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Meng F, Jiang Y, Yu P, Song Y, Zhou L, Xu Y, Zhou Y. Effect of health coaching on blood pressure control and behavioral modification among patients with hypertension: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2023; 138:104406. [PMID: 36473304 DOI: 10.1016/j.ijnurstu.2022.104406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health coaching has emerged as a potential supporting tool for improving hypertension health behavior. However, health coaching efficacy on hypertension has not been reviewed systematically. OBJECTIVE To evaluate the effects of health coaching on blood pressure and behavioral changes among patients with hypertension in randomized controlled trials. DESIGN A systematic review and meta-analysis. METHODS We searched Medline (via PubMed), Web of Science, Embase, Cochrane Central Register of Controlled Trials, Proquest, and Scopus from inception to November 30, 2021. All randomized controlled trials that estimated the effects of health coaching on blood pressure and behavioral changes in adults with hypertension were included. The Cochrane risk-of-bias tool was used to evaluate the quality of the included studies. Standardized mean differences (SMD) and 95 % confidence intervals (CIs) were calculated using random-effects or fixed-effects meta-analysis. Sensitivity analysis and subgroup analysis were also conducted. RESULTS A total of 1655 studies were screened and 12 randomized controlled trials were selected for inclusion, with 2497 participants were included. Most of the studies were at low risk of bias and the quality of evidence was high. The meta-analysis demonstrated that health coaching could significantly reduce systolic blood pressure (SMD: -0.26, 95 % CI: -0.39, -0.13, p < 0.001) and diastolic blood pressure in hypertension (SMD: -0.13, 95 % CI: -0.22, -0.03, p = 0.009). In addition, health coaching showed statistically significant positive effects on dietary behaviors (SMD: 0.76, 95 % CI: 0.08, 1.44, p = 0.02) and self-efficacy (SMD: 0.39, 95 % CI: 0.05, 0.73, p = 0.02). Subgroup analysis indicated that the most common and effective type of health coaching was the phone-based interventions (systolic blood pressure: SMD: -0.27, 95 % CI: -0.44, -0.10, p = 0.002; diastolic blood pressure: SMD: -0.14, 95 % CI: -0.25, -0.03, p = 0.02). The effects of nurse-delivered interventions were larger than other health care professionals (systolic blood pressure: SMD: -0.42, 95 % CI: -0.68, -0.16, p = 0.002; diastolic blood pressure: SMD: -0.19, 95 % CI: -0.35, -0.04, p = 0.02). CONCLUSION Current evidence suggested that health coaching could reduce blood pressure, improve dietary behaviors, and increase self-efficacy among patients with hypertension and thus could be an effective and alternative method in the management of hypertension. The most common and effective types of health coaching were phone-based and nurse-delivered interventions. Thus, more strategies and policies may be needed to implement these types of interventions to more patients with hypertension.
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Affiliation(s)
- Fei Meng
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Yunxia Jiang
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Pengli Yu
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Yuting Song
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Lixue Zhou
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Yanhong Xu
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Yunping Zhou
- School of Nursing, Qingdao University, Qingdao, Shandong, China.
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Robins L, Taylor NF, Hogan G, Callisaya ML, Sounthakith V, Snowdon M, Brooks S, Scanlon S, Urmston K, Snowdon DA. Meeting community ambulation criteria and confidence with walking on discharge from inpatient rehabilitation were positively associated with performance of outdoor community activities 8 weeks after discharge. Disabil Rehabil 2022; 44:6796-6803. [PMID: 34529531 DOI: 10.1080/09638288.2021.1976290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/05/2021] [Accepted: 08/29/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE To assess whether meeting criteria for community ambulation and ambulatory self-confidence on discharge from inpatient rehabilitation are associated with participation in community activities. METHODS Prospective longitudinal observational study design. Participants were assessed within 48-hours of discharge on ability to complete tasks reflective of community ambulation (walking 315 m, ascending/descending three stairs, a ramp, and a street curb and walking at 0.44 m/s) and ambulatory self-confidence. At 8 weeks post-discharge frequency of participation in domestic, leisure/work and outdoor activities was measured using the Frenchay Activities Index (FAI). Multivariable regression analysis determined factors associated with total and outdoor FAI score. RESULTS Seventy-four of 79 participants were followed up at 8 weeks post-discharge. Meeting all ambulation criteria was positively associated with FAI outdoor score (β = 1.85, 95%CI 0.01-3.69, p = 0.049). Ambulatory self-confidence was positively associated with FAI outdoor score (β = 0.03, 95%CI 0-0.05, p = 0.032) and FAI total score (β = 0.05, 95%CI 0-0.1, p = 0.040). Age (β= -0.22, 95%CI -0.36 to -0.08, p = 0.003) and living alone (β = 3.36, 95%CI 0.10-6.61, p = 0.044) were associated with FAI total score. CONCLUSIONS Capacity to meet ambulation criteria and ambulatory self-confidence are modifiable factors that could be targeted during rehabilitation to improve participation in community activities.Implications for rehabilitationMeeting community ambulation criteria and confidence with walking on discharge from inpatient rehabilitation are positively associated with performance of outdoor community activities 8 weeks after discharge.Capacity to meet community ambulation criteria and ambulatory confidence may be useful measures for rehabilitation teams to consider when discharging patients home.Meeting ambulation criteria and ambulatory confidence are modifiable factors that could be addressed through targeted therapy to improve community integration following hospitalisation.
