MI Training Research Articles

Effect of Telerehabilitation-Based Motor Imagery Training on Pain and Related Factors in People with Multiple Sclerosis: Randomized Controlled Pilot Trial

ObjectivesTo investigate the effect of telerehabilitation-based graded motor imagery (MI,GMI) training on pain and pain-related factors in people with multiple sclerosis (MS). DesignRandomized controlled, assessor-blind pilot trial with repeated measure design. SettingNeurology outpatient clinic. ParticipantsThirty-two people with MS were randomly allocated to intervention (n=16) and control (n=16) groups. InterventionsDuring 8-week GMI training period, the first 2-weeks involved implicit MI training while 6-weeks explicit MI training were conducted. Main OutcomeThe primary outcome was the general pain intensity over the past two days, assessed with Visual Analogue Scale, with a minimum clinically important difference (MCID) of 23 mm. Secondary outcomes included general pain and specific body parts' pain intensity over the past seven days, neuropathic pain intensity, MI ability, fatigue, depression, anxiety, quality of life, sleep quality, daytime sleepiness and cognitive functions scores. Assessments were conducted at baseline, at weeks 8 (post-treatment) and 12 (follow-up). ResultsThe intervention group demonstrated a significant reduction in pain intensity over the past two days compared to control group (p<0.05). Furthermore, at the 8-week assessment, the intervention group surpassed the MCID in pain intensity over the past 2 and 7 days (p<0.05), whereas no significant change was observed in the control group (p>0.05). Significant effects were observed post-treatment on general pain over the past seven days, neuropathic pain, MI ability, fatigue, depression, quality of life, processing speed, and visuospatial memory within intervention group compared to control group (p<0.05). However, the impact on anxiety, sleep quality, daytime sleepiness, and verbal memory between groups were not significant (p>0.05). ConclusionTelerehabilitation-based GMI training stands out as viable for management of chronic pain and pain-related psychosocial symptoms for people with MS.

Evidence for motivational interviewing in educational settings among medical schools: a scoping review

BackgroundMotivational interviewing (MI) is a person-centred approach focused on empowering and motivating individuals for behavioural change. Medical students can utilize MI in patient education to engage with patients’ chronic health ailments and maladaptive behaviours. A current scoping review was conducted to 1) determine the types of MI (conventional, adapted, brief and group MI) education programs in medical schools, delivery modalities and teaching methods used; 2) classify educational outcomes on the basis of Kirkpatrick’s hierarchy; and 3) determine the key elements of MI education via the FRAMES (feedback, responsibility, advice, menu of options, empathy, self-efficacy) model.MethodsThis scoping review was conducted via the framework outlined by Arksey and O’Malley. Two online databases, CINAHL and MEDLINE Complete, were searched to identify MI interventions in medical education. Further articles were selected from bibliography lists and the Google Scholar search engine.ResultsFrom an initial yield of 2019 articles, 19 articles were included. First, there appears to be a bimodal distribution of most articles published between the two time periods of 2004--2008 and 2019--2023. Second, all the studies included in this review did not use conventional MI but instead utilized a variety of MI adaptation techniques. Third, most studies used face-to-face training in MI, whereas only one study used online delivery. Fourth, most studies have used a variety of interactive experiences to teach MI. Next, all studies reported outcomes at Kirkpatrick’s Level 2, but only 4 studies reported outcomes at Kirkpatrick’s Level 3. According to the FRAMES model, all studies (n=19; 100%) reported the elements of responsibility and advice. The element that was reported the least was self-efficacy (n = 12; 63.1%).ConclusionOur findings suggest that motivational interviewing can be taught effectively in medical schools via adaptations to MI and a variety of teaching approaches. However, there is a need for further research investigating standardized MI training across medical schools, the adequate dose for training in MI and the implementation of reflective practices. Future studies may benefit from exploring and better understanding the relationship between MI and self-efficacy in their MI interventions.

