Working with People to Make Changes: A Behavioural Change Approach Used in Chronic Low Back Pain Rehabilitation

Abstract

Purpose: To describe the approach used by a physiotherapist who led a rehabilitation programme for injured members of the military with chronic low back pain designed to enhance self-efficacy and self-management skills. Method: This in-depth qualitative study used audio- and video-recorded data from interviews and field observations. Using an inductive analysis process, discussion of emerging themes led to a description of the physiotherapist's approach. Results: The approach has three elements: developing a trusting relationship through building rapport, establishing a need in patients' minds to be actively engaged in their rehabilitation, and finding workable rehabilitation solutions that are most likely to be adopted by individual patients. This approach fits into current theories about health behaviour change (e.g., Transtheoretical Model of Change, Motivational Interviewing, Motivational Model of Patient Self-Management and Patient Self-Management) and elements of the therapeutic alliance. Using the therapeutic alliance (rapport) and behaviour change techniques, the physiotherapist focused on the perceived importance of a behaviour change (need) and then shifted to the patient's self-efficacy in the solutions phase. Conclusions: If we recognize that rehabilitation requires patients to adopt new behaviours, becoming aware of psychological techniques that enhance behaviour change could improve treatment outcomes.