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Affiliation(s)
- Leslie Robins
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Georgia Hogan
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
- Academic Unit, Peninsula Health, Frankston, Australia
| | | | - Megan Snowdon
- Academic Unit, Peninsula Health, Frankston, Australia
| | - Sarah Brooks
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Sinead Scanlon
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Kim Urmston
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
- Academic Unit, Peninsula Health, Frankston, Australia
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Prior JL, Vesentini G, Michell De Gregorio JA, Ferreira PH, Hunter DJ, Ferreira ML. Health Coaching for Low Back Pain and Hip and Knee Osteoarthritis: A Systematic Review with Meta-Analysis. PAIN MEDICINE 2022; 24:32-51. [PMID: 35775931 PMCID: PMC9825146 DOI: 10.1093/pm/pnac099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/12/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Health coaching aims to empower people to reach their goals and is increasingly used in health care settings. Whether health coaching improves pain and disability for people with hip or knee osteoarthritis (OA) or low back pain (LBP) is unknown. METHODS Six databases were searched for randomized controlled trials assessing health coaching or motivational programs in adults with hip or knee OA or LBP, with each condition investigated independently. Meta-analyses were performed with random-effects models in the Cochrane Collaboration Review Manager 5.3 program. RESULTS Seventeen eligible studies were found. No studies analyzing hip OA alone were found. Pooled analyses found statistically significant decreases in mid-term pain (mean difference [MD]: -7.57; 95% confidence interval [CI]: -10.08 to -5.07; P < 0.001, I2 = 0%), short-term disability (standard mean difference [SMD]: -0.22; 95% CI: -0.41 to -0.03; P = 0.02, z = 2.32, I2 = 0%), and mid-term disability (SMD: -0.42; 95% CI: -0.75 to -0.09; P = 0.01, z = 2.49, I2 = 60%), favoring the intervention for chronic LBP. There were significant improvements in knee OA long-term functional disability (MD: -3.04; 95% CI: -5.70 to -0.38; P = 0.03; z = 2.24; I2 = 0%). CONCLUSION Meta-analyses provide evidence that health coaching reduces both disability and pain in people with chronic LBP and reduces disability in people with knee OA, though the clinical significance is unknown. There is currently no evidence supporting or refuting the use of health coaching for hip OA.
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Affiliation(s)
- Joanna Louise Prior
- Correspondence to: Joanna Louise Prior, Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Royal North Shore Hospital, Level 10, The Kolling Building, St Leonards, NSW 2065, Australia. Tel: +61 2 9926 4909; E-mail:
| | - Giovana Vesentini
- Department of Gynaecology and Obstetrics, Botucatu Medical School, UNESP—Univ Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Jose Antonio Michell De Gregorio
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia,The George Institute for Global Health, Sydney, Australia
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David J Hunter
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia,Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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Adding Physical Activity Coaching and an Activity Monitor Was No More Effective Than Adding an Attention Control Intervention to Group Exercise for Patients With Chronic Nonspecific Low Back Pain (PAyBACK Trial): A Randomized Trial. J Orthop Sports Phys Ther 2022; 52:287-299. [PMID: 35536245 DOI: 10.2519/jospt.2022.10874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate whether adding physical activity coaching and an activity monitor enhanced the effects of a group exercise program on pain intensity and disability for people with chronic nonspecific low back pain. DESIGN Randomized controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors. METHODS One hundred sixty participants with chronic nonspecific low back pain who were aged between 18 and 60 years and seeking care at an outpatient physiotherapy clinic participated. Both groups received supervised group exercise therapy. The intervention group also received physical activity coaching sessions aimed at improving physical activity, and physical activity electronic feedback delivered by an activity monitor. The attention control group received modified approaches of coaching sessions and an activity monitor. Disability was measured using the Roland Morris Disability Questionnaire (0-24), and pain intensity was measured using the 11-point Numerical Rating Scale (0-10). Linear mixed models were performed to test for differences between groups. RESULTS There were no differences between groups for reductions in disability (mean difference [MD] = -0.5 out of 24 points; 95% confidence interval [CI]: -2.2, 1.1) and pain intensity (MD = -0.4 out of 10 points; 95% CI: -1.3, 0.5) at 3-month follow-up. There were no between-groups differences at 6- and 12-month follow-up assessments. CONCLUSION Adding targeted physical activity coaching and an activity monitor did not reduce pain intensity or disability more than an attention control approach in participants with chronic low back pain who were undertaking a group exercise program. J Orthop Sports Phys Ther 2022;52(5):287-299. doi:10.2519/jospt.2022.10874.
