This unique model, theory- and evidence-informed, has been developed to help physiotherapists to apply clinical reasoning systematically in the process of behaviour change with their clients.
In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicine content and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.
Governments have enforced measures to limit the spread of COVID-19 with varying degrees of success, which could affect people’s physical activity (PA) and sedentary behavior. This study aimed to examine changes in PA levels, types of PA, and sedentary behavior in the Swedish population before and during the COVID-19 pandemic. Associations between changed PA levels and demographical and behavioral determinants were also investigated. In December 2020, 1035 individuals (18–79 years old) completed a survey about their PA and sedentary behavior before and during the pandemic. Factors influencing their PA were also explored. Fifty-one percent of the sample reported reduced total PA, 18% had no change, and 31% increased their PA. Overall, organized PA decreased the most and sedentary behavior increased. The youngest and oldest age groups reported the greatest reduction in PA, while middle-aged groups reported the most increased PA. Men reported a larger increase in sedentary behavior than women. Mental and physical capability was associated with change in PA. In conclusion, this study indicates that, during the COVID-19 pandemic, the majority of the Swedish population have decreased PA levels with a concurrent increase in sedentary behavior, which may have negative health consequences. Interventions are recommended to address both PA and sedentary behavior, specifically to strengthen people’s ability to perform PA and focusing on the youngest and oldest age groups.
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The interventions in the scoping review were in agreement with the definition of behavioral medicine in physiotherapy, but reported behavior change techniques were few.
Background and aim: ‘Reasoning 4 Change’ (R4C) is a newly developed instrument, including four domains (D1–D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1–D4); inter-rater reliability (D2–D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (α range: 0.67–0.91), satisfactory test-retest reliability (ICC range: 0.46–0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94–1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06–0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.
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