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A brief report on the development of a theoretically-grounded intervention to promote patient autonomy and self-management of physiotherapy patients: Face validity and feasibility of implementation

Matthews, James; Hall, Amanda M.; Hernon, Marian; Murray, Aileen; Jackson, Ben; Taylor, Ian; Toner, John; Guerin, Suzanne; Lonsdale, Chris; Hurley, Deirdre A.

Authors

James Matthews

Amanda M. Hall

Marian Hernon

Aileen Murray

Ben Jackson

Ian Taylor

Dr John Toner John.Toner@hull.ac.uk
Lecturer in Sports Coaching and Performance

Suzanne Guerin

Chris Lonsdale

Deirdre A. Hurley



Abstract

Background Clinical practice guidelines for the treatment of low back pain suggest the inclusion of a biopsychosocial approach in which patient self-management is prioritized. While many physiotherapists recognise the importance of evidence-based practice, there is an evidence practice gap that may in part be due to the fact that promoting self-management necessitates change in clinical behaviours. Evidence suggests that a patient’s motivation and maintenance of self-management behaviours can be positively influenced by the clinician’s use of an autonomy supportive communication style. Therefore, the aim of this study was to develop and pilot-test the feasibility of a theoretically derived implementation intervention to support physiotherapists in using an evidence-based autonomy supportive communication style in practice for promoting patient self-management in clinical practice. Methods A systematic process was used to develop the intervention and pilot-test its feasibility in primary care physiotherapy. The development steps included focus groups to identify barriers and enablers for implementation, the theoretical domains framework to classify determinants of change, a behaviour change technique taxonomy to select appropriate intervention components, and forming a testable theoretical model. Face validity and acceptability of the intervention was pilot-tested with two physiotherapists and monitoring their communication with patients over a three-month timeframe. Results Using the process described above, eight barriers and enablers for implementation were identified. To address these barriers and enablers, a number of intervention components were selected ranging from behaviour change techniques such as, goal-setting, self-monitoring and feedback to appropriate modes of intervention delivery (i.e. continued education meetings and audit and feedback focused coaching). Initial pilot-testing revealed the acceptability of the intervention to recipients and highlighted key areas for refinement prior to scaling up for a definitive trial. Conclusion The development process utilised in this study ensured the intervention was theory-informed and evidence-based, with recipients signalling its relevance and benefit to their clinical practice. Future research should consider additional intervention strategies to address barriers of social support and those beyond the clinician level.

Journal Article Type Article
Publication Date Jul 5, 2015
Journal BMC health services research
Print ISSN 1472-6963
Electronic ISSN 1472-6963
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 15
Issue 1
Article Number ARTN 260
Pages 1-9
Institution Citation Matthews, J., Hall, A. M., Hernon, M., Murray, A., Jackson, B., Taylor, I., …Hurley, D. A. (2015). A brief report on the development of a theoretically-grounded intervention to promote patient autonomy and self-management of physiotherapy patients: Face validity and feasibility of implementation. BMC health services research, 15(1), 1-9. doi:10.1186/s12913-015-0921-1
DOI https://doi.org/10.1186/s12913-015-0921-1
Keywords Implementation; Knowledge translation; Behaviour change; Theoretical domain framework; Physiotherapy; Self-determination theory; Low back pain
Publisher URL http://www.biomedcentral.com/1472-6963/15/260
Additional Information Copy of article first published in: BMC health services research, 2015, v.15, issue 260

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Copyright Statement
© Matthews et al. 2015
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.





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