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Gangwani R, Cain A, Collins A, Cassidy JM. Leveraging Factors of Self-Efficacy and Motivation to Optimize Stroke Recovery. Front Neurol 2022; 13:823202. [PMID: 35280288 PMCID: PMC8907401 DOI: 10.3389/fneur.2022.823202] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/13/2022] [Indexed: 01/01/2023] Open
Abstract
The International Classification of Functioning, Disability and Health framework recognizes that an individual's functioning post-stroke reflects an interaction between their health condition and contextual factors encompassing personal and environmental factors. Personal factors significantly impact rehabilitation outcomes as they determine how an individual evaluates their situation and copes with their condition in daily life. A key personal factor is self-efficacy-an individual's belief in their capacity to achieve certain outcomes. Self-efficacy influences an individual's motivational state to execute behaviors necessary for achieving desired rehabilitation outcomes. Stroke rehabilitation practice and research now acknowledge self-efficacy and motivation as critical elements in post-stroke recovery, and increasing evidence highlights their contributions to motor (re)learning. Given the informative value of neuroimaging-based biomarkers in stroke, elucidating the neurological underpinnings of self-efficacy and motivation may optimize post-stroke recovery. In this review, we examine the role of self-efficacy and motivation in stroke rehabilitation and recovery, identify potential neural substrates underlying these factors from current neuroimaging literature, and discuss how leveraging these factors and their associated neural substrates has the potential to advance the field of stroke rehabilitation.
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Affiliation(s)
- Rachana Gangwani
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Human Movement Sciences Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amelia Cain
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amy Collins
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica M. Cassidy
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Thompson K, Johnson MI, Milligan J, Briggs M. Rethinking pain education from the perspectives of people experiencing pain: a meta-ethnography to inform physiotherapy training. BMJ Open 2022; 12:e046363. [PMID: 35017228 PMCID: PMC8753399 DOI: 10.1136/bmjopen-2020-046363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Pain is a complex, global and multidimensional phenomena that impacts the lives of millions of people. Chronic pain (lasting more than 3 months) is particularly burdensome for individuals, health and social care systems. Physiotherapists have a fundamental role in supporting people who are experiencing pain. However, the appropriateness of pain education in pre-registration physiotherapy training programmes has been questioned.Recent research reports identify the need to integrate the voice of patients to inform the development of the pre-registration curriculum. The aim of this meta-ethnography was to develop new conceptual understanding of patients' needs when accessing physiotherapy for pain management. The concepts were viewed through an educational lens to create a patient needs-based model to inform physiotherapy training. METHODS Noblit and Hare's seven-stage meta-ethnography was used to conduct this qualitative systematic review. Five databases (MEDLINE, CINAHL Complete, ERIC, PsycINFO and AMED) were searched with eligibility criteria: qualitative methodology, reports patient experience of physiotherapy, adult participants with musculoskeletal pain, reported in English. Databases were searched to January 2018. Emerge reporting guidelines guided the preparation of this manuscript. RESULTS A total of 366 citations were screened, 43 full texts retrieved and 18 studies included in the final synthesis. Interpretive qualitative synthesis resulted in six distinct categories that represent patients' needs when in pain. Analysing categories through an education lens resulted in three overall lines of argument to inform physiotherapy training. The categories and lines of argument are represented in a 'needs-based' model to inform pre-registration physiotherapy training. DISCUSSION The findings provide new and novel interpretations of qualitative data in an area of research that lacks patient input. This is a valuable addition to pain education research. Findings support the work of others relative to patient centredness in physiotherapy.
