title: TTM-based motivational counselling does not increase physical activity of low back pain patients in a primary care setting--A cluster-randomized controlled trial.
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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute for Medical Psychology, University of Marburg, Germany. cleonhar@med.uni-marburg.de
authors.forename: Corinna
authors.initials: C
authors.lastname: Leonhardt
authors.forename: Stefan
authors.initials: S
authors.lastname: Keller
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Chenot
authors.forename: Judith
authors.initials: J
authors.lastname: Luckmann
authors.forename: Heinz-Dieter
authors.initials: HD
authors.lastname: Basler
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Erika
authors.initials: E
authors.lastname: Baum
authors.forename: Norbert
authors.initials: N
authors.lastname: Donner-Banzhoff
authors.forename: Michael
authors.initials: M
authors.lastname: Pfingsten
authors.forename: Jan
authors.initials: J
authors.lastname: Hildebrandt
authors.forename: Michael M
authors.initials: MM
authors.lastname: Kochen
authors.forename: Annette
authors.initials: A
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003376:Counseling; D015444:Exercise; D005194:Family Practice; D005260:Female; D005858:Germany; D006801:Humans; D017116:Low Back Pain / Q000451:nursing / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009042:Motivation; D010349:Patient Compliance; D017064:Process Assessment, Health Care; D012044:Regression Analysis