Patients' health outcomes after an implementation intervention targeting the physiotherapists' clinical behaviour

Johanna Fritz, Lena Almqvist, Anne Söderlund, Lars Wallin, Maria Sandborgh, Johanna Fritz, Lena Almqvist, Anne Söderlund, Lars Wallin, Maria Sandborgh

Abstract

Background: A behavioural medicine approach in physiotherapy has shown positive effects on increased and sustained activities and participation, including reduced sick leave for patients with persistent musculoskeletal pain. The aim of this study was to explore the health outcomes of patients with persistent musculoskeletal pain treated by physiotherapists who had received active compared with passive support when implementing a behavioural medicine approach.

Methods: An explorative and comparative pre-/post-test trial was conducted. A total of 155 patients with musculoskeletal pain ≥4 weeks were consecutively recruited by physiotherapists in primary healthcare who had received active or passive support when implementing a behavioural medicine approach. Data concerning health outcomes for patients were collected using questionnaires before and after the physiotherapy treatment and at half-, one- and two-year follow-ups. Descriptive, non-parametric and parametric bi- and multivariate statistics were used.

Results: There were no differences over time between the patients treated by physiotherapists who had received active compared to passive implementation support regarding pain-related disability, pain intensity, self-rated health, self-efficacy in performing daily activities, catastrophic thinking related to pain, and fear of movement. Significant improvements over time were identified in both groups regarding all variables and the effect sizes were large. The percentage of patients on sick leave significantly decreased in the patient group treated by physiotherapists who had received active implementation support.

Conclusion: It is very important to include patient outcomes when evaluating the implementation of multicomponent interventions. It seems that the implementation method did not play a major role for the patients' outcomes in this study. Most of the patients' health outcomes improved regardless of whether they were treated by physiotherapists who had received active or passive support when implementing a behavioural medicine approach. This was likely because the active implementation support was not extensive enough to enable the physiotherapists to sustain the behavioural medicine approach.

Trial registration: The study protocol was retrospectively registered in ClinicalTrials.gov . ID NCT03118453 , March 20, 2017.

Keywords: Behavioural medicine; Implementation; Musculoskeletal pain; Patient outcomes; Physiotherapy; Primary healthcare; Sick leave.

Conflict of interest statement

The authors (JF, LA, AS, LW, MS) declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
The number of participating patients at each measurement point
Fig. 2
Fig. 2
Mean values for the health outcomes for the patients treated by the physiotherapists in the active and passive implementation support groups before and after the treatment period and at half-, 1- and 2-year follow-ups
Fig. 3
Fig. 3
The treatment content reported by the patients treated by the physiotherapists in the active and passive implementation support groups

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Source: PubMed

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