Optimising Exercise Therapy to improve healthy movement behaviour in the patient’s context
Patiënten met langdurige spier- en gewrichtsklachten komen vaak bij de oefentherapeut, omdat zij pijn en beperkingen in het dagelijks leven ervaren. Om deze patiënten weer optimaal te laten bewegen, past de oefentherapeut verschillende behandelstrategieën toe, zoals motorisch leren, gedragsverandering en zelfmanagement. Patiënten hebben vaak moeite met het toepassen van ander beweeggedrag in de eigen leefomgeving, bijvoorbeeld op het werk, tijdens het sporten of gewoon thuis.
We ontwikkelen een online toolbox of app die patiënten en oefentherapeuten ondersteunt bij het succesvol aanpassen van beweeggedrag in de eigen leefomgeving van de patiënt.
Gericht op de dagelijkse toepassing van ander beweeggedrag in de eigen leefomgeving, gaan we in dit onderzoeksproject de kennis over behandelstrategieën van de oefentherapeut vergroten. Ook verzamelen we meer kennis over meetinstrumenten voor gezond bewegen in de leefomgeving van de patiënt.
Samenvatting van de aanvraag
OBJECTIVE(S)/RESEARCH QUESTION(S) The overall goal of this project is to optimise exercise therapy (ET) with potentially successful coaching strategies in the guidance of patients with chronic (>6 months) musculoskeletal pain in self-regulating their movement behaviour in their own context. In this project patients’ context is defined as the natural environment that includes physical, social, emotional, and personal dimensions. To realise this aim several sub-aims have been formulated. First, we will unravel ET-elements that successfully coach patients on movement behaviour in their own context. Experienced barriers, facilitators at patient and therapist level will be addressed. Second, we will investigate measurement tools assessing motor performance, self-management skills and behaviour change. Third, we will develop a web-based toolbox that supports patient and therapist in motor learning, self-management and behavioural change techniques and practical measurements. The feasibility of the platform will be tested in a pilot study. Fourth, we will set up an ET Research Community with people who share a concern or passion for ET-research, driven to innovate and improve ET-practice. The primary research question in this project is: ”How can we optimize exercise therapy to successfully coach patients with chronic musculoskeletal pain in self-regulating their movement behaviour and functioning (activities of daily living) in their own context?” STUDY DESIGN In WP1 we perform a systematic review, semi-structured interviews with patients and focus group sessions with therapists. In WP2 we perform a scoping review, a Delphi survey study with exercise therapists followed by semi-structured interviews with patients. In WP3 we will use 50 observations of actual use of ET treatment elements (motor learning, behavioural change, self- management) and how these elements are used to change patients’ movement behaviour and functioning in their own context. In WP4, we will develop a web-based toolbox and test it on feasibility constructs. In WP5, we will start a research community to create an infrastructure for a sustainable research programme. In WP6 we will monitor and manage the project. RESEARCH POPULATION Patients with chronic (>6 months) musculoskeletal pain. Musculoskeletal conditions, such as chronic low back pain, fibromyalgia, and osteoarthritis are associated with significant physical disability and an enormous burden to individuals and society. Exercise therapists predominantly see patients with chronic musculoskeletal pain. OUTCOME MEASURES WP1: movement behaviour and functioning (activities of daily living). Movement behaviour will be divided into quality of movement (eg. movement speed, coordination) and quantity of movement (intensity and duration of physical activity).As effect moderators, experiences of patients and therapists with facilitators and barriers towards movement behaviour and functioning in patients’ context are identified. Deliverable: framework for ET-elements. WP2: motor skills (motricity, gross motor skills, fine motor skills), behaviour change (stage of change, intention of/actual behaviour change), self management (self efficacy, goal setting, health beliefs). Deliverable: set of valid, reliable and applicable tools for measuring the outcomes of ET treatment elements. WP3: count of the actually applied ET elements in practice. WP4: feasibility of toolbox, include usability, usage, integration, implementation, and efficacy. Deliverable: a web-based toolbox. WP5/6: n.a. RELEVANCE Patients struggle to transfer newly learned movement behaviour, self-management skills and behaviour change from the treatment room to their own context. It is insufficiently known how and which ET- elements are used to improve functioning and movement behaviour in patients’ own context and how to measure these outcomes within the natural environment of patients. TIME SCHEDULE - WP 1: September 2021 until August 2022 (12 months). A literature search, semi-structured interviews with patients and focus group sessions with exercise therapists. - WP 2: September 2022 until August 2023 (12 months). A scoping review, Delphi survey study with exercise therapists, and a qualitative study with semi-structured interviews with patients - WP 3: September 2023 until April 2024 (8 months). Treatment observations in practice of patients - WP 4: January 2024 until August 2025 (20 months). Development of an online toolbox and conducting a feasibility study - WP 5: September 2022 and onwards (48 months).Search community meetings, signing letter of intent, establishing ET-Research Community. - WP 6: September 2021 until August 2025 (48 months). Management and communication activities