The Development and Testing of a Checklist to Study Behaviour Change Techniques used in a Treatment Programme for Canadian Armed Forces Members with Chronic Non-specific Low Back Pain

The GLA:D BACK self-management adherence and competence checklist (SMAC Checklist)-Development, content validity and feasibility

OBJECTIVES

To unpack the complexity and impact of self-management interventions targeting musculoskeletal health conditions, we need to learn more about treatment delivery in clinical settings. Fidelity evaluation can illuminate how complex treatments are delivered and help understand the elements that lead to the effect. The objective of this study was to develop a checklist for the evaluation of the clinicians' delivery of structured patient education and exercise intervention for people with persistent back pain, the GLA:D Back intervention. The intent was to provide a checklist adaptable for the general delivery of self-management interventions for musculoskeletal pain.

METHODS

We derived items for the treatment delivery fidelity checklist from behaviour change techniques and theory about communication style. We applied a three-step developmental process covering developing a preliminary fidelity intervention framework, validating checklist content and piloting and refining the checklist.

RESULTS

We developed the adaptable fidelity checklist, The GLA:D BACK Self-management Adherence and Competence Checklist (SMAC Checklist). Evaluation of clinical practice using the checklist was feasible and acceptable by clinicians. Preliminary results indicate satisfactory observer agreement during pilot testing of the checklist.

CONCLUSION

The GLA:D BACK Self-management Adherence and Competence Checklist is a fidelity measurement tool for the assessment of the delivery of a self-management supportive intervention for people with persistent back pain. The intention is that it can be useful as an adaptable tool for use across self-management interventions for musculoskeletal pain.

Assessing physiotherapists' communication skills for promoting patient autonomy for self-management: reliability and validity of the communication evaluation in rehabilitation tool

PURPOSE

To assess the inter-rater reliability and concurrent validity of the Communication Evaluation in Rehabilitation Tool, which aims to externally assess physiotherapists competency in using Self-Determination Theory-based communication strategies in practice.

MATERIALS AND METHODS

Audio recordings of initial consultations between 24 physiotherapists and 24 patients with chronic low back pain in four hospitals in Ireland were obtained as part of a larger randomised controlled trial. Three raters, all of whom had Ph.Ds in psychology and expertise in motivation and physical activity, independently listened to the 24 audio recordings and completed the 18-item Communication Evaluation in Rehabilitation Tool. Inter-rater reliability between all three raters was assessed using intraclass correlation coefficients. Concurrent validity was assessed using Pearson's r correlations with a reference standard, the Health Care Climate Questionnaire.

RESULTS

The total score for the Communication Evaluation in Rehabilitation Tool is an average of all 18 items. Total scores demonstrated good inter-rater reliability (Intraclass Correlation Coefficient (ICC) = 0.8) and concurrent validity with the Health Care Climate Questionnaire total score (range: r = 0.7-0.88). Item-level scores of the Communication Evaluation in Rehabilitation Tool identified five items that need improvement.

CONCLUSION

Results provide preliminary evidence to support future use and testing of the Communication Evaluation in Rehabilitation Tool. Implications for Rehabilitation Promoting patient autonomy is a learned skill and while interventions exist to train clinicians in these skills there are no tools to assess how well clinicians use these skills when interacting with a patient. The lack of robust assessment has severe implications regarding both the fidelity of clinician training packages and resulting outcomes for promoting patient autonomy. This study has developed a novel measurement tool Communication Evaluation in Rehabilitation Tool and a comprehensive user manual to assess how well health care providers use autonomy-supportive communication strategies in real world-clinical settings. This tool has demonstrated good inter-rater reliability and concurrent validity in its initial testing phase. The Communication Evaluation in Rehabilitation Tool can be used in future studies to assess autonomy-supportive communication and undergo further measurement property testing as per our recommendations.

'I didn't pay her to teach me how to fix my back': a focused ethnographic study exploring chiropractors' and chiropractic patients' experiences and beliefs regarding exercise adherence

AIM

To inform future research and exercise prescription for patients with chronic low back pain (CLBP), this study explored chiropractors' and chiropractic patients' experiences and beliefs regarding the barriers and facilitators to prescribed exercise adherence.

METHODS

A focused ethnographic approach was used involving 16 semi-structured interviews, including pilot interviews (n = 4) followed by interviews with chiropractors (n = 6) and chiropractic patients with CLBP (n = 6).

RESULTS

Barriers and facilitators to prescribed exercise adherence revolved around four themes: diagnostic and treatment beliefs motivating behavior, passive-active treatment balance, the therapeutic alliance and patient-centered care, and exercise delivery.

CONCLUSION

Exercise adherence may be facilitated in patients with CLBP with simple exercise prescription changes made by chiropractors. However, changing chiropractors' and patients' diagnostic and treatment beliefs that are barriers to exercise adherence appears challenging. Training chiropractors in pain neuroscience education and the intentional use of behavior change techniques warrants future investigation.