Lifestyle and behaviour change interventions in osteoarthritis and rheumatoid arthritis


Have you ever tried to make and sustain a lifestyle or behaviour change? How easy was it? Someone once explained to me that some things in life are simple, but that doesn’t equate to them being easy. For example, if you want to lose weight, it’s simple – exercise more and eat less, but if you’ve tried to do this, it ain’t easy! So how can healthcare professionals assist those with long-term conditions like osteoarthritis (OA) and rheumatoid arthritis (RA) to make health-related behavioural changes, when required?  A review article by Knittle et al (2012) tries to address this with a useful overview of current theories of behaviour-change with evidence based suggestions for clinical practice.

Here’s what they did

The review discusses several health behaviours associated with the progression and impact of OA and RA, including weight management, physical activity, medication adherence and smoking. An overview of current theories of behaviour-change is provided and  evaluation studies of interventions targeting weight loss, physical activity and medication adherence in patients with OA or RA are presented and discussed.

Here’s what they found

Of existing behaviour-change interventions that have been researched with patients with OA and RA few have taken a comprehensive theory-based approach to behaviour-change.

The authors concluded

man pushing ball through square hole

Practitioners should avoid prescriptive approaches & assist in setting personal change goals

“Practitioners who provide lifestyle or behavioural advice to patients would do well to adopt a less prescriptive and more patient-centred approach in which they assist the patient in formulating personal change goals, in translating good intentions into specific action plans and in closely monitoring their progress towards self-chosen goals.”

They offer the following practice points:

  • Investigate patient preferences and set personally important goals;
  • Use motivational strategies to ensure patient commitment to behaviour-change or lifestyle modification;
  • Motivation can be fostered by linking long-term outcome goals to more manageable short-term objectives;
  • Teach patients how to plan to achieve their goals, monitor their progress and restructure goals when necessary;
  • Periodically contact patients to refocus attention on the behaviour in question.

The Musculoskeletal Elf’s view

The Musculoskeletal Elf

I’m delighted that the review authors highlight motivational interviewing, as I am a big fan this and would highly recommend the accessing of materials by Stephen Rollnick, William Miller and Christopher Butler, including their easy to read and apply textbook for health care professionals (Rollnick, et al, 2008) and useful summary article (Rollnick & Miller, 1995).

“Motivational interviewing uses a guiding style to engage with patients, clarify their strengths and aspirations, evoke their own motivations for change, and promote autonomy of decision making” (Rollnick & Butler, 2010). Useful video demonstrations of motivational interviewing techniques are readily available on You Tube that could be used by healthcare professionals for CPD purposes.

How confident are you in applying motivational interviewing principles and techniques? Do you tend to slip into directive and prescriptive treatment interventions?

Send us your views on this blog and become part of the ever expanding Musculoskeletal Elf community.


Knittle K, De Gucht V, Maes S. (2012) Lifestyle- and behaviour-change interventions in musculoskeletal conditions, Best Practice & Research Clinical Rheumatology, Volume 26, Issue 3, 293–304. [pubmed abstract]

Rollnick S, Miller, W.R., Butler, C.C. (2008) Motivational Interviewing in Health Care: Helping Patients Change Behavior (Applications of Motivational Interviewing), Guilford Press. 

Rollnick S, & Miller, W.R. (1995).  What is motivational interviewing?  Behavioural and Cognitive Psychotherapy, 23, 325-334 [available online] [accessed 27-9-12]

Rollnick S, Butler, C.C., Kinnersley, P., Gregory, J., Mash, B. (2010) Motivational interviewing, British Medical Journal, 340, doi: 10.1136/bmj.c1900

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