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Affiliation(s)
- Kate Thompson
- School of Health, Leeds Beckett University, Leeds, UK
- Centre for Pain Research, Leeds Beckett University, Leeds, UK
| | - Mark I Johnson
- School of Health, Leeds Beckett University, Leeds, UK
- Centre for Pain Research, Leeds Beckett University, Leeds, UK
| | - James Milligan
- School of Health, Leeds Beckett University, Leeds, UK
- Centre for Pain Research, Leeds Beckett University, Leeds, UK
| | - Michelle Briggs
- Division of Nursing, Midwifery & Social Work, Manchester University NHS Foundation Trust, Manchester, UK
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Snowdon DA, Sounthakith V, Kolic J, Brooks S, Scanlon S, Taylor NF. Many inpatients may not be physically prepared for community ambulation on discharge from a publicly funded rehabilitation centre: a cross-sectional cohort study. Disabil Rehabil 2021; 43:3672-3679. [PMID: 32250178 DOI: 10.1080/09638288.2020.1745906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/23/2020] [Accepted: 03/18/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE We assessed the ability of patients discharging home from inpatient rehabilitation to meet criteria for community ambulation. METHODS Cross-sectional observational study design. Participants were assessed, within 48-hours of discharge on their ability to: ascend/descend three steps, walk at a speed of 0.44 m/s, ascend/descend a slope, ascend/descend a kerb, and walk 315 m continuously. Demographic data were collected from medical records. Multiple logistic regression determined factors predictive of meeting criteria. RESULTS Of 200 participants (mean 73 years, 66% women, mixed diagnosis), 64 (32%) met all criteria. The least commonly met criteria were walking 315 m continuously (37%) and ascending/descending steps (70%). Participants who were female (OR: 0.27, 95%CI: 0.12-0.61), with a high comorbidity index (OR: 0.71, 95%CI: 0.56-0.91) or a traumatic orthopaedic diagnosis (OR: 0.22, 95%CI: 0.05-0.96) were less likely to meet all criteria. Participants with a higher admission functional independence walk item score (OR: 1.37, 95%CI: 1.05-1.78) or higher ambulatory self-confidence (OR: 1.02, 95%CI: 1.01-1.04) were more likely to meet all criteria. CONCLUSIONS Approximately, one-third of inpatients discharged home from a publicly funded rehabilitation centre met the community ambulation criteria, suggesting many may not be physically prepared to participate in their community.Implications for RehabilitationOnly about one in three inpatients discharging home from a publicly funded rehabilitation centre met physical criteria for community ambulation.Patients discharging home from inpatient rehabilitation have most difficulty walking long distances (≥315 m) compared to other criteria required for community ambulation (i.e., walking at a speed of 0.44 m/s, stepping up/down a kerb, ascending/descending a slope and ascending/descending three steps) and rehabilitation during this phase may require an increased focus on improving walking endurance/physical activity.Women with a high co-morbidity index, traumatic orthopaedic diagnosis, low self-confidence with ambulation on discharge and who require more assistance with walking on admission are least likely to meet the physical criteria for community ambulation at discharge, and therefore may require additional rehabilitation or supports.
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Affiliation(s)
- David A Snowdon
- Peninsula Clinical School, Peninsula Health, Monash University, Frankston, Australia
| | | | - Jessica Kolic
- Peninsula Clinical School, Peninsula Health, Monash University, Frankston, Australia
| | - Sarah Brooks
- Department of Physiotherapy, Peninsula Health, Frankston, Australia
| | - Sinead Scanlon
- Department of Physiotherapy, Peninsula Health, Frankston, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Haynes A, Sherrington C, Wallbank G, Wickham J, Tong A, Kirkham C, Manning S, Ramsay E, Tiedemann A. Using self-determination theory to understand and improve recruitment for the Coaching for Healthy Ageing (CHAnGE) trial. PLoS One 2021; 16:e0259873. [PMID: 34797820 PMCID: PMC8604286 DOI: 10.1371/journal.pone.0259873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intervention trials promoting physical activity among older people frequently report low and unrepresentative recruitment. Better understanding of reasons for participation can help improve recruitment. This study explored why participants enrolled in the Coaching for Healthy Ageing (CHAnGE) trial, including how their decision was influenced by recruitment strategies. CHAnGE was a cluster randomised controlled trial testing the effectiveness of a healthy ageing program targeting inactivity and falls. Seventy-two groups of people aged 60+ were recruited from community organisations via informal presentations by the health coaches. METHODS We conducted a secondary thematic analysis of interview data from our wider qualitative evaluation in which 32 purposively sampled trial participants took part in semi-structured interviews about their experiences of CHAnGE. Data relating to recruitment and participation were analysed inductively to identify themes, then a coding framework comprising the core constructs from self-determination theory-autonomy, competence and relatedness-was used to explore if and how this theory fit with and helped to explain our data. RESULTS Recruitment presentations promoted the CHAnGE intervention well in terms of addressing value expectations of structured support, different forms of accountability, credibility, achievability and, for some, a potential to enhance social relationships. Participation was motivated by the desire for improved health and decelerated ageing, altruism and curiosity. These factors related strongly to self-determination concepts of autonomy, competence and relatedness, but the intervention's demonstrated potential to support self-determination needs could be conveyed more effectively. CONCLUSIONS Findings suggest that recruitment could have greater reach using: 1. Strengths-based messaging focusing on holistic gains, 2. Participant stories that highlight positive experiences, and 3. Peer support and information sharing to leverage altruism and curiosity. These theory-informed improvements will be used to increase participation in future trials, including people in hard-to-recruit groups. They may also inform other physical activity trials and community programs.
