A randomised controlled trial. European Journal of Pain 2007, 11:31-37.
• [19]Rhodes R, Fiala B: Building motivation and sustainability into the prescription and recommendations for physical activity and exercise therapy: The evidence. Physiotherapy Theory and Practice 2009, 25(5):424-441.
• [20]Michie S, Abraham C: Interventions to change health behaviours: Evidence-based or evidence-inspired? Psychol Heal 2004, 19(1):29-49.
• [21]Slade SC, Molloy E, Keating JL: `Listen to me, tell me': a qualitative study of partnership in care for people with non-specific chronic low back pain. Clin Rehabil 2009, 23(3):270-280.
• [22]Cooper K, Smith B, Hancock E: Patient-centredness in physiotherapy from the perspective of the chronic low back pain patient. Physiotherapy 2008, 94(3):244-252.
• [23]Leonhardt C, Keller S, Chenot J-F, Luckmann J, Basler H-D, Wegscheider K, Baum E, Donner-Banzhoff N, Pfingsten M, Hildebrandt J, et al.: TTM-based motivational counselling does not increase physical activity of low back pain patients in a primary care setting–A cluster-randomized controlled trial. Patient Education and Counseling 2008, 70(1):50-60.
• [24]Sluijs E, Kok G, van der Zee J: Correlates of exercise compliance in physical therapy. Phys Ther 1993, 73(11):771.
• [25]Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I: Combined exercise and motivation program: Effect on the compliance and level of disability of patients with chronic low back pain: A randomized controlled trial* 1. Archives of Physical Medicine and Rehabilitation 1998, 79(5):475-487.
• [26]Chan DK, Lonsdale C, Ho HP, Yung PSH, Chan KMT: Patient motivation and adherence to post-surgery rehabilitation exercise recommendations: The influence of physiotherapists’ autonomy supportive behaviors. The Archives of Physical Medicine and Rehabilitation 2009, 90(12):1977-1982.
• [27]Ryan RM, Deci EL: Overview of self-determination theory: An organismic dialectical perspective. In Handbook of self-determination research. Edited by Deci EL, Ryan RM. The University of Rochester Press, Rochester NY; 2002.
• [28]Ng J, Thogersen-Ntoumani EC, Ntoumanis N, Deci EL, Ryan RM, Duda JL, Williams GC: Self-Determination Theory applied to health contexts: A meta-analysis. Perspect Psychol Sci 2001. in press
• [29]Braddock CH, Edwards KA, Hasenberg NM, Laidley TL, Levinson W: Informed decision making in outpatient practice: Time to get back to basics. JAMA 1999, 282(24):2313-2320.
• [30]Williams GC, McGregor HA, Sharp D, Levesque C, Kouides RW, Ryan RM, Deci EL: Testing a self-determination theory intervention for motivating tobacco cessation: Supporting autonomy and competence in a clinical trial. Heal Psychol 2006, 25(1):91-101.
• [31]Williams GC, McGregor HA, Zeldman A, Freedman ZR, Deci EL: Testing a Self-Determination Theory Process Model for Promoting Glycemic Control Through Diabetes Self-Management. Heal Psychol 2004, 23:58-66.
• [32]Fortier MS, Sweet SN, O'Sullivan TL, Williams GC: A self-determination process model of physical activity adoption in the context of a randomized controlled trial. Psychology of Sport and Exercise 2007, 8(5):741-757.
• [33]Williams GC, Rodin GC, Ryan RM, Grolnick WS, Deci EL: Autonomous regulation and long-term medication adherence in adult outpatients. Heal Psychol 1998, 17:269-276.
• [34]Halvari AEM, Halvari H: Motivational predictors of change in oral health: An experimental test of self-determination theory. Motiv Emot 2006, 30:295-306.
• [35]Levy RL, Polman RCJ, Borkoles E: Examining the relationship between perceived autonomy support and age in the context of rehabilitation adherence in sport. Rehabilitation Psychology 2008, 53:224-230.
• [36]Lonsdale C, Murray A, Tenant Humphries M, McDonough S, Williams GC, Hurley D: Testing a theory-based intervention designed to increase chronic low back pain patients’ adherence to physiotherapists’ recommendations: A pilot study. Journal of Sport & Exercise Psychology 2010, 32:S192-S193.
