The public defense of Johanna Fritz’s doctoral thesis
The public defense of Johanna Fritz’s doctoral thesis in physiotherapy will take place at Mälardalen University, room Beta (Västerås Campus) at 13:15 on May 15, 2020.
Title: Implementation of a behavioural medicine approach in physiotherapy. Determinants, clinical behaviours, patient outcomes and the implementation process
Current research shows that a behavioural medicine approach in physiotherapy increases the ability to participate in daily activities and decreases sick leave in patients with persistent musculoskeletal pain. A behavioural medicine approach means that the physiotherapist systematically consider biopsychosocial factors of importance for the patient's activity and participation. Active patient involvement is central and behaviour change techniques are used. One in seven of the patients in primary health care suffers from persistent musculoskeletal pain. Therefore, the behavioural medicine approach needs to be implemented in primary health care. However, implementation of new methods is challenging and there are no studies describing successful implementation interventions of a behavioural medicine approach in physiotherapy. The overall aim of this thesis is therefore to develop and evaluate an intervention to support the implementation of a behavioural medicine approach in physiotherapy for patients with persistent musculoskeletal pain.
In study I, determinants of using a behavioral medicine approach in physiotherapy were identified. These were associated with the physiotherapist, the patient and the workplace. An implementation intervention, based on these determinants, was developed consisting of supervision in clinic, peer coaching, educational materials, individual goalsetting, video feedback, self-monitoring in a diary, stimulation of manager support and information leaflets for patients. The implementation intervention was tested during six months and the evaluation focused on physiotherapists' clinical behaviour change in study II, and effects on patients' health in study III. The results show that the physiotherapists changed their clinical behaviour immediately after the implementation period, but these changes were not sustained. The patients, treated by these physiotherapists, received no further health improvement compared to a control group. In study IV, a process evaluation was conducted in order to explain the impact mechanisms of the implementation intervention. Supervision in clinic, peer coaching, educational material and individual goalsetting were perceived as the most useful methods, supporting the implementation through external motivation, multiple learning methods, action planning, processing experiences and increasing self-efficacy beliefs.
The conclusion is that the thesis can contribute to increased understanding of the complexity of what affects implementation, as well as identifying promising methods and their impact mechanisms to support implementation. The thesis also highlights the importance of supporting sustainability of the physiotherapists’ clinical behaviour changes in order for the behavioural medicine approach to benefit the patients.