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Affiliation(s)
- Abby Haynes
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Geraldine Wallbank
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - James Wickham
- School of Biomedical Sciences, Charles Sturt University, Orange, NSW, Australia
| | - Allison Tong
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Catherine Kirkham
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Shona Manning
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Christian Homes Tasmania Inc, Kingston, TAS, Australia
| | - Elisabeth Ramsay
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Roidl A, Gabriel A, Beckmann J. Ergebnisse einer deutschlandweiten Umfrage über Beratung zu lebensstilbezogener Verhaltensänderung (BzlV) in der physiotherapeutischen Versorgung – eine Querschnittstudie. PHYSIOSCIENCE 2021. [DOI: 10.1055/a-1384-0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zusammenfassung
Hintergrund Es ist unklar, in welchem Umfang Beratung zu lebensstilbezogener Verhaltensänderung (BzlV) in Deutschland bereits in die physiotherapeutische Arbeit integriert ist und ob Physiotherapeut*innen die erforderlichen Kompetenzen aufweisen.
Ziel Erfassung der Einstellung von Physiotherapeut*innen zur Gesundheitsförderung sowie zu Praxis, Kompetenzen und möglichen Barrieren für die Umsetzung von BzlV.
Methode Mittels Online-Umfrage wurden in Deutschland tätige Physiotherapeut*innen zu ihren allgemeinen Einstellungen zur Gesundheitsförderung sowie zu Praxis, Kompetenzen und möglichen Barrieren für die Umsetzung von BzlV befragt. Neben einer deskriptiven Analyse der Angaben wurden Unterschiede zwischen akademisch und nicht akademisch ausgebildeten Physiotherapeut*innen mithilfe des Mann-Whitney-U-Tests ermittelt.
Ergebnisse 511 Physiotherapeut*innen nahmen an der Umfrage teil, davon konnten 413 Fragebögen in die deskriptive Analyse eingeschlossen werden (Alter: 36,4 (± 10,88 SD) Jahre; w/m: 281/132). 92,7 % der Befragten hielten Gesundheitsförderung für einen fundamentalen Bestandteil der physiotherapeutischen Arbeit und 93,4 % stimmten zu, dass die Förderung eines gesunden Lebensstils zur Arbeit von Physiotherapeut*innen gehöre. Die Befragten erhoben (a) und berieten (b) am häufigsten zum Risikofaktor körperliche Inaktivität (a: 89,8 %; b: 91,3 %) und gaben an, über geringe bis mittlere Kompetenzen für die Beratung zur Verhaltensänderung zu verfügen. Akademisch ausgebildete Physiotherapeut*innen schätzten ihre Kompetenzen besser als nicht akademisch ausgebildete Physiotherapeut*innen (W = 8253,5, p = 0,001, r = 0,182) ein. Als häufigste Barrieren bei der Umsetzung von BzlV wurden strukturelle Ursachen, wie Zeitmangel (64,9 %) und fehlende Vergütung (70,5 %), genannt.
Schlussfolgerung Physiotherapeut*innen haben überwiegend eine positive Einstellung zur Gesundheitsförderung und erachten BzlV als sehr wichtig. Derzeit bestehen aber noch viele Barrieren, die Physiotherapeut*innen an der Umsetzung hindern. Damit diese in Deutschland dennoch einen Beitrag zur Gesundheitsförderung leisten können, sollten Rahmenbedingen und Ausbildungsinhalte angepasst werden.
