Development and evaluation of a novel complex physiotherapy behaviour change intervention promoting physical activity adoption and maintenance in patients with lower limb osteoarthritis

Willett, Matthew James (2024). Development and evaluation of a novel complex physiotherapy behaviour change intervention promoting physical activity adoption and maintenance in patients with lower limb osteoarthritis. University of Birmingham. Ph.D.

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Abstract

Lower-limb (hip and knee) Osteoarthritis (OA) is a prevalent condition that causes substantial pain and disability in adults over 45 years of age. Optimising physical activity (PA) can help patients with lower-limb OA self-manage their symptoms and reduce the likelihood of developing secondary non-communicable diseases. However, patients with lower-limb OA tend to be less active than people without musculoskeletal pain.
Individuals undergo several ‘phases’ of change when incorporating new behaviours (such as PA) into their lifestyle, with the most important phases to target in interventions being adoption/initiation and maintenance. Physiotherapists are specialists in the assessment and management of musculoskeletal conditions and the primary healthcare provider of PA interventions within the United Kingdom’s National Health Service (NHS). Regarding the promotion of PA by physiotherapists, patients would be adopting PA behaviours while receiving treatment and maintenance would be manifested post-discharge.
Although physiotherapists believe that they have the necessary skills to promote PA, evidence suggests that they do not possess the requisite knowledge of behavioural theories or techniques to apply them effectively in their clinical practice. This PhD thesis details the iterative development and feasibility testing of a novel physiotherapy behaviour change intervention that aimed to promote PA adoption and maintenance in patients with lower-limb OA. The thesis structure includes several interconnecting studies including:
• A systematic review that identified the most effective behaviour change techniques (BCTs) used in physiotherapy interventions to promote short, medium, and long-term PA adherence in patients with lower-limb OA. Most BCTs demonstrated modest effects at optimising PA adherence. Findings also identified specific techniques to be most effective over the short-term while others were more effective over the longer-term.
• Semi-structured interviews that examined the views of patients with lower-limb OA regarding the barriers and facilitators to adherence to physiotherapist prescribed PA during treatment (adoption) and post-discharge (maintenance). The results revealed that the promotion of a PA routine within a positive patient-centred physiotherapy environment was deemed integral to behavioural adoption. Ensuring the PA environment is supportive was perceived to be critical to facilitate maintenance. Building on these findings, a theoretically informed physiotherapy intervention which incorporated 26 BCTs was proposed. The included BCTs were defined as either ‘phase specific’, targeting the theoretical determinants of PA adoption, routine formation, or maintenance or ‘recurring’ if they were relevant throughout the behaviour change process.
• Presentation of the proposed intervention to focus groups of physiotherapists to assess their perspectives on its acceptability and feasibility for implementation in an NHS physiotherapy department. Although the physiotherapists found the intervention highly acceptable and did not suggest any alteration of intervention BCTs, they believed that they required further training in behaviour change theory, especially in strategies for creating a more supportive motivational treatment climate and how to optimally deliver the BCTs.
• A review of the descriptions and conceptual models of theories of behaviour change to identify an appropriate candidate theory to underpin physiotherapy training in how to create a more supportive and motivational treatment climate. Self-determination Theory (SDT) was chosen as the primary theory to underpin physiotherapist training due to its’ theoretical model interlinking a person’s feelings of competence with their social interactions and motivation quality, which were consistent with patient perspectives identified in the interviews. A further mapping exercise linked the proposed interventions’ BCTs against SDTs theoretical constructs, to refine intervention content in preparation for feasibility testing. The resulting intervention had the overarching aim of creating a more motivationally empowering treatment climate and to implement specific BCTs to support patients with lower-limb OA to adopt and maintain PA.
• A single-arm, mixed methods, feasibility trial which evaluated the feasibility and acceptability of delivering the behaviour change intervention in people with lower-limb OA. N=36 patients with lower-limb OA were recruited and followed up for 6 months post-baseline. The recruitment strategy, multi-component intervention, and training programme were acceptable and feasible to deliver with minor modifications. Further adaptations to data collection processes were required to optimise the amount of data secured.
Overall, the multi-component, sequentially developed, theory-based behaviour change intervention was feasible and acceptable to patients with lower-limb OA and practicing physiotherapists. However, refinement and further piloting of the data collection processes are required prior to undertaking a full-scale parallel group (1:1) randomised controlled trial to evaluate the intervention’s effectiveness within post-COVID physiotherapy services.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):