Avatar embodiment prior to motor imagery training in VR does not affect the induced event-related desynchronization: a pilot study

Motor-imagery brain-computer interfaces (MI-BCIs) have the potential to improve motor function in individuals with neurological disorders. Their effectiveness relies on patients’ ability to generate reliable MI-related electroencephalography (EEG) patterns, which can be influenced by the quality of neurofeedback. Virtual Reality (VR) has emerged as a promising tool for enhancing proprioceptive feedback due to its ability to induce a sense of embodiment (SoE), where individuals perceive a virtual body as their own. Although prior research has highlighted the importance of SoE in enhancing MI skills and BCI performance, to date, no study has successfully isolated nor manipulated the SoE in VR before MI training, creating a gap in our understanding of the precise role of the priming effect of embodiment in MI-BCIs. In this study, we aimed to examine whether the virtual SoE when induced, as priming of avatar embodiment, and assessed before MI training, could enhance MI-induced EEG patterns. To achieve this, we divided 26 healthy participants into two groups: the embodied group, which experienced SoE with an avatar before undergoing VR-based MI training, and the non-embodied group, which underwent the same MI training without a prior embodiment phase, serving as a control. We analyzed subjective measures of embodiment, the event-related desynchronization (ERD) power of the sensorimotor rhythms, lateralization of ERD, and offline classification BCI accuracy. Although the embodiment phase effectively induced SoE in the embodied group, both groups exhibited similar MI-induced ERD patterns and BCI classification accuracy. This suggests that the induction of SoE prior to MI training may not significantly influence the training outcomes. Instead, it appears that the integration of embodied VR feedback during MI training itself is sufficient to induce appropriate ERD, as evidenced by previous research.

Brain–Computer Interface Using Functional Near-Infrared Spectroscopy for Post-Stroke Motor Rehabilitation: Case Series

Introduction. Non-invasive brain–computer interfaces (BCIs) enable feedback motor imagery [MI] training in neurological patients to support their motor rehabilitation. Nowadays, the use of BCIs based on functional near-infrared spectroscopy (fNIRS) for motor rehabilitation is yet to be investigated.&#x0D; Objective: To evaluate the potential fNIRS BCI use in hand MI training for comprehensive post-stroke rehabilitation.&#x0D; Materials and methods. This pilot study included clinically stable patients with mild-to-moderate post-stroke hand paresis. In addition to the standard rehabilitation, the patients underwent 10 nine-minute MI fNIRS BCI training sessions. To evaluate the quality of fNIRS BCI control, we assessed the percentage of time during which the classifier accurately detected patient's mental state. We scored the hand function using the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FMA).&#x0D; Results. The study included 5 patients at 1 day to 12 months of stroke. All the participants completed the study. All study participants achieved BCI control rates higher than random (41–68%). While three patients demonstrated the clinically significant improvements in their ARAT scores, one of them also showed an improvement in the FMA score. All the participants reported experiencing drowsiness during training.&#x0D; Conclusions. Post-stroke patients can operate the fNIRS BCI system under investigation. We suggest adjusting the feedback system, extending the duration of training, and incorporating functional electromyostimulation to enhance training effectiveness.

Action observation and motor imagery improve motor imagery abilities in patients with Parkinson’s disease – A functional MRI study

IntroductionMotor imagery (MI) skills can be affected in Parkinson's disease (PD). We aimed at assessing MI and brain functional changes after action observation and MI training (AOT-MI) associated with gait/balance exercises in PD patients with postural instability and gait disorders (PD-PIGD). MethodsTwenty-five PD-PIGD patients were randomized into two groups: DUAL-TASK + AOT-MI group performed 6-week gait/balance training combined with AOT-MI; DUAL-TASK group performed the same exercises without AOT-MI. Before and after training, MI was assessed using Kinesthetic-and-Visual-Imagery Questionnaire (KVIQ) and a MI functional MRI (fMRI) task. During fMRI, subjects were asked to watch first-person perspective videos representing gait/balance tasks and mentally simulate their execution. At baseline patients were compared with 23 healthy controls. ResultsPD groups did not differ in the MI scores. Both patient groups increased kinesthetic KVIQ score after training, while only DUAL-TASK + AOT-MI group improved visual and total KVIQ scores. At baseline, both PD groups showed reduced fMRI activity of sensorimotor, temporal and cerebellar areas relative to controls. After training, DUAL-TASK + AOT-MI patients increased activity of anterior cingulate, fronto-temporal and motor cerebellar areas, and reduced the recruitment of cognitive cerebellar regions. DUAL-TASK group showed increased recruitment of occipito-temporal areas and reduced activity of cerebellum crus-I. DUAL-TASK + AOT-MI relative to DUAL-TASK group had increased activity of cerebellum VIII-IX. In DUAL-TASK + AOT-MI group, KVIQ improvement correlated with increased activity of cerebellum IX and anterior cingulate, and with reduced activity of crus-I. ConclusionsAOT-MI improves MI abilities in PD-PIGD patients, promoting the functional plasticity of brain areas involved in MI processes and gait/balance control.

