FRI0625-HPR Learning To Guide People with Rheumatoid Arthritis To Health-Enhancing Physical Activity Behavior: Physiotherapists' Knowledge, Beliefs and Behavior
Authors: T. Nessen, C.H. Opava, I. Demmelmaier
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Physiotherapists (PTs) are raised in a biomedical tradition. They promote health-enhancing physical activity (HEPA) in persons with RA mainly by providing information, instructions and follow-up of prescribed exercises. To facilitate maintained HEPA behavior, PTs in rheumatology need to integrate their knowledge on RA and exercise physiology with use of evidence-based behavior change techniques (BCTs). Detailed, theory-based studies of how PTs can integrate these competencies are scarce. To gain more knowledge on PTs learning in this aspect, we performed the present study as a substudy in a HEPA intervention in the Physical Activity in RA (PARA 2010) program. <h3>Objectives</h3> To describe changes in PTs9 knowledge, beliefs and behaviours assessed before, during and after a theory-based skills training course preparing them to guide persons with RA to HEPA within a one-year intervention trial. <h3>Methods</h3> This was a longitudinal case study performed within a one-year HEPA intervention for persons with RA, including circuit training at public gyms twice a week and 30 minutes daily free-living physical activity of moderate intensity, framed by 20 bi-weekly support group sessions led by a PT. Our participants were ten registered PTs leading 10 support groups with 5–10 persons each. To prepare the PTs for their task we gave a course based on Social Cognitive Theory (SCT) principles and structured use of BCTs, see Figure 1. Data were collected by questionnaire at five occasions; at baseline, three times during the course and once after the course, assessing knowledge on physical activity in RA (score 0–6), knowledge on BCTs (score 0–18), fear-avoidance beliefs about physical activity in RA (score 8–48), and self-efficacy to guide in behaviour change (score 9–54). The questionnaire had good face validity and good test-retest reliability with ICC 0.88–0.98 for the four variables. Data were also collected by a log book for self-reported use of BCTs during group sessions, dichotomised as adherence to the support group session protocol or not. <h3>Results</h3> PTs9 knowledge on BCTs and their self-efficacy to guide in behaviour change increased significantly (Friedman9s test, p&lt;0.05) from baseline to post-course from median 9 to 13 and from median 38 to 46.5, respectively. Their knowledge on physical activity in RA and their fear-avoidance beliefs were adequate at baseline and did not change. Two out of ten PTs fulfilled the pre-established criteria for adherence to the group session protocol for use of BCTs throughout the HEPA intervention. <h3>Conclusions</h3> A course for PTs based on SCT principles emphasizing skills training and feedback on performance seems useful to affect knowledge on BCTs and self-efficacy to guide in behaviour change. To improve adherence in PTs applying evidence-based BCTs to guide persons with RA to HEPA, closer monitoring and more frequent feedback on performance are suggested. <h3>References</h3> Nessen T, Opava CH, Martin C, Demmelmaier I. (2014). From clinical expert to guide: experiences from coaching people with rheumatoid arthritis to increased physical activity. Phys Ther, 94(5):644–53. Nordgren B, Fridén C, Demmelmaier I, Bergstrom G, Opava CH. (2012). Long-term health-enhancing physical activity in rheumatoid arthritis. The PARA 2010 study. BMC Public Health, 12, 397. <h3>Disclosure of Interest</h3> None declared