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Affiliation(s)
- Anna Roidl
- Technische Universität München, Fakultät für Sport- und Gesundheitswissenschaften, München, Deutschland
- Klinik und Poliklinik für Kinder- und Jugendmedizin der Universität Regensburg, KinderUniKlinik Ostbayern (KUNO), Abteilung für Neonatologie, Barmherzige Brüder Klinik St. Hedwig, Regensburg, Deutschland
| | - Anna Gabriel
- Technische Universität München, Professur für Konservative und Rehabilitative Orthopädie, München, Deutschland
| | - Jürgen Beckmann
- Technische Universität München, Fakultät für Sport- und Gesundheitswissenschaften, München, Deutschland
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Rethorn ZD, Bezner JR, Pettitt CD. From expert to coach: health coaching to support behavior change within physical therapist practice. Physiother Theory Pract 2021; 38:2352-2367. [PMID: 34620046 DOI: 10.1080/09593985.2021.1987601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Negative health behaviors are a significant risk factor for non-communicable diseases (NCDs) and are responsible for 40-50% of the burden of disease in the US population. Physical therapists (PTs) have the capacity to effect behavior change in their patients to reduce their risk of disease and promote health. Competence in health behavior change is recommended for physical therapists. One way to achieve this competence is by learning and adopting a health coaching approach. Objectives: To provide a theoretical and practical approach to applying a health coaching approach in physical therapist clinical practice. Methods: 1) Describe a health coaching approach to facilitating behavior change; 2) present behavior change theories, communication strategies, and models underpinning health coaching; and 3) provide suggestions for ways PTs can integrate health coaching in clinical practice. Results: Health coaching is a dynamic and collaborative approach to health behavior change that harnesses the patient's or client's values and strengths to realize their goals for health. Conclusion: Adopting a health coaching approach may enhance adherence to physical therapists' recommendations as well as improve health outcomes.
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Affiliation(s)
- Zachary D Rethorn
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA.,Rocky Mountain University of Health Professions, Provo, UT, USA
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, 601 University Dr, Round Rock, TX, USA
| | - Cherie D Pettitt
- Rocky Mountain University of Health Professions, Provo, UT, USA.,WGU Academy, Western Governors University, Salt Lake City, Ut, USA
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Haynes A, Sherrington C, Ramsay E, Kirkham C, Manning S, Wallbank G, Hassett L, Tiedemann A. "Sharing Success with Someone": Building therapeutic alliance in physiotherapist-delivered physical activity coaching for healthy aging. Physiother Theory Pract 2021; 38:2771-2787. [PMID: 34324406 DOI: 10.1080/09593985.2021.1946872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Therapeutic alliance, a goal-orientated partnership between clients and practitioners, can enhance program engagement and adherence, and improve treatment outcomes and satisfaction. OBJECTIVES To develop an empirical model that describes how therapeutic alliances can be operationalized in clinical and research settings and use this in our evaluation of the Coaching for Healthy Ageing (CHAnGE) trial. METHODS Secondary analysis of interviews with participants in the CHAnGE trial (n = 32) and a focus group with the physiotherapists who delivered health coaching in that trial (n = 3). Analysis was inductive (thematic) and deductive (using a therapeutic alliance model derived from a literature review and informed by earlier analyses). RESULTS Data from participants and physiotherapists indicated that health coaching in CHAnGE built effective therapeutic alliances (i.e. it facilitated collaborative decision-making and trusting person-centered relationships) which were underpinned by professional skills and structural supports. Components of the intervention that strengthened therapeutic alliance were health coaching training, home visits, the coaching format, and provision of free activity monitors. CONCLUSION This study identifies key concepts and practical 'building blocks' of therapeutic alliance, showing how these were operationalized within an intervention. This may help those in clinical and research settings to recognize the importance and characteristics of therapeutic alliance and put it into practice.
