TTM-based motivational counselling does not increase physical activity of low back pain patients in a primary care setting—A cluster-randomized controlled trial

Leonhardt, Corinna; Keller, Stefan; Chenot, Jean-François; Luckmann, Judith; Basler, Heinz-Dieter; Wegscheider, Karl; Baum, Erika; Donner-Banzhoff, Norbert; Pfingsten, Michael; Hildebrandt, Jan; Kochen, Michael M.; Becker, Annette

doi:10.1016/j.pec.2007.09.018

« Previous Next »Patient Education and Counseling
Volume 70, Issue 1 , Pages 50-60, January 2008

TTM-based motivational counselling does not increase physical activity of low back pain patients in a primary care setting—A cluster-randomized controlled trial

Corinna Leonhardt
- Institute for Medical Psychology, University of Marburg, Germany
- Corresponding author at: Institute for Medical Psychology, Philipps-University of Marburg, Bunsenstraße 3, 35037 Marburg, Germany. Tel.: +49 6421 28 63774; fax: +49 6421 28 64881.
Stefan Keller
- Department of Public Health Sciences, University of Hawaii at Manoa, USA
Jean-François Chenot
- Department of General Practice, University of Göttingen, Germany
Judith Luckmann
- Institute for Medical Psychology, University of Marburg, Germany
Heinz-Dieter Basler
- Institute for Medical Psychology, University of Marburg, Germany
Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University of Hamburg, Germany
Erika Baum
- Department of General Practice, Preventive and Rehabilitation Medicine, University of Marburg, Germany
Norbert Donner-Banzhoff
- Department of General Practice, Preventive and Rehabilitation Medicine, University of Marburg, Germany
Michael Pfingsten
- Department of Anaesthesiology, Pain Clinic, University of Göttingen, Germany
Jan Hildebrandt
- Department of Anaesthesiology, Pain Clinic, University of Göttingen, Germany
Michael M. Kochen
- Department of General Practice, University of Göttingen, Germany
Annette Becker
- Department of General Practice, Preventive and Rehabilitation Medicine, University of Marburg, Germany

Received 23 April 2007; received in revised form 25 July 2007; accepted 23 September 2007.

Abstract

Objective

To investigate the effectiveness of a TTM-based motivational counselling approach by trained practice nurses to promote physical activity of low back pain patients in a German primary care setting.

Methods

Data were collected in a cluster-randomized controlled trial with three study arms via questionnaires and patient interviews at baseline and after 6 and 12 months. We analysed total physical activity and self-efficacy by using random effect models to allow for clustering.

Results

A total of 1378 low back pain patients, many with acute symptoms, were included in the study. Nearly 40% of all patients reported sufficient physical activity at baseline. While there were significant improvements in patients’ physical activity behaviour in all study arms, there was no evidence for an intervention effect.

Conclusion

The outcome may be explained by insufficient performance of the practice nurses, implementation barriers caused by the German health care system and the heterogenous sample.

Practice implications

Given the objective to incorporate practice nurses into patient education, there is a need for a better basic training of the nurses and for a change towards an organizational structure that facilitates patient–nurse communication. Counselling for low back pain patients has to consider more specificated aims for different subgroups.

Keywords: Physical activity, Low back pain, Motivational counselling, Primary care