The state of motivational interviewing training in school counseling graduate programs

AbstractMotivational interviewing (MI) is a brief, evidence‐based counseling style that helps people make positive behavior changes. Scholars have advocated for MI's use by school counselors (SCs), and research lends evidence to MI's effectiveness in schools. However, there are little data focused on how SCs are trained to utilize MI. Researchers investigated MI training in school counseling graduate programs from the perspective of SCs and counselor educators (CEs). The article presents two qualitative studies that discussed the importance of MI training in graduate programs. Researchers identified six themes and discussed their implications for graduate programs.

Designing Practical Motivational Interviewing Training for Mental Health Practitioners Implementing Behavioral Lifestyle Interventions: Protocol for 3 Pilot Intervention Studies

Motivational interviewing (MI) is an evidence-based, patient-centered communication method shown to be effective in helping persons with serious mental illness (SMI) to improve health behaviors. In clinical trials where study staff conducted lifestyle interventions incorporating an MI approach, cardiovascular disease (CVD) risk profiles of participants with SMI showed improvement. Given the disproportionate burden of CVD in this population, practitioners who provide somatic and mental health care to persons with SMI are ideally positioned to deliver patient-centered CVD risk reduction interventions. However, the time for MI training (traditionally 16-24 hours), follow-up feedback, and the coaching required to develop and maintain patient-centered skills are significant barriers to incorporating MI when scaling up these evidence-based practices. We describe the design and development of the following 2 scalable MI training approaches for community mental health practitioners: real-time brief workshops and follow-up asynchronous avatar training. These approaches are being used in 3 different pilot implementation research projects that address weight loss, smoking cessation, and CVD risk reduction in people with SMI who are a part of ALACRITY Center, a research-to-practice translation center funded by the National Institute of Mental Health. Clinicians and staff in community mental health clinics across Maryland were trained to deliver 3 distinct evidence-based physical health lifestyle interventions using an MI approach to persons with SMI. The real-time brief MI workshop training for ACHIEVE-D weight loss coaches was 4 hours; IMPACT smoking cessation counselors received 2-hour workshops and prescribers received 1-hour workshops; and RHYTHM CVD risk reduction program staff received 4 hours of MI. All workshop trainings occurred over videoconference. The asynchronous avatar training includes 1 common didactic instructional module for the 3 projects and 1 conversation simulation unique to each study's target behavior. Avatar training is accessible on a commercial website. We plan to assess practitioners' attitudes and beliefs about MI and evaluate the impact of the 2 MI training approaches on their MI skills 3, 6, and 12 months after training using the MI Treatment Integrity 4.2.1 coding tool and the data generated by the avatar-automated scoring system. The ALACRITY Center was funded in August 2018. We have implemented the MI training for 126 practitioners who are currently delivering the 3 implementation projects. We expect the studies to be complete in May 2023. This study will contribute to knowledge about the effect of brief real-time training augmented with avatar skills practice on clinician MI skills. If MI Treatment Integrity scoring shows it to be effective, brief videoconference trainings supplemented with avatar skills practice could be used to train busy community mental health practitioners to use an MI approach when implementing physical health interventions. DERR1-10.2196/44830.

Resting-State EEG in Alpha Rhythm May Be Indicative of the Performance of Motor Imagery-Based Brain-Computer Interface.

