J. Bury1,2, C. Jinks3, J. Selfe2, G. Yeowell2
1Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust, Physiotherapy, Doncaster, United Kingdom, 2Manchester Metropolitan University, Health and Education, Manchester, United Kingdom, 3Keele University, School of Medicine, Keele, United Kingdom
Background:
Shoulder pain is common. The rotator cuff muscles and tendons, which move and stabilise the shoulder joint, are a frequent contributor. Routine treatments for this condition offer only small to moderate benefits and many patients report long-term shoulder pain. Lifestyle factors, including smoking, diet and physical inactivity are associated with the onset and persistence of shoulder pain. These factors are linked to ‘modifiable health behaviours’ that patients can be supported to change, which might then help improve their shoulder pain. Despite this evidence, physiotherapists do not routinely integrate health behaviour change approaches within consultations as part of the management for people with rotator cuff disorders.
Purpose:
This study aimed to develop a physiotherapist-supported treatment approach, ‘The COMBINED approach’, that integrates health behaviour change within a physiotherapy consultation for people with a rotator cuff disorder.
Methods: An iterative intervention development approach combined theory, evidence, and stakeholder co-design across four workstreams:
(1) Review of behaviour change theory;
(2) Narrative review of existing brief (behaviour change) interventions;
(3) Stakeholder engagement using principles of co-design;
(4) Prototype design. Ethical approval was granted by Manchester Metropolitan University Faculty Health and Education Research Ethics Committee, UK.No.2020-25512-21923.
(1) Review of behaviour change theory;
(2) Narrative review of existing brief (behaviour change) interventions;
(3) Stakeholder engagement using principles of co-design;
(4) Prototype design. Ethical approval was granted by Manchester Metropolitan University Faculty Health and Education Research Ethics Committee, UK.No.2020-25512-21923.
Results: A narrative review identified 14 potential brief interventions to form a component of The COMBINED approach. Twenty-five stakeholders attended four virtual workshops including patients, multidisciplinary healthcare professionals, health psychologists and public health experts. Through stakeholder co-design, one of the brief interventions, ‘Moving Medicine’, was recommended to meet their needs and could be adapted to target the specified health behaviours. Barriers to implementing the proposed approach were identified, including physiotherapist's lack of knowledge and skills (e.g., coaching), and patient resources to support effective health behaviour change conversations. Facilitators included a training package and resources (e.g., scripts) to specifically support physiotherapists to deliver this approach. The barriers and facilitators were mapped to the COM-B model of behaviour change and Theoretical Domains Framework to identify intervention components to address these barriers using established behaviour change techniques.
A prototype intervention was designed to target:
(1) Patient-level behaviour change, which includes a brief intervention and supporting resources delivered by physiotherapists to assess and address the modifiable health behaviours associated with a rotator cuff disorder;
(2) Clinician-level behaviour change through an implementation toolkit, including a training package and supporting resources.
A prototype intervention was designed to target:
(1) Patient-level behaviour change, which includes a brief intervention and supporting resources delivered by physiotherapists to assess and address the modifiable health behaviours associated with a rotator cuff disorder;
(2) Clinician-level behaviour change through an implementation toolkit, including a training package and supporting resources.
Conclusions: This systematic, iterative approach to intervention development informed the design of a new treatment approach and implementation toolkit, The COMBINED approach. Insights through stakeholder co-design revealed a need to focus on supporting physiotherapist’s behaviour change for future successful implementation, thus the development of a multi-level intervention. Usability testing is currently being conducted to refine The COMBINED approach prior to evaluation in a feasibility study.
Implications:
The COMBINED approach has been designed to support both patients with health behaviour change as part of the management for rotator cuff disorders and physiotherapists to implement this in practice. This work will be a platform for future research to evaluate the effectiveness of The COMBINED approach in improving outcomes for people with a rotator cuff disorder and other musculoskeletal conditions.
Funding acknowledgements: Julie Bury is funded through the NIHR as part of a HEE/NIHR ICA Programme Clinical Doctoral Research Fellowship, NIHR300541.
Keywords:
Rotator cuff
Health behaviour change
Intervention development
Rotator cuff
Health behaviour change
Intervention development
Topics:
Musculoskeletal: upper limb
Health promotion & wellbeing/healthy ageing/physical activity
Research methodology, knowledge translation & implementation science
Musculoskeletal: upper limb
Health promotion & wellbeing/healthy ageing/physical activity
Research methodology, knowledge translation & implementation science
Did this work require ethics approval? Yes
Institution: Manchester Metropolitan University
Committee: Faculty Health and Education Ethics Committee, UK, REC
Ethics number: 2020-25512-21923
All authors, affiliations and abstracts have been published as submitted.
