In my last blog I emphasised the importance of addressing recovery expectations during treatment sessions with individuals with low back pain (LBP) and highlighted a simple screening instrument. However, the question remains, if a person has ‘low scoring’ recovery expectations how can we go about helping them? With that question in mind, I was delighted to come across a potential intervention that could assist with this: health coaching via the telephone, in other words, telephone coaching.
Health coaching, which is often used to increase individuals’ physical activity levels, represents an intervention that addresses psychosocial factors that are of importance to the person, using motivational interviewing, cognitive behavioural strategies and effective goal setting (Lindner et al, 2003). These types of strategies were employed via telephone coaching sessions in a randomised controlled trial (RCT) conducted by Iles et al (2011).
Here’s what they did
This RCT compared usual physiotherapy with usual physiotherapy plus telephone coaching with individuals with non-chronic (<8 weeks), non-specific LBP. The telephone coaching included motivational interviewing and cognitive behavioural strategies as related to the Stages of Change Model. Outcomes were measured at baseline, 4 and 12 weeks via a posted questionnaire. Telephone coaching was once per week for 4 weeks, plus one further session 3 weeks later. Usual physiotherapy was at the discretion of the treating therapist. Measures included: Patient Specific Functional Scale (PSFS); recovery expectation (rated 0-10); Oswestry Disability Index (ODI); primary non-leisure activity; and Pain Self Efficacy Questionnaire (PSEQ). Blinding and randomisation processes were implemented.
Here’s what they found
The authors concluded
The addition of telephone coaching to usual physiotherapy care for people with non-chronic, non-specific LBP led to clinically important improvements in activity and recovery expectation.
The Musculoskeletal Elf’s view
What I find encouraging about this trial is that the intervention (telephone coaching) was delivered by a physiotherapist following just three days of health coaching.
Furthermore, the overall extra input was less than 90 minutes, which may indicate that telephone coaching is a cost-effective addition to usual care. As there was no control group (with sham intervention), what is not certain is what aspects of the telephone coaching had the benefits. Was it the fact that patients were empowered and encouraged to self-manage, or was it that just having a supportive voice at the end of the phone had a positive impact? Answers on a postcard…or comment below.
Have you been involved in telephone coaching or treatment? How did/ do you find it? What possible advantages are there of tele-rehabilitation versus face to face?
Send us your views on this blog and become part of the ever expanding Musculoskeletal Elf community.
Lindner, H., Menzies, D., Kelly, J., Taylor, S. & Shearer, M. 2003, “Coaching for behaviour change in chronic disease: A review of the literature and the implications for coaching as a self-management intervention”, Australian journal of primary health, Vol. 9, no. 3, pp. 177-185. [link to PDF]
Hello Heather. It’s great to hear your perspective on the study. We are hoping to extend the research in this area soon. What might be of interest is the fact that we did further analysis of the intervention. We applied qualitative analysis techniques to the notes taken by the coach during the intervention and we have published the results. We were hoping to shed light on what aspect of the coaching was most effective. The majority of the time was spent on goal setting and action planning – but only after it was established that the person was ready for it. See the reference below for the details:
Iles, R. A., Taylor, N. F., Davidson, M., & O’Halloran, P. (2013). An effective coaching intervention for people with low recovery expectations and low back pain: A content analysis. Journal of Back and Musculoskeletal Rehabilitation. doi: 10.3233/BMR-130424