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Affiliation(s)
- Abby Haynes
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Elisabeth Ramsay
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Catherine Kirkham
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Shona Manning
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia.,Christian Homes Tasmania Inc, Kingston, TAS, Australia
| | - Geraldine Wallbank
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Leanne Hassett
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia.,School of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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Rethorn ZD. Telehealth and wellness coaching: mirage or mainstay? Dev Med Child Neurol 2021; 63:631. [PMID: 33620099 DOI: 10.1111/dmcn.14840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Zachary D Rethorn
- Doctor of Physical Therapy Division, Duke University, Durham, NC, USA
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“Someone’s Got My Back”: Older People’s Experience of the Coaching for Healthy Ageing Program for Promoting Physical Activity and Preventing Falls. J Aging Phys Act 2021; 29:296-307. [DOI: 10.1123/japa.2020-0116] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 11/18/2022]
Abstract
The Coaching for Healthy Ageing trial evaluated the impact on physical activity (PA) and falls based on a year-long intervention in which participants aged 60+ receive a home visit, regular health coaching by physiotherapists, and a free activity monitor. This interview study describes the participants’ experiences of the intervention and ideas for improvement. The authors sampled purposively for maximum variation in experiences. The data were analyzed thematically by two researchers. Most of the 32 participants reported that the intervention increased PA levels, embedded activities, and generated positivity about PA. They were motivated by quantified PA feedback, self-directed goals, and person-centered coaching. Social connectivity motivated some, but the intervention did not support this well. The intervention structure allowed participants to trial and embed activities. Autonomy and relatedness were emphasized and should be included in future program theory. The authors identified synergistic effects, likely “essential ingredients,” and potential areas for improving this and similar interventions.
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Shore H, Hebron C. Musculoskeletal physiotherapists' perceptions of health promotion. Musculoskelet Sci Pract 2020; 50:102260. [PMID: 33010738 DOI: 10.1016/j.msksp.2020.102260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Non-communicable diseases from unhealthy lifestyles account for most preventable deaths in the UK. Physiotherapy training now includes Health Promotion (HP) for the reduction of unhealthy lifestyles such as obesity, smoking, alcohol and inactivity. However, physiotherapists' perceptions of HP in the context of musculoskeletal care in the UK have not been explored. OBJECTIVES To explore musculoskeletal physiotherapists' perceptions of HP. DESIGN Phenomenographic qualitative research. METHOD semi-structured interviews with 7 musculoskeletal physiotherapists. RESULTS/FINDINGS Physiotherapist conceptions of HP were analysed using phenomenographic analysis and three main categories emerged. These were the concepts of physiotherapists' self, education in the therapeutic alliance and persons' agency for change. Each category contained a variety of perceptions which were sometimes conflicting, and each category had scope for influencing the others. CONCLUSIONS Participants' (physiotherapists) perceptions of their personal and professional self were entwined with perceptions of persons' agency when describing health promotion in their practice. Within the therapeutic alliance concepts of health coaching were discussed but these conceptualisations sometimes contradicted descriptions of experiences. This research may encourage physiotherapists to reflect on their perceptions of, and role in HP.
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Affiliation(s)
- Heather Shore
- University of Brighton, School of Health Sciences, Robert Dodd Building, 49, Darley Road, Eastbourne, BN20 7UR, United Kingdom.
| | - Clair Hebron
- University of Brighton, School of Health Sciences, Robert Dodd Building, 49, Darley Road, Eastbourne, BN20 7UR, United Kingdom.
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McNerney NA, Losensky MJ, Lash MM, Rozaieski KR, Ortiz D, Garcia AN, Rethorn ZD. Low theoretical fidelity hinders the research on health coaching for opioid reduction: A systematic review of randomized controlled trials. PLoS One 2020; 15:e0241434. [PMID: 33119705 PMCID: PMC7595321 DOI: 10.1371/journal.pone.0241434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To systematically review the literature in order to evaluate the effects of health coaching on patients’ reduction of opioid usage and opioid discontinuation. In addition, this systematic review investigated the effects of health coaching on pain intensity, physical function, and quality of life. Methods Four electronic databases (PubMed, Embase, Scopus, and PsychINFO) were searched from inception to December 2019. Randomized controlled trials assessing the effects of health coaching interventions in adult patients currently using opioids were included. We considered trials if they included any of the four defined key constructs of health coaching adopted in this review: motivational interviewing, positive psychology, the transtheoretical model, and self-determination theory Independent reviewers screened and selected studies, extracted data, and assessed risk of bias using Revised Cochrane risk-of-bias tool for randomized trials (RoB2) and quality of evidence using Grading, Recommendation, Assessment, Development, and Evaluation (GRADE). The review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) databased as CRD42019136201. It was not possible to perform a meta-analysis due to heterogeneity between included trials. Results Eleven studies met our inclusion criteria (n = 4,516 participants). No study assessed all four constructs of health coaching. All eleven studies utilized only one of the constructs, brief motivational interviewing. Thus, we reported our results in terms of motivational interviewing. There is conflicting and very low quality of evidence that brief motivational interviewing may or may not be more effective than education to reduce opioid usage. There is very low quality of evidence that brief motivational interviewing is more effective than educational monthly diaries to reduce opioid use. There is very low to low quality of evidence that brief motivational interviewing is not more effective than no behavioral intervention to reduce opioid use at 6 months follow-up, treatment as usual (TAU) to improve overdose risk behaviors, and TAU to improve physical and psychological health. Conclusion There is no direct evidence related to the effect of health coaching on opioid reduction. There is limited, low quality evidence to conclude brief motivational interviewing reduces opioid usage in opioid-dependent patients. Future research should focus on the impact of high theoretical health coaching interventions on opioid usage.