Motor imagery-based brain-computer interfaces (MI-BCIs) have great application prospects in motor enhancement and rehabilitation. However, the capacity to control a MI-BCI varies among persons. Predicting the MI ability of a user remains challenging in BCI studies. We first calculated the relative power level (RPL), power spectral entropy (PSE) and Lempel-Ziv complexity (LZC) of the resting-state open and closed-eye EEG of different frequency bands and investigated their correlations with the upper and lower limbs MI performance (left hand, right hand, both hands and feet MI tasks) on as many as 105 subjects. Then, the most significant related features were used to construct a classifier to separate the high MI performance group from the low MI performance group. The results showed that the features of open-eye resting alpha-band EEG had the strongest significant correlations with MI performance. The PSE performed the best among all features for the screening of the MI performance, with the classification accuracy of 85.24%. These findings demonstrated that the alpha bands might offer information related to the user's MI ability, which could be used to explore more effective and general neural markers to screen subjects and design individual MI training strategies.

Motivational interviewing for employment: An exploration of practitioner skill and client change talk

AbstractMotivational interviewing (MI) is an evidenced‐based approach for building and strengthening motivation for change. The effect of MI training on practitioner conversations with unemployed clients within a government work and income service was evaluated using a mixed‐method approach, comprising a multiple‐baseline across practitioner (n = 5) design and a pre/post quasi‐experimental design. After workshop MI training, practitioners demonstrated greater MI skills in conversations with clients, and MI skills were maintained during the period of post‐workshop feedback and coaching. There was also more change talk spoken by clients in conversations that occurred post‐MI workshop training compared to pre‐training, suggesting increased motivation for change.

Cognitive Training Improves Disconnected Limbs' Mental Representation and Peripersonal Space after Spinal Cord Injury.

Paraplegia following spinal cord injury (SCI) affects the mental representation and peripersonal space of the paralysed body parts (i.e., lower limbs). Physical rehabilitation programs can improve these aspects, but the benefits are mostly partial and short-lasting. These limits could be due to the absence of trainings focused on SCI-induced cognitive deficits combined with traditional physical rehabilitation. To test this hypothesis, we assessed in 15 SCI-individuals the effects of adding cognitive recovery protocols (motor imagery–MI) to standard physical rehabilitation programs (Motor + MI training) on mental body representations and space representations, with respect to physical rehabilitation alone (control training). Each training comprised at least eight sessions administered over two weeks. The status of participants’ mental body representation and peripersonal space was assessed at three time points: before the training (T0), after the training (T1), and in a follow-up assessment one month later (T2). The Motor + MI training induced short-term recovery of peripersonal space that however did not persist at T2. Body representation showed a slower neuroplastic recovery at T2, without differences between Motor and the Motor + MI. These results show that body and space representations are plastic after lesions, and open new rehabilitation perspectives.

A different point of view: the evaluation of motor imagery perspectives in patients with sensorimotor impairments in a longitudinal study

BackgroundMotor imagery (MI) has been successfully applied in neurological rehabilitation. Little is known about the spontaneous selection of the MI perspectives in patients with sensorimotor impairments. What perspective is selected: internal (first-person view), or external (third-person view)? The aim was to evaluate the MI perspective preference in patients with sensorimotor impairments.MethodsIn a longitudinal study including four measurement sessions, 55 patients (25 stroke, 25 multiple sclerosis, 5 Parkinson’s disease; 25 females; mean age 58 ± 14 years) were included. MI ability and perspective preference in both visual and kinaesthetic imagery modalities were assessed using the Kinaesthetic and Visual Imagery Questionnaire-20 (KVIQ-20), the body rotation task (BRT), and mental chronometry (MC). Additionally, patients’ activity level was assessed. Descriptive analyses were performed regarding different age- (< 45, 45–64, > 64), activity levels (inactive, partially active, active), and KVIQ-20 movement classifications (axial, proximal, distal, upper and lower limb). A mixed-effects model was used to investiage the relationship between the primary outcome (MI perspective: internal, external) with the explanatory variables age, MI modality (visual, kinaesthetic), movement type (axial, proximal, distal), activity levels and the different assessments (KVIQ-20, BRT, MC).ResultsImagery modality was not a significant predictor of perspective preference. Over the four measurement sessions, patients tended to become more consistent in their perspective selection, however, time point was not a significant predictor. Movement type was a significant predictor: imagination of distal vs. axial and proximal vs. axial movements were both associated with preference for external perspective. Patients with increased physical activity level tend to use internal imagery, however, this effect was borderline not statistically significant. Age was neither a significant precictor. Regarding the MI assessments, the KVIQ- 20 score was a significant predictor. The patients with higher test scores tend to use the external perspective.ConclusionIt is recommended to evaluate the spontaneous MI perspective selection to design patient-specific MI training interventions. Distal movements (foot, finger) may be an indicator when evaluating the consistency of the MI perspective in patients with sensorimotor impairments.

