THE EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING IN PHYSIOTHERAPY WITH PEOPLE WHO HAVE MUSCULOSKELETAL CONDITIONS: A SYSTEMATIC REVIEW

M. Nicholson¹, S. McLean¹, C. Homer¹, M. Butler¹, D. Harrop¹, J. Breckon¹

¹Sheffield Hallam University, Health Research Institute, Sheffield, United Kingdom

Background: Musculoskeletal (MSK) conditions were the leading cause of disability in four of the six World Health Organisation (WHO) regions in 2017 (WHO, 2019). Physiotherapy is advocated for patient with MSK conditions (pwMSK) although patient engagement with physiotherapy recommendations is generally poor (Beinhart et al., 2013; Campbell et al., 2001). Patient education and support for behaviour change could help to lessen the disability and pain associated with MSK conditions (National Institute for Health Research, 2018). Nevertheless, there is a lack of evidence on how education and behaviour change is best utilised to support pwMSK to achieve their rehabilitation goals (Jordan et al., 2010, McLean et al., 2010). One approach to increase engagement is Motivational Interviewing (MI); little is known about MI applications in MSK physiotherapy.

Purpose: To date, there have been limited published studies focussing on the quality of physiotherapist training in MI, and fidelity and effective utilisation of MI in MSK settings (Alperstein & Sharp, 2016; Chilton et al., 2012; Frost et al., 2018; Knight et al., 2006; Martin et al., 2019; McGrane et al., 2015). This can result in limited ability to draw strong conclusions around the effectiveness of MI (Miller & Rollnick, 2013). The primary aim of this review is to critically evaluate studies reporting to have underpinned traditional physiotherapy interventions with MI for those patients living with MSK. A secondary aim is to investigate the fidelity and consistency of the MI approach within MSK physiotherapy.

Methods: A systematic review was conducted in accordance with Cochrane and PRISMA Guidelines. Databases were searched for studies that investigated effectiveness of MI in MSK physiotherapy. Reference lists were manually searched. Two reviewers independently searched for studies that reported use of MI with physiotherapy in pwMSK conditions. Levels of certainty of findings were assessed using a modified GRADE* approach. *Grading of Recommendations, Assessment, Development and Evaluations is a framework for presenting summaries of evidence and provides a systematic approach.

Results: From 631 unique hits, 50 articles were selected for full text assessment; seven articles were included. A moderate level of certainty that MI is effective for improving pain, function, and psychological parameters (PP) was found. Studies showed a lack of accurate reporting of quality MI training and subsequent MI fidelity.

Conclusions: This review identified seven RCT’s applying MI as all or part of their intervention in physiotherapy for MSK conditions and identified that MI is effective at improving pain, function, psychological parameters, and quality of life (moderate level of certainty) and to a lesser extent self-efficacy (low level of certainty) and a greater extent adherence to physiotherapy (very low level of certainty). There was also a lack of fidelity to MI and poor transparency around quality of MI training indicating that results reported within these studies may not be optimal.

Implications: MI may be effective in improving function, PP and pain when used with pwMSK conditions; more robust training and delivery is required to ensure delivery of MI to internationally recognised standards.

Funding acknowledgements: PhD funding from Wrexham University

Keywords:
Physiotherapy
Musculoskeletal
Motivational interviewing

Topics:
Musculoskeletal

Did this work require ethics approval? No

Reason: This was a systematic review of existing literature and therefore it was deemed by the director of studies for PhD study that ethical approval was not required