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Haig LJ1
1London South Bank University, Allied Health Sciences, London, United Kingdom
Background: Many physiotherapists lack the knowledge and skills to deliver psychologically-informed practice, which for people with persistent low back pain (LBP) requires consideration of their needs, preferences and values. Motivational interviewing (MI) has been recommended as a psychologically-informed approach for musculoskeletal physiotherapists although little research has been carried out into its use.
Purpose: This study aimed to investigate the effects of MI training on physiotherapists' beliefs, attitudes and practice in relation to people with persistent LBP.
Methods: A convergent parallel mixed methods study was undertaken. Volunteer musculoskeletal physiotherapists (n=16) were recruited from a public sector provider in greater London and allocated to either a MI training Group A (n=10) or a comparison Group B (n=6). The MI training group received an initial two-day MI course followed up by monthly supervision sessions. Outcomes were measured pre-training (baseline) then at three and six months later for both groups. Beliefs and attitudes to persistent low back pain were measured using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS). Self-reported proficiency, confidence and intention to use MI were measured using visual analogues scales (VAS). The Motivational Interviewing Training Integrity scale (MITI) generated global ratings and behaviour counts from audio-recordings of initial consultations with people with persistent LBP. Physiotherapists´ experiences were explored through semi-structured interviews with Group A physiotherapists only at six months.
Results: A significant post-training decrease in biomedical orientation was demonstrated between the MI training group and the comparison group at three months (HC-PAIRS) and six months (PABS-PT and HC-PAIRS) using independent t-tests. The MI training group had significantly increased proficiency, confidence and intention to use MI at three and six months (VAS); increased MITI global ratings of Spirit (at three months), Collaboration (at three months) and Evocation (at six months). Qualitative content analysis of the semi-structured interviews revealed that the physiotherapists embraced MI as an approach. They were able to overcome initial challenges and found positive individual and collective ways to introduce and sustain their use of MI.
Conclusion(s): The results of this study contribute new insights into the understanding of the role and impact of training musculoskeletal physiotherapists in MI, although the small sample size means that the results should be interpreted with caution. MI is acceptable to physiotherapists. Physiotherapists were able to embrace the spirit of MI and to embed MI within their practice. This allows them to development their skills as person-centred practitioners and to cope more effectively with patients perceived as difficult and those with complex presentations. However, ongoing supervision is required to develop MI proficiency, which can be expensive. Future research will incorporate the findings of this research to develop approaches to MI training for larger physiotherapist cohorts.
Implications: MI is acceptable to physiotherapists who seem keen to adopt this psychologically informed approach. MI may provide a useful approach for enhancing person-centred practice in physiotherapists. However, for MI practice to become adopted more widely across the profession, sustainable training approaches and appropriate professional support structures are required.
Keywords: physiotherapy, motivational interviewing, person-centred
Funding acknowledgements: No funding was received to support this work.
Purpose: This study aimed to investigate the effects of MI training on physiotherapists' beliefs, attitudes and practice in relation to people with persistent LBP.
Methods: A convergent parallel mixed methods study was undertaken. Volunteer musculoskeletal physiotherapists (n=16) were recruited from a public sector provider in greater London and allocated to either a MI training Group A (n=10) or a comparison Group B (n=6). The MI training group received an initial two-day MI course followed up by monthly supervision sessions. Outcomes were measured pre-training (baseline) then at three and six months later for both groups. Beliefs and attitudes to persistent low back pain were measured using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS). Self-reported proficiency, confidence and intention to use MI were measured using visual analogues scales (VAS). The Motivational Interviewing Training Integrity scale (MITI) generated global ratings and behaviour counts from audio-recordings of initial consultations with people with persistent LBP. Physiotherapists´ experiences were explored through semi-structured interviews with Group A physiotherapists only at six months.
Results: A significant post-training decrease in biomedical orientation was demonstrated between the MI training group and the comparison group at three months (HC-PAIRS) and six months (PABS-PT and HC-PAIRS) using independent t-tests. The MI training group had significantly increased proficiency, confidence and intention to use MI at three and six months (VAS); increased MITI global ratings of Spirit (at three months), Collaboration (at three months) and Evocation (at six months). Qualitative content analysis of the semi-structured interviews revealed that the physiotherapists embraced MI as an approach. They were able to overcome initial challenges and found positive individual and collective ways to introduce and sustain their use of MI.
Conclusion(s): The results of this study contribute new insights into the understanding of the role and impact of training musculoskeletal physiotherapists in MI, although the small sample size means that the results should be interpreted with caution. MI is acceptable to physiotherapists. Physiotherapists were able to embrace the spirit of MI and to embed MI within their practice. This allows them to development their skills as person-centred practitioners and to cope more effectively with patients perceived as difficult and those with complex presentations. However, ongoing supervision is required to develop MI proficiency, which can be expensive. Future research will incorporate the findings of this research to develop approaches to MI training for larger physiotherapist cohorts.
Implications: MI is acceptable to physiotherapists who seem keen to adopt this psychologically informed approach. MI may provide a useful approach for enhancing person-centred practice in physiotherapists. However, for MI practice to become adopted more widely across the profession, sustainable training approaches and appropriate professional support structures are required.
Keywords: physiotherapy, motivational interviewing, person-centred
Funding acknowledgements: No funding was received to support this work.
Topic: Musculoskeletal; Professional practice: other; Education: clinical
Ethics approval required: Yes
Institution: National Health Service Health Research Authority
Ethics committee: NRES Committee London City & East
Ethics number: REC reference: 14/LO/2274 IRAS project ID: 71363
All authors, affiliations and abstracts have been published as submitted.
