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

被引:21
作者
Matthews, James [1 ]
Hall, Amanda M. [2 ]
Hernon, Marian [1 ]
Murray, Aileen [1 ]
Jackson, Ben [3 ]
Taylor, Ian [4 ]
Toner, John [5 ]
Guerin, Suzanne [6 ]
Lonsdale, Chris [7 ,8 ]
Hurley, Deirdre A. [1 ]
机构
[1] Univ Coll Dublin, Sch Publ Hlth Physiotherapy & Populat Sci, Inst Sport & Hlth, Dublin 2, Ireland
[2] Univ Oxford, Nuffield Dept Populat Hlth, George Inst Global Hlth, Oxford, England
[3] Univ Western Australia, Sch Sport Sci Exercise & Hlth, Perth, WA 6009, Australia
[4] Univ Loughborough, Sch Sport Exercise & Hlth Sci, Loughborough LE11 3TU, Leics, England
[5] Univ Hull, Dept Sport Hlth & Exercise Sci, Kingston Upon Hull HU6 7RX, N Humberside, England
[6] Univ Coll Dublin, Sch Psychol, Dublin 2, Ireland
[7] Australian Catholic Univ, Inst Posit Psychol, Strathfield, NSW, Australia
[8] Australian Catholic Univ, Educ Fac Hlth, Strathfield, NSW, Australia
关键词
Implementation; Knowledge translation; Behaviour change; Theoretical domain framework; Physiotherapy; Self-determination theory; Low back pain; LOW-BACK-PAIN; BEHAVIOR-CHANGE; SUPPORTING AUTONOMY; CLINICAL GUIDELINES; DESIGN; HEALTH; ADHERENCE; CONSENSUS; CARE;
D O I
10.1186/s12913-015-0921-1
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
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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页数:9
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