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MusculoskeletalApr 11, 2023

Research looks at effects of MSK physios having 'healthy conversations' with their patients

Physiotherapy patients living with musculoskeletal (MSK) conditions and pain need more opportunities to join support groups that will ‘promote long-term self-management’.

That is one of the key recommendations contained in an open access paper that was published last month in BMC Musculoskeletal Disorders. The paper’s first author is Amelia Parchment, a research associate based at the University of Bath’s department for health who conducted the research as part of a PhD.

It notes: 'Making support groups more accessible following physiotherapy treatment may be a cost-effective, valuable way of enhancing self-management, reducing health-service use and providing emotional and social benefits to those with chronic MSK conditions and pain.'

After liaising with physiotherapists in Wessex who had received training in gaining ‘healthy conversation skills’ (HCS) – part of the national Making Every Contact Count (MECC) initiative – Dr Parchment conducted semi-structured interviews with eight patients who had long-term MSK conditions.


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Groups may reduce the 'burden' on physio services and support social connectedness

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Five of the interviewees had been engaging with physiotherapists who had integrated their MECC HCS training into routine physiotherapy sessions, while the other three had been treated by physiotherapists who had not received the training and were instead delivering ‘usual care’.

‘Those who had engaged with MECC HCS trained physiotherapists found their physiotherapy care highly acceptable and felt that their physiotherapist listened to them, tried to understand their context and world, and helped them plan for change,’ Dr Parchment and her colleagues state.

‘These individuals experienced increases in self-efficacy and motivation for self-managing their MSK conditions. A need for continued support following physiotherapy treatment was, however, emphasised for long-term self-management. These groups may be a cost-effective way to facilitate long-term self-management, reduce burden on physiotherapy services, and support social connectedness for those living with MSK conditions and pain,’ the results section of the paper states.

'Shift in physiotherapists' approach

As background, the paper refers to a ‘growing public health concern’ over MSK conditions, which affect many people’s quality of life and place an economic burden on employers and the health service. There has been ‘shift’ away from ‘hierarchal, clinician-led physiotherapy care, focused on pathological “cure”’, towards a ‘more holistic, person-centred approach to care’ in recent years. As a result, patients are now recognised as being ‘active, rather than passive, agents in the effective management of MSK conditions and pain’.

Dr Parchment and her team note: ‘Physiotherapists are thus encouraged to empower patients, using person-centred principles, to take responsibility for, and actively manage their own conditions This could involve supporting patients to take steps to change their behaviour and improve lifestyle factors such as sleep, physical activity and stress.

‘Such active self-management has been associated with reduced pain-related disability and use of healthcare services and may be important for long-term management of MSK conditions and pain, when physiotherapy treatment has ended.'

Patient's view: 'coming out of a rut'

One participant said she had previously been 'consumed by her chronic pain', unable to find strength or motivation to do anything she enjoyed. With support from her physiotherapist, her motivation increased 'through setting small, personal goals' [which] had a 'positive impact on both her physical and mental health and wellbeing', the paper notes.

The patient, who had felt she had been 'going downhill mentally' before, was enthusiastic about setting goals with her physiotherapist. 'I do find [goal-setting] useful, because it makes you do it … you know, it's pulling me out of this rut that I've got myself in to … it makes me … it makes me motivated, to start with. And I can feel myself coming out of the rut.’ 


The authors acknowledge that the findings are based on a relatively small-scale exploratory study that might have been subject to 'recruitment bias' as most of the patients who were eligible were identified by their physiotherapists. In addition, it was conducted following the Covid-19 pandemic when NHS services and trusts were still facing 'unprecedented capacity issues'. 

Groups may be a cost-effective way to facilitate long-term self-management, reduce burden on physiotherapy services, and support social connectedness for those living with MSK conditions and pain [Amelia Parchment et al]

More long-term support needed

Dr Parchment and her five co-authors conclude: ‘MECC HCS is highly acceptable to patients with MSK conditions and pain and may successfully facilitate health-promoting behaviour change and enhance self-management. Providing opportunities to join support groups following physiotherapy treatment may promote long-term self-management and provide social and emotional benefits for individuals.'

They add: ‘The positive findings of this small qualitative study warrant further investigation on the differences in experiences and outcomes between patients engaging with MECC HCS physiotherapists and those receiving treatment as usual during routine physiotherapy care.’

What is MECC HCS?

MECC HCS, the paper states, is a 'person-centred approach to behaviour change that aims to empower individuals to take control of their health behaviours by building self-efficacy'.

The training programme helps healthcare professionals to develop skills in

  • using ‘open discovery’ questions to explore context and allow patients to identify barriers and generate solutions
  • listening more than giving information and making suggestions
  • reflecting on practice
  • supporting Specific, Measurable, Action-oriented, Realistic, Timed, Evaluated, Reviewed (SMARTER) goal setting 

To read the full version of the paper – which is titled ‘I can feel myself coming out of the rut’: a brief intervention for supporting behaviour change is acceptable to patients with chronic musculoskeletal conditions – click here





Author: Ian A McMillan
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