Feasibility of motor imagery and effects of activating and relaxing practice on autonomic functions in healthy young adults: A randomised, controlled, assessor-blinded, pilot trial.

Motor imagery (MI) is the mental rehearsal of a motor task. Between real and imagined movements, a functional equivalence has been described regarding timing and brain activation. The primary study aim was to investigate the feasibility of MI training focusing on the autonomic function in healthy young people. Further aims were to evaluate participants' MI abilities and compare preliminary effects of activating and relaxing MI on autonomic function and against controls. A single-blinded randomised controlled pilot trial was performed. Participants were randomised to the activating MI (1), relaxing MI (2), or control (3) group. Following a MI familiarisation, they practiced home-based kinaesthetic MI for 17 minutes, 5 times/week for 2 weeks. Participants were called once for support. The primary outcome was the feasibility of a full-scale randomised controlled trial using predefined criteria. Secondary outcomes were participants' MI ability using the Movement Imagery Questionnaire-Revised, mental chronometry tests, hand laterality judgement and semi-structured interviews, autonomic function. A total of 35 participants completed the study. The feasibility of a larger study was confirmed, despite 35% attrition related to the COVID-19 pandemic. Excellent MI capabilities were seen in participants, and significant correlations between MI ability measures. Interview results showed that participants accepted or liked both interventions. Seven major themes and insider recommendations for MI interventions emerged. No significant differences and negligible to medium effects were observed in MI ability or autonomic function between baseline and post-intervention measures or between groups. Results showed that neither activating nor relaxing MI seems to change autonomic function in healthy individuals. Further adequately powered studies are required to answer open questions remaining from this study. Future studies should investigate effects of different MI types over a longer period, to rule out habituation and assess autonomic function at several time points and simultaneously with MI.

Advancing Motivational Interviewing Training with Artificial Intelligence: ReadMI.

BackgroundMotivational interviewing (MI) is an evidence-based, brief interventional approach that has been demonstrated to be highly effective in triggering change in high-risk lifestyle behaviors. MI tends to be underutilized in clinical settings, in part because of limited and ineffective training. To implement MI more widely, there is a critical need to improve the MI training process in a manner that can provide prompt and efficient feedback. Our team has developed and tested a training tool, Real-time Assessment of Dialogue in Motivational Interviewing (ReadMI), that uses natural language processing (NLP) to provide immediate MI metrics and thereby address the need for more effective MI training.MethodsMetrics produced by the ReadMI tool from transcripts of 48 interviews conducted by medical residents with a simulated patient were examined to identify relationships between physician-speaking time and other MI metrics, including the number of open- and closed-ended questions. In addition, interrater reliability statistics were conducted to determine the accuracy of the ReadMI’s analysis of physician responses.ResultsThe more time the physician spent talking, the less likely the physician was engaging in MI-consistent interview behaviors (r = −0.403, p = 0.007), including open-ended questions, reflective statements, or use of a change ruler.ConclusionReadMI produces specific metrics that a trainer can share with a student, resident, or clinician for immediate feedback. Given the time constraints on targeted skill development in health professions training, ReadMI decreases the need to rely on subjective feedback and/or more time-consuming video review to illustrate important teaching points.

