Working With People to Make Changes a Behavioural
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BEHAVIOURAL CHANGE Working with People to Make Changes: A Behavioural Change Approach Used in Chronic Low Back Pain Rehabilitation Katherine Harman, PT, MSc, PhD; * Marsha MacRae, PT, MSc; ‡ Michael Vallis, PhD; †§ Raewyn Bassett, PhD ¶ ABSTRACT Purpose: To describe the approach used by a physiotherapist who led a rehabilitation programme for injured members of the military with chronic low back pain designed to enhance self-efficacy and self-management skills. Method: This in-depth qualitative study used audio- and video-recorded data from interv iews and field observa tions. Using an induct ive analysis process , discus sion of emerg ing themes led to a descr iptio n of the physiothe rapis t’s approach. Results: The appro ach has three elements : deve lopin g a trusti ng relat ionsh ip throug h build ing rapport , establishing a need in patients’ minds to be activ ely engaged in their rehabil itation, and finding worka ble rehabilita tion solutions that are most likely to be adopted by individual patients. This approach fits into current theories about health behaviour change (e.g., Transtheoretical Model of Change, Motivational Interviewing, Motivational Model of Patien t Self-M anage ment and Patie nt Self-M anage ment) and eleme nts of the therapeuti c allia nce. Using the therapeuti c allia nce ( rapport ) and behaviour change techni ques, the physi other apist focused on the perceived importa nce of a behav iour change ( need ) and then shifted to the patient’s self-efficacy in the solutions phase. Conclusions: If we recognize that rehabilitation requires patients to adopt new behaviours, becoming aware of psychological techniques that enhance behaviour change could improve treatment outcomes. Key Words: cognitive therapy; exercise; low back pain; professional-patient relations; rehabilitation. RE ´ SUME ´ Objet : De ´ crire l’approche suivie par un physiothe´ rapeute qui a dirige ´ un programme de re ´ adaptat ion pour militaires blesse ´ s atteints de lombalgie chronique. Le programme visait a ` ame ´ liorer les techniques d’autoefficacite ´ et d’autoprise en charge. Me ´ thode : Cette e ´ tude qualitati ve en profon deur a utilis e ´ des donne ´ es audio et vide ´ o enregistre ´ es a ` la suite d’entrevues et des observations sur le terrain. Base´ e sur un processus d’analyse inductive, la discussion sur les the ` mes e ´ mergents a abouti a ` une description de la de ´ marche du physiothe ´ rapeute. Re ´ sultats : L’approche comporte trois e ´ le ´ ments: e ´ tablissement d’une relation de confiance par la cre ´ ation d’une complicite ´ , e ´ tablissement, dans l’esprit des patients, d’un besoin de participer activement a ` la re ´ adaptation et de ´ couverte de solutions de re ´ adaptation pratiques que chaque patient en particulier est le plus susceptible d’adopter. Cette approche correspond aux the ´ ories actuelles sur les changements de comportement en sante ´ (p. ex., mode ` le transthe ´ oriqu e du changement, entrevues de motivation, mode ` le de motivation de l’autoprise en charge par les patients et autoprise en charge par les patients) et les e ´ le ´ ments de l’alliance the ´ rapeutique. En se basant sur l’alliance the ´ rapeutique ( complicite ´ ) et des techniques de modification du comportement, le physiothe´ rapeute s’est concentre ´ sur l’importance perc ¸ ue d’un changement de comportement ( besoin ) et est passe ´ ensuite a ` l’autoefficacite ´ du patie nt au cours de la phase des solutions . Conclusions : Si nous recon- naissons que la re ´ adaptation oblige les patients a ` adopter de nouveaux comportements, une sensibilisation aux techniques qui appuient les changements de comportement pourrait ame ´ liorer les re ´ sultats du traitement. Researchers have been investigating chronic low back pain (LBP) rehabilitation for years. Unfortunately, clini- cal outcomes remain relatively poor, and the associated costs of this chronic disease remain ‘‘a substantial bur- den on society.’’ 1(p.8) LBP is one of the most prominent chronic mus cul osk el etal con dit ion s in the Can adi an Forces; a recent health and lifestyle survey found that nea rly 20% of reg ula r-fo rce per son nel (co nsi der abl y higher than the 9% reported by a Canadian survey study of 118,000 residents 2 ) and 9% of reserve-force personnel 82 From the: *School of Physiotherapy and † Department of Psychology, Dalhousie University; ‡ CFB Stadacona; § Behaviour Change Institute, Capital District Health Au- thority, Halifax; ¶ Independent Scholar, Dartmouth, N.S. Correspondenc e to: Katherine Harman, School of Physiothera py, 5869 University Ave. PO Box 15000, Halifax, NS B3H 4R2; k.harman@dal. ca. Contributors: All authors designed the study; collected, analyzed, and interpreted the data; drafted or critically revised the article; and approved the final draft. Competing Interests: None declared. Acknowledgements: The authors would like to thank the physiotherapist and the military members who participated in this study and recognize the anonymous reviewers’ comments that helped improve the manuscript. Physiotherapy Canada 2014; 66(1);82–90; doi:10.3138/ptc.2012-56BC
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