Telephone-Delivered Exercise Advice and Behavior Change Support by Physical Therapists for People with Knee Osteoarthritis: Protocol for the Telecare Randomized Controlled Trial

Arthritis Care & Research

Campbell

et al. 2020

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Objective. To explore therapeutic alliance between physical therapists and patients with knee osteoarthritis during telephone consultations. Specifically, to describe and compare physical therapist and patient ratings, to determine whether alliance changes over time, and to evaluate whether individual characteristics are associated with alliance.Methods. We performed a secondary analysis of 84 patients in the intervention arm of a randomized controlled trial who completed 5-10 consultations with 1 of 8 physical therapists via telephone over 26 weeks, involving education, advice, and prescription of a strengthening and physical activity program. Therapeutic alliance was measured after the second (week 4) and final consultations (week 26), using the Working Alliance Inventory-Short Form.Results. Patient and physical therapist ratings of the alliance were high. At week 4, patients rated the overall alliance, and all 3 subscales, higher than therapists. At 26 weeks, patients rated the Task subscale higher than therapists. Patient ratings for the Goal subscale decreased over time, while physical therapist ratings for total alliance and the Bond subscale increased. For patients, the variables of living with others, consulting with a therapist with no previous experience delivering care remotely, having more telephone consultations, and having a higher self-efficacy were associated with greater alliance ratings. Therapists were more likely to perceive a stronger alliance if they had less clinical experience and when treating patients who were younger and had higher self-efficacy.Conclusion. Physical therapist perceptions of the therapeutic alliance tended to be lower than those of patients early in treatment, but differences were small and of unclear clinical significance. Some subgroups of patients rated the alliance more strongly than others.

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Therapeutic Alliance Between Physical Therapists and Patients With Knee Osteoarthritis Consulting Via Telephone: A Longitudinal Study

Arthritis Care & Research

Campbell

et al. 2020

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“…A qualitative longitudinal case study, nested within an ongoing randomized controlled trial (RCT) was conducted . A qualitative approach was chosen to explore training experiences and impacts.…”

Section: Methodsmentioning

confidence: 99%

Training Physical Therapists in Person‐Centered Practice for People With Osteoarthritis: A Qualitative Case Study

Delany

Arthritis Care & Research

et al. 2018

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Although physical therapists found training overwhelming initially as they realized the limitations of their current knowledge and clinical practice, they felt more confident and able to provide person-centered care to people with knee osteoarthritis by the end of training. Training in structured person-centered methodology that provides opportunity for skills practice with patients using a restructured consultation framework can change physical therapists' beliefs about their roles when managing patients with osteoarthritis and positively impact their clinical practice.

“…The study was nested within the Telecare randomized controlled trial (RCT). A detailed study protocol for the Telecare trial has been published (Hinman et al, ), including specific details of the intervention.…”

Section: Methodsmentioning

confidence: 99%

“…Following training, each physiotherapist was randomly assigned four patients with knee OA, in order to practice implementing the person‐centred practice principles and techniques taught. These patients were participants in the Telecare trial who were recruited from the community, as described elsewhere (Hinman et al, ). Each physiotherapist made two telephone calls to each patient (a total of eight consultations per physiotherapist).…”

Section: Methodsmentioning

confidence: 99%

Implementation of person‐centred practice principles and behaviour change techniques after a 2‐day training workshop: A nested case study involving physiotherapists

Kasza

et al. 2019

Musculoskeletal Care

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Objectives The aims of the present study were to determine how well physiotherapists implemented person‐centred practice principles and behaviour change techniques after a workshop, and to evaluate whether self‐audit of performance differed from audits of an experienced training facilitator. Methods Eight physiotherapists each completed a 2‐day workshop followed by two telephone consultations with four patients with knee osteoarthritis. The training facilitator audited audio‐recordings of all consultations, and therapists self‐audited 50% of consultations using a tool comprising: (a) 10 person‐centred practice principles rated on a numerical rating scale of 0 (need to work on this) to 10 (doing really well); and (b) seven behaviour change techniques rated with an ordinal scale (using this technique effectively; need to improve skill level; or need to learn how to apply this technique). Results Physiotherapists showed “moderate” fidelity to person‐centred principles, with mean scores between 5 and 7 out of 10. For behaviour change techniques, the training facilitator believed that physiotherapists were using three of seven techniques “effectively” during most consultations and “needed to improve skill levels” with most other techniques. Physiotherapists scored themselves significantly lower than the training facilitator for two of 10 person‐centred principles, and tended to rate their skills using behaviour change techniques less favourably. Conclusions Physiotherapists performed moderately well when implementing person‐centred practice principles and behaviour change techniques immediately after training, but had room for improvement, particularly for skills relating to providing management options and changing thinking habits. Physiotherapists' self‐ratings of performance generally did not differ from expert ratings; however, they underestimated their ability to implement some principles and techniques.