Background Physiotherapists (PTs) are raised in a biomedical tradition. They promote health-enhancing physical activity (HEPA) in persons with RA mainly by providing information, instructions and follow-up of prescribed exercises. To facilitate maintained HEPA behavior, PTs in rheumatology need to integrate their knowledge on RA and exercise physiology with use of evidence-based behavior change techniques (BCTs). Detailed, theory-based studies of how PTs can integrate these competencies are scarce. To gain more knowledge on PTs learning in this aspect, we performed the present study as a substudy in a HEPA intervention in the Physical Activity in RA (PARA 2010) program.
Objectives To describe changes in PTs' knowledge, beliefs and behaviours assessed before, during and after a theory-based skills training course preparing them to guide persons with RA to HEPA within a one-year intervention trial.
Methods This was a longitudinal case study performed within a one-year HEPA intervention for persons with RA, including circuit training at public gyms twice a week and 30 minutes daily free-living physical activity of moderate intensity, framed by 20 bi-weekly support group sessions led by a PT. Our participants were ten registered PTs leading 10 support groups with 5–10 persons each. To prepare the PTs for their task we gave a course based on Social Cognitive Theory (SCT) principles and structured use of BCTs, see Figure 1. Data were collected by questionnaire at five occasions; at baseline, three times during the course and once after the course, assessing knowledge on physical activity in RA (score 0–6), knowledge on BCTs (score 0–18), fear-avoidance beliefs about physical activity in RA (score 8–48), and self-efficacy to guide in behaviour change (score 9–54). The questionnaire had good face validity and good test-retest reliability with ICC 0.88–0.98 for the four variables. Data were also collected by a log book for self-reported use of BCTs during group sessions, dichotomised as adherence to the support group session protocol or not.
Results PTs' knowledge on BCTs and their self-efficacy to guide in behaviour change increased significantly (Friedman's test, p<0.05) from baseline to post-course from median 9 to 13 and from median 38 to 46.5, respectively. Their knowledge on physical activity in RA and their fear-avoidance beliefs were adequate at baseline and did not change. Two out of ten PTs fulfilled the pre-established criteria for adherence to the group session protocol for use of BCTs throughout the HEPA intervention.
Conclusions A course for PTs based on SCT principles emphasizing skills training and feedback on performance seems useful to affect knowledge on BCTs and self-efficacy to guide in behaviour change. To improve adherence in PTs applying evidence-based BCTs to guide persons with RA to HEPA, closer monitoring and more frequent feedback on performance are suggested.
Nessen T, Opava CH, Martin C, Demmelmaier I. (2014). From clinical expert to guide: experiences from coaching people with rheumatoid arthritis to increased physical activity. Phys Ther, 94(5):644–53.
Nordgren B, Fridén C, Demmelmaier I, Bergstrom G, Opava CH. (2012). Long-term health-enhancing physical activity in rheumatoid arthritis. The PARA 2010 study. BMC Public Health, 12, 397.
Disclosure of Interest None declared
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