Cross-cultural adaptation of motivational interviewing for use in rural Nepal

BackgroundMotivational Interviewing (MI) has a robust evidence base in facilitating behavior change for several health conditions. MI focuses on the individual and assumes patient autonomy. Cross-cultural adaptation can face several challenges in settings where individualism and autonomy may not be as prominent. Sociocultural factors such as gender, class, caste hinder individual decision-making. Key informant perspectives are an essential aspect of cross-cultural adaptation of new interventions. Here, we share our experience of translating and adapting MI concepts to the local language and culture in rural Nepal, where families and communities play a central role in influencing a person’s behaviors.MethodsWe developed, translated, field-tested, and adapted a Nepali MI training module with key informants to generate insights on adapting MI for the first time in this cultural setting. Key informants were five Nepali nurses who supervise community health workers. We used structured observation notes to describe challenges and experiences in cross-cultural adaptation. We conducted this study as part of a larger study on using MI to improve adherence to HIV treatment.ResultsParticipants viewed MI as an effective intervention with the potential to assist patients poorly engaged in care. Regarding patient autonomy, they initially shared examples of family members unsuccessfully dictating patient behavior change. These discussions led to consensus that every time the family members restrict patient's autonomy, the patient complies temporarily but then resumes their unhealthy behavior. In addition, participants highlighted that even when a patient is motivated to change (e.g., return for follow-up), their family members may not “allow” it. Discussion led to suggestions that health workers may need to conduct MI separately with patients and family members to understand everyone’s motivations and align those with the patient’s needs.ConclusionsMI carries several cultural assumptions, particularly around individual freedom and autonomy. MI adaptation thus faces challenges in cultures where such assumptions may not hold. However, cross-cultural adaptation with key informant perspectives can lead to creative strategies that recognize both the patient’s autonomy and their role as a member of a complex social fabric to facilitate behavior change.

SBIRT and MI Training among School Nurses and Psychiatric Mental Health Nurse Practitioner Students: A Pilot Study of Competency and Acceptability

Madridge Nursing Journal is an excellent investment for nursing professional, hospitals, libraries, and academic institutes. This journal include general publications of interest to all those working in the nursing field. Reports of original work, research, reviews, and policy papers focusing on professional nursing are published.

MI Implementation in Juvenile Justice: A Case Report

AbstractMotivational interviewing (MI) is a communication style focused on enhancing clients’ own motivation towards change. In the justice system MI has evidence to support that it enhances communication and change behaviors in youth. As most MI training is designed for healthcare settings training and implementation of MI must be adapted to fit the juvenile justice model. This includes both rehabilitation and restorative justice. Here we describe the details that allowed one county small county in Pennsylvania to roll out MI training and initial skills review in less than 6 months. The case reviews the details of planning, trainings, and timing of activities. We then discuss what elements of those details fit into a greater implementation plan that may be applied elsewhere. Four key elements were instrumental to implementation: 1) appreciation of JPO time constraints, 2) cost containment 3) using blending to enhance JPO flexibility with MI use, and 4) policies that normalize use of MI. This outline may assist other courts in their own implementation efforts.

Effectiveness of Motor Imagery Training for Children with Developmental Coordination Disorder Among Indian Children- A Pilot Study

Children with developmental coordination disorder (DCD) experiences difficulty in performing coordinated movement task as there is a defect in the internal of movements. The of DCD has been examined in several studies which reveal several viable hypotheses including reduced processing speed, problems in executive functioning, poor cross-model integration and low perceptual-motor coupling. Researchers well documented that the predictive control of movements is impaired in children with Developmental Coordination Disorder (DCD), it was examined that impaired control of movements was due to a deficit in the internal of movements. Motor imagery training has been used to test this internal deficit. Motor imagery training is useful for children with DCD as it focuses on internal of movements. The current study aims to examine the effectiveness of Motor imagery training focused on mental imagery task to enhance the movement coordination abilities of children with DCD. By random sampling, 20 children with DCD were randomly divided into two groups, Group A received MI training, and Group B received COOP- Cognitive orientation to daily occupational performance. Both groups received intervention for nine sessions of 45 minutes. The results provided by the current study will help to describe treatment protocol for children with DCD with evidence. Both children and therapist will be benefited from the study.

Learning motivational interviewing: prospects to preserve practitioners' well-being

PurposeMotivational interviewing (MI) is a collaborative communication style designed to help clients achieve desired behavior changes. MI includes communication methods along with a mindset that avoids attempting to impose behavior change. Relying on the conservation of resources theory, this research report argues that learning MI helps practitioners communicate more effectively and preserve their own psychological health resources.Design/methodology/approachWe tested whether MI training resulted in beneficial effects on practitioners' resilience and burnout (i.e. exhaustion and disengagement), surveying participants (N = 42) from various disciplines who learned MI at a training institute. Subjects received a questionnaire before and one month after MI training. The post-training questionnaire also assessed whether participants applied the training content in practice.FindingsThe results revealed that the training reduced participants' disengagement. Practical application was a predictor for this decrease as well as an increase in resilience.Research limitations/implicationsDue to the small sample size and self-reported data, this paper should be considered an experimental study that could inspire future research in this area, using more elaborate research designs.Practical implicationsLearning MI not only helps in facilitating behavior change in clients but also in bolstering practitioners' own resources. MI novices should aim to apply their newly acquired skills.Originality/valueThis study is among the first to explicitly hint at the possibility that learning MI helps practitioners preserve their psychological resources.

