J. Bieles1, B. Volkmer1, M. Galea Holmes2, S. Duvnjak1, G. Fisher1, R. Keane1, B. Modarai3, J. Peacock4, C. Sackley1, J. Weinman5, L. Bearne1
1King's College, London, School of Population Health & Environmental Sciences, London, United Kingdom, 2University College, London, Department of Applied Health Research, London, United Kingdom, 3King's College, London, Department of Vascular Surgery, London, United Kingdom, 4Dartmouth College, Geisel School of Medicine at Dartmouth, USA, Hanover, United States, 5King's College, London, Institute of Pharmaceutical Sciences, London, United Kingdom
Background: MOtivating Structured walking Activity for Intermittent Claudication (MOSAIC) is a novel, physiotherapist-led, behavioural intervention. It aims to support people with intermittent claudication (IC) caused by peripheral arterial disease meet walking guidance. It is underpinned by motivational interviewing (MI) and incorporates theory-based behaviour change techniques (BCT). A bespoke training programme was developed for physiotherapists delivering the intervention as part of a randomised controlled trial evaluating the efficacy of MOSAIC. Physiotherapists received 18 hours training over 6 months, a bespoke training manual, and ongoing supervision from the training team.
Purpose: This study evaluated the effect of MOSAIC training on therapeutic empathy, knowledge and confidence of delivering MI, and, skills and confidence managing people with IC among UK-based physiotherapists.
Methods: MOSAIC physiotherapists were enrolled from six UK NHS Trusts. Consenting physiotherapists completed standardised questionnaires assessing a) demographics (pre-training only); b) Therapeutic Empathy (modified Helpful Responses Questionnaire (HRQ)–5 items), 5-point Likert scale (1=no reflection to 5=complex reflection); c) MI knowledge and confidence (2-items) and self-reported skills and confidence managing people with IC (2-items), 5-point Likert scale (1=completely disagree to 5=completely agree); at 3 time-points (pre-training, post-initial training and 6-month follow-up).
HRQ responses were independently scored by two raters. Scores were summed, and averaged, at each time-point to generate a total mean score (maximum score=5).
Data were summarised descriptively (mean(±standard deviation)). Time-point differences were evaluated using the Friedman Test, with Wilcoxon signed-rank tests performed post-hoc to assess the effect of training on physiotherapist’s therapeutic empathy, confidence, knowledge and skills. Effect size (ES) values between 0.1-0.29, 0.3-0.49 and >0.5 were considered low, moderate, or large effects.
HRQ responses were independently scored by two raters. Scores were summed, and averaged, at each time-point to generate a total mean score (maximum score=5).
Data were summarised descriptively (mean(±standard deviation)). Time-point differences were evaluated using the Friedman Test, with Wilcoxon signed-rank tests performed post-hoc to assess the effect of training on physiotherapist’s therapeutic empathy, confidence, knowledge and skills. Effect size (ES) values between 0.1-0.29, 0.3-0.49 and >0.5 were considered low, moderate, or large effects.
Results: 14 physiotherapists (10 female, 7.8±4.0 years post-registration, Band 5-8) were recruited.
All scores varied significantly across the time-points (χ2(2)=11.640, p=0.003).
Mean therapeutic empathy (HRQ) was 1.72(±0.84) pre-training. Mean HRQ increased post-training (2.84(±1.18) ES 0.48) and remained higher than pre-training at 6-month follow-up (2.29 (±0.80) ES 0.43).
Before training, mean MI knowledge and confidence were 3.50(±1.09) and 2.75(±1.13). MI knowledge and confidence improved post-training (4.57(±0.51) ES 0.51) and 4.25(±0.58) ES 0.59). This improvement was sustained at 6-month follow up (4.57(±0.51) ES 0.50 and 4.29(±0.61) ES 0.57).
Self-reported skills and confidence regarding managing people with IC were 3.88(±0.81) and 3.75(±1.07) pre-training and these improved post-training (4.69(±0.48) ES 0.48 and 4.69(±0.48) ES 0.49) and remained higher than pre-training at 6 months (4.36(±0.50) ES 0.39 and 4.36(±0.50) ES 0.44).
All scores varied significantly across the time-points (χ2(2)=11.640, p=0.003).
Mean therapeutic empathy (HRQ) was 1.72(±0.84) pre-training. Mean HRQ increased post-training (2.84(±1.18) ES 0.48) and remained higher than pre-training at 6-month follow-up (2.29 (±0.80) ES 0.43).
Before training, mean MI knowledge and confidence were 3.50(±1.09) and 2.75(±1.13). MI knowledge and confidence improved post-training (4.57(±0.51) ES 0.51) and 4.25(±0.58) ES 0.59). This improvement was sustained at 6-month follow up (4.57(±0.51) ES 0.50 and 4.29(±0.61) ES 0.57).
Self-reported skills and confidence regarding managing people with IC were 3.88(±0.81) and 3.75(±1.07) pre-training and these improved post-training (4.69(±0.48) ES 0.48 and 4.69(±0.48) ES 0.49) and remained higher than pre-training at 6 months (4.36(±0.50) ES 0.39 and 4.36(±0.50) ES 0.44).
Conclusion(s): The MOSAIC training significantly improved UK-based physiotherapist’s therapeutic empathy, knowledge and confidence of MI and self-reported skills and confidence to manage people with IC. Improvements remained higher at six months than before training commenced.
Implications: Physiotherapists can be trained to deliver psychologically informed interventions using advanced communication and behavioural skills. These new skills and abilities could be integrated into their clinical practice and improve patient care. The MOSAIC intervention will potentially transform IC management.
Funding, acknowledgements: This work was supported by The Dunhill Medical Trust (grant number R477/0516).
Keywords: Intermittent Claudication, Physiotherapist Training, Motivational Interviewing
Topic: Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? Yes
Institution: King’s College London and Guy’s & St Thomas’s NHS Foundation Trust
Committee: London - Bloomsbury Research Ethics Committee
Ethics number: 17/LO/0568
All authors, affiliations and abstracts have been published as submitted.