• [37]Meriwhether RA, Lafleur AS, Wiseman P: Physical Activity Counseling. Am Fam Physician 2008, 77:1129-1136.
• [38]Campbell MK, Elbourne DR, Altman DG: CONSORT statement: Extension to cluster randomised trials. British Medical Journal 2004, 328:702-708.
• [39]Hurley D, O'Donoghue G, Tully M, Moffett J, van Mechelen W, Daly L, Boreham C, McDonough S: A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial). BMC Musculoskelet Disord 2009, 10(1):79. BioMed Central Full Text
• [40]Chakraborty: A Mixed Model Approach for Intent-to-Treat Analysis in Longitudinal Clinical Trials with Missing Values. Research Triangle Institute, Research Triangle Park, NC; 2009.
• [41]Wilson PM, Rogers WT, Rodgers WM, Wild TC: The Psychological Need Satisfaction in Exercise Scale. Journal of Sport & Exercise Psychology 2006, 28:231-251.
• [42]Kolt GS, Brewer BW, Pizzari T, Schoo AMM, Garrett N: The Sport Injury Rehabilitation Adherence Scale: A reliable scale for use in clinical physiotherapy. Physiotherapy 2007, 93(1):17-22.
• [43]Craig C, Marshall A, Sjostrom M, Bauman A, Booth M, Ainsworth B, Pratt M, Ekelund U, Yngve A, Sallis J: International physical activity questionnaire: 12-country reliability and validity. Medicine & Science in Sports & Exercise 2003, 35(8):1381.
• [44]Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft PR, Koes BW, et al.: Outcome measures for low back pain research: A proposal for standardized use. Spine 1998, 23(18):2003-2013.
• [45]Roland M, Morris R: A study of the natural history of back pain: part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 1983, 8(2):141.
• [46]Pengel LHM, Refshauge KM, Maher CG: Responsiveness of pain, disability, and physical impairment outcomes in patients with low back pain. Spine 2004, 29(8):879.
• [47]Stratford PW, Binkley J, Solomon P, Gill C, Finch E: Assessing change over time in patients with low back pain. Phys Ther 1994, 74(6):528-533.
• [48]Hurst NP, Kind P, Ruta D, Hunter M, Stubbings A: Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D). Rheumatology 1997, 36(5):551-559.
• [49]Williams GC, Freedman ZR, Deci EL: Supporting autonomy to motivate glucose control in patients with diabetes. Diabetes Care 1998, 21(10):1644-1651.
• [50]Levesque CS, Williams GC, Elliot D, Pickering MA, Bodenhamer B, Finley PJ: Validating the theoretical structure of the Treatment Self-Regulation Questionnaire (TSRQ) across three different health behaviors. Heal Educ Res 2006, 22(5):691-702.
• [51]Waddell G, Newton M, Henderson I, Somerville D, et al.: A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993, 52(2):157-168.
• [52]Tudor-Locke C, Williams JE, Reis JP, Pluto D: Utility of pedometers for assessing physical activity. Sports Medicine 2002, 32(12):795-808.
• [53]Kamper SJ, Maher CG, Mackay G: Global rating of change scales: a review of strengths and weaknesses and considerations for design. The Journal of Manual & Manipulative Therapy 2009, 17(3):163.
• [54]Williams GC, Grow VM, Freedman ZR, Ryan RM, Deci EL: Motivational predictors of weight loss and weight-loss maintenance. J Personal Soc Psychol 1996, 70(1):115-126.
• [55]Black AE, Deci EL: The effects of instructors' autonomy support and students' autonomy motivation on learning organic chemistry: A SDT perspective. Sci Educ 1989, 84(6):740-756.
• [56]Smeets RJEM, Beelen S, Goossens MEJB, Schouten EGW, Knottnerus JA, Vlaeyen JWS: Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. The Clinical Journal of Pain 2008, 24(4):305.
• [57]Lovibond SH, Lovibond PF: Maual for the Depression Anxiety Stress Scales. Psychology Foundation, Sydney; 1995.