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Implementation of a behavioral medicine approach in physiotherapy: impact and sustainability

Journal article
Authors J. Fritz
Lars Wallin
A. Soderlund
L. Almqvist
M. Sandborgh
Published in Disability and Rehabilitation
ISSN 0963-8288
Publication year 2019
Published at Institute of Health and Care Sciences
Language en
Links dx.doi.org/10.1080/09638288.2019.15...
Keywords Physiotherapy, clinical competence, evidence-based practice, musculoskeletal pain, primary health care, self-efficacy, low-back-pain, psychosocial factors, management, facilitation, strategies, quality, skills, Rehabilitation
Subject categories Physiotherapy

Abstract

Purpose: To explore the effects on and sustainability of physiotherapists' clinical behavior when using facilitation to support the implementation of a behavioral medicine approach in primary health care for patients with persistent musculoskeletal pain. Methods: A quasi-experimental pre-/post-test trial was conducted. Fifteen physiotherapists were included in the experimental group, and nine in the control group. Based on social cognitive theory and the Promoting Action on Research Implementation in Health Services framework, facilitation with multifaceted implementation methods was used during a six-month period. Clinical behaviors were investigated with a study-specific questionnaire, structured observations, self-reports and patient records. Descriptive and non-parametric statistical methods were used for analyzing differences over time and effect size. Results: A sustained increase in self-efficacy for applying the behavioral medicine approach was found. Clinical actions and verbal expressions changed significantly, and the effect size was large; however, changes were not sustained at follow-ups. The behavioral changes were mainly related to the goal setting, self-monitoring and functional behavioral analysis components. No changes in clinical behavior were found in the control group. Conclusion: Tailored multifaceted facilitation can support the implementation of a behavioral medicine approach in physiotherapy in primary health care, but more comprehensive actions targeting sustainability are needed.

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