Make today the day your patients’ lives ‘will surely change’, MSK physiotherapists are urged
Are musculoskeletal (MSK) physiotherapists armed with the confidence and skills they need to persuade people to change their behaviours and live more healthily?
That is the central question in a debate article appearing in the latest issue of Physiotherapy, titled This is the day your life must surely change: Prioritising behavioural change in musculoskeletal practice.
The article’s lead author is Professor Jeremy Lewis, who is based at University of Hertfordshire’s department of allied health professions in the school of health and social work.
The second author is Colette Ridehalgh, from the IWK Health Centre, Halifax, Canada. The other two authors are Ann Moore and Kevin Hall, both of whom are based at the University of Brighton.
Physiotherapists need to ask ourselves if we understand the importance of behavioural change and if we have the skills and knowledge to incorporate it as an integral part of the management we offer [Prof Lewis et al.]Challenging conclusion
At the conclusion of their article, the authors throw out a dramatic challenge to their colleagues practising in the MSK field and beyond.
‘Physiotherapists need to ask ourselves if we understand the importance of behavioural change and if we have the skills and knowledge to incorporate it as an integral part of the management we offer.
‘Communication is key to changing lives, so that today is the day that change starts.’
A number of the article’s key messages are gleaned from the field of behavioural change science, which asserts that morbidity and mortality are linked to certain behaviours that can be modified.
But clinicians need a good understanding of the importance of self-management and the impact it can have on people’s lifestyles, according to Professor Lewis and his colleagues.
‘It is essential for clinicians to include behavioural change in the management of people with musculoskeletal problems and provide ways of working collaboratively with the patient to identify WHAT needs to change and HOW it could be introduced.’
What prompts behavioural change?
‘It is about sharing the benefits of lifestyle choices that promote health, discussing how to introduce and maintain them, and supporting people through their journey of change, so the change becomes the new normal,’ the article states.
As an example of a successful attempt to change people’s behaviours, the authors cite changing attitudes to smoking, which reduced death rates globally from 146 per 100,000 people in 1990 to 90 per 100,000 in 2017. They acknowledge, however, that improvements tend to have occurred mainly in high income countries.
Turning to MSK conditions – now considered to be the group of health concerns associated with the longest number of years lived with disability – achieving blanket behavioural changes may not be straightforward. This is due to factors such as individuals’ contrasting beliefs, motivation levels and personal preferences.
‘Physiotherapists have a responsibility to offer holistic, evidence informed, sustainable and person-centred care,’ the paper notes.
‘Managing musculoskeletal conditions involves, education, advice and usually some form of exercise. However, adherence to exercise is problematic, with 50-70 per cent of people not adhering to their exercise program in spite of poor adherence predicting poor outcomes.’
Professor Lewis and his co-authors point out that patients' adherence levels are often poorly addressed, both clinically and in research. For example, a recent systematic review found that patterns of home exercise adherence for people with rotator cuff related disorder were not reported in 13 out of 17 studies.
Components of behavioural change
Work collaboratively to identify a behaviour that aligns with the person’s goals and contributes to improving health, they argue.
According to a recent comprehensive review of behaviour change theories, the factors needed to drive change are:
The authors focus on the COM-B model – standing for Capability Opportunity and Motivation – Behaviour), which was developed to help clinicians and researchers to identify targets for their behaviour change interventions.
The move towards self-management is now central to the health strategy in England (https://www.england.nhs.uk/wp-content/uploads/2020/03/supported-self-management-summaryguide.pdf), but the concept and meaning of the term may be poorly understood, the article suggests.
To see the article, This is the day your life must surely change: Prioritising behavioural change in musculoskeletal practice, visit: https://doi.org/10.1016/j.physio.2021.05.007Author: Ian A McMillan