COmbining brief interventions for Modifiable health Behaviours withIN a routine physiotherapy consultation for pEople with a rotator cuff Disorder: development and testing in a single-arm feasibility study (COMBINED)

Bury, Julie Ann (2024) COmbining brief interventions for Modifiable health Behaviours withIN a routine physiotherapy consultation for pEople with a rotator cuff Disorder: development and testing in a single-arm feasibility study (COMBINED). Doctoral thesis (PhD), Manchester Metropolitan University.

Preview

Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (10MB) | Preview

Abstract

Background: Musculoskeletal conditions pose a significant burden and healthcare challenge, and current physiotherapy treatments often have uncertain clinical effects. Modifiable lifestyle factors such as smoking, overweight/obesity and physical inactivity are associated with the onset and persistence of musculoskeletal conditions. However, physiotherapists do not routinely integrate health behaviour change approaches into their management plans. A rigorously developed intervention that integrates a brief behaviour change intervention (brief intervention) to target these modifiable health behaviours within a routine physiotherapy consultation could improve patient outcomes and help address this current healthcare problem. Shoulder rotator cuff disorders, a common musculoskeletal condition, served as a test case to achieve the project’s aims. Aims: (1) To develop and test a physiotherapist-supported treatment approach, ‘The COMBINED approach’, that combines a brief intervention to target modifiable health behaviours, with current management strategies, within a routine physiotherapy consultation for people with a rotator cuff disorder; (2) to understand how best to support physiotherapists to integrate such an approach into clinical practice. Methods: The COMBINED approach was developed using a theory-, evidence-, and pragmatic-based approach, consisting of five interconnected workstreams (WS) within a multistage mixed methods design: (WS1) Narrative review to identify a range of brief interventions; (WS2) Stakeholder engagement co-design; (WS3) Prototype design, informed by behaviour change theory; (WS4) Prototype testing and refinement in a mixed-methods usability study; (WS5) Non-randomised mixed-methods feasibility study. Findings: (WS1) A narrative review identified 14 potential brief interventions to form a component of The COMBINED approach; (WS2) 25 stakeholders attended a series of 4 co-design workshops. Stakeholders selected a suitable brief intervention from WS1 to form a component of The COMBINED approach and informed the intervention design. Potential implementation barriers and facilitators were identified; (WS3) Barriers and facilitators were mapped to behaviour change theory to identify important targets for behaviour change. Behaviour change techniques were selected to address these barriers and design intervention components. A prototype included (i) a patient-level intervention (brief intervention; supporting resources); (ii) a clinician-level intervention (implementation toolkit); (WS4) The prototype was feasible and acceptable; however, refinements were required to improve fidelity; (WS5) The feasibility of a future definitive trial was demonstrated in terms of intervention fidelity, patient recruitment, and acceptability. Identification of factors influencing implementation will inform further refinements in readiness for a future, large, randomised controlled trial. Conclusion: The COMBINED approach has been developed through a rigorous intervention development process, making an original contribution to new knowledge. This novel intervention to address the modifiable health behaviours associated with a rotator cuff disorder, and a comprehensive implementation strategy to support physiotherapists to implement this approach, is now ready for evaluation in a future randomised controlled trial.