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Communication style and exercise compliance in physiotherapy (CONNECT): a cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients' adherence to physiotherapists' recommendations: study rationale, design, and methods.
BMC Musculoskelet Disord. 2012 Jun 15; 13:104.BM

Abstract

BACKGROUND

Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist's recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients' autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists' recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists' autonomy-supportive communication on low back pain patients' adherence to physical activity and exercise therapy recommendations.

METHODS/DESIGN

This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded.We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects.

DISCUSSION

This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients' adherence to rehabilitation recommendations.

Authors+Show Affiliations

School of Science and Health, University of Western Sydney, Penrith, NSW, Australia. c.lonsdale@uws.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22703639

Citation

Lonsdale, Chris, et al. "Communication Style and Exercise Compliance in Physiotherapy (CONNECT): a Cluster Randomized Controlled Trial to Test a Theory-based Intervention to Increase Chronic Low Back Pain Patients' Adherence to Physiotherapists' Recommendations: Study Rationale, Design, and Methods." BMC Musculoskeletal Disorders, vol. 13, 2012, p. 104.
Lonsdale C, Hall AM, Williams GC, et al. Communication style and exercise compliance in physiotherapy (CONNECT): a cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients' adherence to physiotherapists' recommendations: study rationale, design, and methods. BMC Musculoskelet Disord. 2012;13:104.
Lonsdale, C., Hall, A. M., Williams, G. C., McDonough, S. M., Ntoumanis, N., Murray, A., & Hurley, D. A. (2012). Communication style and exercise compliance in physiotherapy (CONNECT): a cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients' adherence to physiotherapists' recommendations: study rationale, design, and methods. BMC Musculoskeletal Disorders, 13, 104. https://doi.org/10.1186/1471-2474-13-104
Lonsdale C, et al. Communication Style and Exercise Compliance in Physiotherapy (CONNECT): a Cluster Randomized Controlled Trial to Test a Theory-based Intervention to Increase Chronic Low Back Pain Patients' Adherence to Physiotherapists' Recommendations: Study Rationale, Design, and Methods. BMC Musculoskelet Disord. 2012 Jun 15;13:104. PubMed PMID: 22703639.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Communication style and exercise compliance in physiotherapy (CONNECT): a cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients' adherence to physiotherapists' recommendations: study rationale, design, and methods. AU - Lonsdale,Chris, AU - Hall,Amanda M, AU - Williams,Geoffrey C, AU - McDonough,Suzanne M, AU - Ntoumanis,Nikos, AU - Murray,Aileen, AU - Hurley,Deirdre A, Y1 - 2012/06/15/ PY - 2012/05/09/received PY - 2012/05/29/accepted PY - 2012/6/19/entrez PY - 2012/6/19/pubmed PY - 2013/3/13/medline SP - 104 EP - 104 JF - BMC musculoskeletal disorders JO - BMC Musculoskelet Disord VL - 13 N2 - BACKGROUND: Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist's recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients' autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists' recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists' autonomy-supportive communication on low back pain patients' adherence to physical activity and exercise therapy recommendations. METHODS/DESIGN: This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded.We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects. DISCUSSION: This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients' adherence to rehabilitation recommendations. SN - 1471-2474 UR - https://www.unboundmedicine.com/medline/citation/22703639/Communication_style_and_exercise_compliance_in_physiotherapy__CONNECT_:_a_cluster_randomized_controlled_trial_to_test_a_theory_based_intervention_to_increase_chronic_low_back_pain_patients'_adherence_to_physiotherapists'_recommendations:_study_rationale_design_and_methods_ L2 - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-13-104 DB - PRIME DP - Unbound Medicine ER -