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Affiliation(s)
- Natalie A. McNerney
- Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Michael J. Losensky
- Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
| | - Madison M. Lash
- Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
| | - Kendal R. Rozaieski
- Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
| | - Daniela Ortiz
- Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
| | - Alessandra N. Garcia
- Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
| | - Zachary D. Rethorn
- Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
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Perlman AI, Abu Dabrh AM. Health and Wellness Coaching in Serving the Needs of Today's Patients: A Primer for Healthcare Professionals. Glob Adv Health Med 2020; 9:2164956120959274. [PMID: 33014630 PMCID: PMC7509728 DOI: 10.1177/2164956120959274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022] Open
Abstract
The past six decades have been marked by leaps and bounds in medical advances, while concurrently clinical outcomes and the quality of life continued to lag or decline. There is a need for more comprehensive approaches to delivering healthcare to patients that address illness and wellness within and outside healthcare settings. Mounting evidence shows that making sustainable changes in healthcare requires approaching patients'/individuals' care as a continuum-within and outside healthcare settings-while addressing their capacity (ie ability) and workload (ie demands) and incorporating their values and preferences. Health and Wellness Coaching (HWC) has been proposed as a solution to create partnerships to empower individuals to take ownership, leadership, and accountability of their well-being, using nondirective, empathic, and mindful conversations that employ motivational-interviewing and evidence-based approaches. Insufficient clarity exists among healthcare professionals in understanding the definition, roles, and types of HWC. This primer summarizes HWC concepts and history and compares HWC types and its potential role in promoting, supporting, and improving the well-being, clinical outcomes, and quality of life of the pertinent stakeholders. This primer also highlights current and potential areas of application of HWC within different subpopulations and healthcare-related settings.
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Affiliation(s)
- Adam I Perlman
- Integrative Medicine and Health, General Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida
| | - Abd Moain Abu Dabrh
- Integrative Medicine and Health, General Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida.,Department of Family Medicine, Mayo Clinic Florida, Jacksonville, Florida
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Rethorn ZD, Pettitt RW, Dykstra E, Pettitt CD. Health and wellness coaching positively impacts individuals with chronic pain and pain-related interference. PLoS One 2020; 15:e0236734. [PMID: 32716976 PMCID: PMC7384647 DOI: 10.1371/journal.pone.0236734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/12/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives Health and wellness coaching (HWC) interventions have been reported to improve health outcomes for individuals with chronic diseases such as diabetes, cardiovascular disease, or cancer. However, HWC also holds potential as an effective intervention within a biopsychosocial chronic pain management framework. The aim of the present study was to evaluate the effects of HWC on individuals with chronic pain. Methods Participants were referred by their primary care provider or insurance company to a comprehensive telephonic 12-month pain management HWC program. Relationships between pain outcomes and physical and psychological factors were retrospectively analyzed. Mixed linear-effects modeling explored whether physical and psychological variables were associated with pain outcomes over time. Results Four hundred nineteen participants (female, 58.9%; mean age, 54.8) enrolled in the program and 181 completed the intervention. After 12 months in the program, statistically and clinically significant reductions were observed for pain intensity (Hedges’ g = 1.00) and pain-related interference (Hedges’ g = 1.13). Linear mixed-effects modeling indicated that improvements in physical functioning and psychological factors were associated with improvements in pain intensity. Discussion Our results provide a novel analysis on the effects of HWC on chronic pain and pain-related interference. HWC appears to be a promising intervention to improve pain-related outcomes in a population with chronic pain. Further investigation of HWC as an intervention for chronic pain is warranted.
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Affiliation(s)
- Zachary D. Rethorn
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, United States of America
- Rocky Mountain University of Health Professions, Provo, Utah, United States of America
- * E-mail:
| | - Robert W. Pettitt
- Rocky Mountain University of Health Professions, Provo, Utah, United States of America
| | - Emily Dykstra
- Rocky Mountain University of Health Professions, Provo, Utah, United States of America
| | - Cherie D. Pettitt
- Rocky Mountain University of Health Professions, Provo, Utah, United States of America
- WGU Academy, Western Governors University, Salt Lake City, Utah, United States of America
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