Learning motivational interviewing (MI) for use in pulmonary rehabilitation (PR)

Abstract

Background: MI is a potential method for improving PR engagement and adherence. The quality of MI is known to influence outcomes, but the extent to which PR clinicians can develop skill in this complex counselling method has not been determined. Aim: To evaluate the impact of a tailored training package on MI skill amongst PR clinicians. Method: Eleven PR clinicians (7 physiotherapists, 3 nurses, 1 exercise specialist) participated in a 2-day workshop and 5 individualised coaching/feedback sessions scheduled over 10 weeks. MI skill was measured through MI Treatment Integrity coding (MITI 3.1.1) of audio-recorded PR consultations at baseline, post-workshop, post-coaching and at 4 months. Results: MI skill acquisition was variable. Mean MI skill increased and some aspects surpassed basic competency thresholds at 4 months, but no participants achieved all thresholds simultaneously. Training did not alter the relative frequency and depth of reflective listening sufficiently and some participants struggled to adjust to MI9s collaborative, evocative spirit. Observations of patient functioning often did not show the pattern of language that is predictive of change. These results may reflect a 9best-case9 scenario, since participants could choose which consultation to record. Mean time to complete training was 18 weeks (±8.26), with service demands commonly cited for the delay. Conclusion: Prior to widespread adoption of MI as part of PR, it is essential to ensure that those responsible for MI delivery can do so competently. Following the sub-optimal gains in skill observed an updated training package (including the 9PREAMP9 manual to guide the integration of MI into PR) is being evaluated.