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

J. Matthews, A.M. Hall, M. Hernon, A. Murray, Ben Jackson, I. Taylor, J. Toner, S. Guerin, C. Lonsdale, D.A. Hurley

    Research output: Contribution to journalArticle

    13 Citations (Scopus)

    Abstract

    © 2015 Matthews et al. 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.
    Original languageEnglish
    Pages (from-to)1-9
    JournalBMC Health Services Research
    Volume15
    Issue number1
    DOIs
    Publication statusPublished - 2015

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    Self Care
    Reproducibility of Results
    Physical Therapists
    Communication
    Evidence-Based Practice
    Low Back Pain
    Focus Groups
    Practice Guidelines
    Social Support
    Motivation
    Primary Health Care
    Theoretical Models
    Education
    Therapeutics

    Cite this

    Matthews, J. ; Hall, A.M. ; Hernon, M. ; Murray, A. ; Jackson, Ben ; Taylor, I. ; Toner, J. ; Guerin, S. ; Lonsdale, C. ; Hurley, D.A. / 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. In: BMC Health Services Research. 2015 ; Vol. 15, No. 1. pp. 1-9.
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    abstract = "{\circledC} 2015 Matthews et al. 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.",
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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, J.; Hall, A.M.; Hernon, M.; Murray, A.; Jackson, Ben; Taylor, I.; Toner, J.; Guerin, S.; Lonsdale, C.; Hurley, D.A.

    In: BMC Health Services Research, Vol. 15, No. 1, 2015, p. 1-9.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - 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

    AU - Matthews, J.

    AU - Hall, A.M.

    AU - Hernon, M.

    AU - Murray, A.

    AU - Jackson, Ben

    AU - Taylor, I.

    AU - Toner, J.

    AU - Guerin, S.

    AU - Lonsdale, C.

    AU - Hurley, D.A.

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    AB - © 2015 Matthews et al. 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.

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