Pilot study of the influence of self-coding on empathy within an introductory motivational interviewing training

BackgroundMotivational interviewing (MI) is a framework for addressing behavior change that is often used by healthcare professionals. Expression of empathy during MI is associated with positive client outcomes, while absence of empathy may produce iatrogenic effects. Although training in MI is linked to increased therapeutic empathy in learners, no research has investigated individual training components’ contribution to this increase. The objective of this study was to test whether a self-coding MI exercise using smartphones completed at hour 6 of an 8-h MI training was superior in engendering empathy to training as usual (watching an MI expert perform in a video clip for the same duration at the same point in the training).MethodsThis was a pilot study at two sites using randomization and control groups with 1:1 allocation. Allocation was achieved via computerized assignment (site 1, United Kingdom) or facedown playing card distribution (site 2, United States). Participants were 58 students attending a university class at one of two universities, of which an 8-h segment was dedicated to a standardized MI training. Fifty-five students consented to participate and were randomized. The intervention was an MI self-coding exercise using smartphone recording and a standardized scoring sheet. Students were encouraged to reflect on areas of potential improvement based on their self-coding results. The main outcome measure was score on the Helpful Responses Questionnaire, a measure of therapeutic empathy, collected prior to and immediately following the 8-h training. Questionnaire coding was completed by 2 blinded external reviewers and assessed for interrater reliability, and students were assigned averaged empathy scores from 6 to 30. Analyses were conducted via repeated-measures ANOVA using the general linear model.ResultsFifty-five students were randomized, and 2 were subsequently excluded from analysis at site 2 due to incomplete questionnaires. The study itself was feasible, and overall therapeutic empathy increased significantly and substantially among students. However, the intervention was not superior to the control condition in this study.ConclusionsReplacing a single passive learning exercise with an active learning exercise in an MI training did not result in a substantive boost to therapeutic empathy. However, consistently with prior research, this study identified significant overall increases in empathy following introductory MI training. A much larger study examining the impact of selected exercises and approaches would likely be useful and informative.

TEACHING MOTIVATIONAL INTERVIEWING OF OLDER ADULTS IN AN INTERPROFESSIONAL EDUCATION SETTING: A PILOT STUDY

Motivational interviewing (MI), a person-centered method of strengthening personal motivation for change, improves health behaviors (i.e. blood pressure control) in older adults. However, literature lacks exploration of teaching MI in interprofessional and geriatric settings. We sought to pilot and assess the utility of an MI curriculum for an interprofessional group of second-year graduate students (medical, physician assistant, nursing, and speech pathology) working with older adults. The 5-week curriculum included a 2-hour interactive workshop, a geriatric standardized patient (SP), and small group meetings with a geriatric community member. We employed a pretest/posttest design to assess perceived importance and confidence using a 5-point Likert scale and knowledge acquisition using a modified version of the Motivational Interviewing Knowledge and Attitudes Test. Feedback from students on curricular design was obtained via a post-curriculum survey. Of the 17 students enrolled, 100% (17/17) completed the pretest and posttest and 94% (16/17) completed the post-curriculum survey. Previous MI training ranged from 0 to 12 hours. Students felt more confident in their MI skills (p<0.05) after the curriculum. Aggregate knowledge scores did not achieve statistical significance. Feedback indicated that students enjoyed practicing with SPs and processing feedback and would have preferred more student diversity and a more advanced curriculum. While limited by sample size, this pilot demonstrated that a brief geriatric-specific curriculum was well received and improved student confidence in MI skills. Larger studies should explore tailoring teaching methods of MI knowledge and skills in a diverse learner population working with older adults to promote health behavior change.