Can healthcare practitioners deliver health behaviour change to patients with musculoskeletal injuries as part of routine care?: a feasibility study

Abstract

The requirement to consider whole patient health is a core component of physiotherapy professional standards across several countries, including the U.K, Australia, New Zealand and the U.S.A. Although the wording varies, the standards place an obligation on practitioners to promote good health and prevent ill-health in patients. However, healthcare practitioners have reported a lack of confidence and skills to provide the necessary health behaviour change support. This study assessed the feasibility of implementing a practitioner training programme designed to enable physiotherapists to deliver health behaviour change support to patients with musculoskeletal injuries during the care pathway. A mixed-methods study utilising a quality improvement (QI) programme approach included the delivery of a training package to 21 healthcare practitioners at three musculoskeletal (MSK) primary care clinics within UK Defence. The study used the RE-AIM framework to guide the evaluation of programme implementation and determine factors influencing feasibility, successful adoption and maintenance by practitioners. Qualitative data including focus groups were used to inform assessment of the programme. The development of a patient health behaviour self-report tool, the Defence Health Behaviour Index (DHBI), is reported and its utility to initiate health conversations, where 99% of patients (n = 750) completed the DHBI. Evidence is presented demonstrating that it was possible to deliver training that enabled physiotherapists to include health behaviour change interventions during routine care, and that patients were receptive to these interventions. However, there were individual and organisational challenges in implementing this QI programme across a multi-centre, multi-practitioner patient population. Contribution of the Paper: • Delivery of a training programme enabled healthcare practitioners to include health behaviour change support to patients, as part of standard musculoskeletal (MSK) care. • This approach is consistent with national physiotherapy registrant standards which now require practitioners to promote good health and prevent ill-health in patients. • The development and use of a patient self-report health behaviour tool helped reduce perceived barriers to discussing health topics.

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