POS1559-HPR PHYSIOTHERAPISTS MAKE LIMITED USE OF BEHAVIOUR CHANGE TECHNIQUES DURING PHYSICAL ACTIVITY COUNSELLING FOR PEOPLE WITH AXIAL SPONDYLOARTHRITIS

Abstract

BackgroundThe 2018 EULAR recommendations for physical activity (PA) in people with inflammatory arthritis and osteoarthritis state that PA in generally recommended dose is effective, safe and feasible (1). Based on the recommendations, the Ankylosing Spondylitis Association of Switzerland (SVMB) developed a concept for their exercise groups, consisting of guidance on exercising, regular fitness assessments and individual PA counselling by the group-leading physical therapist (PT). The use of behaviour change techniques (BCTs) during PA counselling ought to support counselees’ adherence to individual, unsupervised exercising.ObjectivesTo assess the BCTs used by the PTs during their PA counselling sessions with the members of their axSpA exercise groups.MethodsAn observational cross-sectional study was performed with the first cohort of PTs (n=16) who applied the new concept and provided PA counselling, and their group members who agreed to participate. All first counselling sessions with an individual with axSpA were audiotaped, transcribed and analysed using a coding manual for BCTs (2). The manual includes 38 BCTs across the determinants ‘knowledge’ (2 BCTs), ‘awareness’ (8 BCTs), ‘social influence’ (3 BCTs), ‘attitude’ (4 BCTs)’, ‘self-efficacy’ (6 BCTs), ‘intention (6 BCTs)’, ‘action control’ (2 BCTs), ‘facilitation’ (2 BCTs), ‘maintenance’ (5 BCTs). Two raters familiar with BCTs identified the BCTs used by the PTs. They repeatedly discussed and agreed about their classifications of PTs’ phrasings to BCTs in an iterative process to achieve consistency over all counselling sessions. A BCT could be used several times within one counselling session.ResultsA total of 12 PTs (75%) who counselled 41 people with axSpA participated. All 41 PA counselling sessions, lasting between 30-55 minutes were analysed. Overall, 15 out of the 38 BCTs were identified. Across each determinant (with its number of BCTs), the most and least frequently used BCTs were as follows: 1) determinant ‘knowledge’ (1 of 2 BCTs used): ‘provide general information’ (469 times by 12 PTs); 2) ‘awareness’ (3 of 8 BCTs used): reflective listening and ‘self-monitoring of behaviour’ (328x by 12 PTs and 39x by 9 PTs respectively); 3) ‘social influence’: none of 3 BCTs used; 4) ‘attitude’ (1 of 4 BCTs used): persuasive communication (184x by 11 PTs); 5) ‘self-efficacy’ (3 of 6 BCTs used): verbal persuasion and guided practice (77x by 11 PTs and 3x by 3 PTs respectively); 6) ‘intention’ (4 of 6 BCTs used): general intention formation and develop training schedule (250x by 12 PTs and 18x by 5 PTs respectively); 7) ‘action control’ (1 of 2 BCTs used): use of cues (199x by 12 PTs), 8) ‘facilitation’: none (of 2) BCTs used; 9) ‘maintenance’ (2 of 5 BCTs used): continuous professional support and individualize regimen (137x by 12 PTs and 70x by 10 PTs respectively).ConclusionThe study identified that PTs used only a limited number of BCTs. BCTs considered less effective such as providing information were widely used, whereas BCTs that are considered effective, such as specific aims or coping with barriers were much less or not at all used. This study provides an insight in real clinical practice and may help to develop counselling training for PTs. There is a need to translate theoretical BCTs into effective measures that are easy to use in clinical practice.