The Use of Motivational Interviewing in Physical Therapy Education and Practice: Empowering Patients Through Effective Self-Management

Abstract

BACKGROUND AND PURPOSEIn 2012, the United States Department of Health and Human Services outlined a list of public health priorities related to cardiovascular, pulmonary, musculoskeletal, neuromuscular, integumentary, and metabolic health. This document, known as Healthy People 2020, focuses on health conditions including heart disease and stroke, respiratory disease, arthritis, osteoporosis and chronic back conditions, diabetes, and chronic kidney disease.1 As specialists in human movement and exercise, these issues are particularly pertinent to physical therapists (PTs) and physical therapist assistants (PTAs), on account of limited physical activity being a common risk factor in the development of each of these health conditions.2,3 Sedentary behaviors are inherently linked to a significant burden of chronic disease and disability, as well as diminished health-related quality of life. The lack of appropriate levels of physical activity results in at least 300,000 cases of premature mortality and more than $90 billion in direct medical costs annually within the United States alone.4 Less than 5% of Americans currently meet the minimum recommendations of 30 minutes of moderate physical activity per day, and only 8% of adolescents and 45% of children meet recommendations for 60 minutes per day.5 Lack of exercise and the pervasiveness of a sedentary lifestyle represent a large unmet need for exercise promotion as a key strategy in chronic disease prevention and management.6 Given our level of professional knowledge and expertise, PTs and PTAs have a moral obligation to address the current health care crisis by empowering individuals to assume an active role in health promotion and wellness through changes in personal behaviors. This role is reflected by the American Physical Therapy Associations revised Vision Statement for the Physical Therapy Profession,7 adopted in 2013-transforming society by optimizing movement to improve the human experience-and is consistent with guiding principles enabling PTs and PTAs to achieve this vision through the prevention and treatment of impairments, activity limitations, and restrictions related to movement, function, and health.Most people are aware that exercise is good for their health; however, an inability to overcome ambivalence and perceived barriers to an active lifestyle can interfere with participation in physical activity. While advice and personalized exercise prescription can be helpful, further consideration of additional factors is warranted. These factors often involve an individuals readiness to change, his or her interest in pursuing improved health and fitness, and a belief in his or her capacity to engage in new behaviors.8 Therefore, it is essential that PTs and PTAs possess not only the expertise to prescribe and administer the correct exercises, but the knowledge and skill to encourage individual motivation in establishing lifelong health habits known to reduce the risk of morbidity, disability, and premature mortality. PTs and PTAs can achieve these goals by working collaboratively. By including an assessment of the patients readiness to change as part of the initial patient interview and follow-up evaluations, the PT can determine the best approach for empowering patients in choosing healthy behaviors. The PTA can further these goals by working with the PT in applying appropriate evidence-based strategies that engender and support these changes.Motivational interviewing (MI) is a patient-centered approach to promoting changes in personal health behaviors, including improved nutrition, weight loss, and physical activity.9 Professional training in the use of MI and associated patient education methods can improve PT and PTA skill level and self-confidence in helping patients recognize the importance of behavioral risks. Through the use of motivational interviewing, PTs can assess an individuals readiness to change, deliver tailored patient education, and empower patients and clients to play an active role in self-management. …