title: A brief report on the development of a theoretically-grounded intervention to promote patient autonomy and self-management of physiotherapy patients: face validity and feasibility of implementation.
abstract: BACKGROUND
  Clinical practice guidelines for the treatment of low back pain suggest the inclusion of a biopsychosocial approach in which patient self-management is prioritized. While many physiotherapists recognise the importance of evidence-based practice, there is an evidence practice gap that may in part be due to the fact that promoting self-management necessitates change in clinical behaviours. Evidence suggests that a patient's motivation and maintenance of self-management behaviours can be positively influenced by the clinician's use of an autonomy supportive communication style. Therefore, the aim of this study was to develop and pilot-test the feasibility of a theoretically derived implementation intervention to support physiotherapists in using an evidence-based autonomy supportive communication style in practice for promoting patient self-management in clinical practice.
  
  
  METHODS
  A systematic process was used to develop the intervention and pilot-test its feasibility in primary care physiotherapy. The development steps included focus groups to identify barriers and enablers for implementation, the theoretical domains framework to classify determinants of change, a behaviour change technique taxonomy to select appropriate intervention components, and forming a testable theoretical model. Face validity and acceptability of the intervention was pilot-tested with two physiotherapists and monitoring their communication with patients over a three-month timeframe.
  
  
  RESULTS
  Using the process described above, eight barriers and enablers for implementation were identified. To address these barriers and enablers, a number of intervention components were selected ranging from behaviour change techniques such as, goal-setting, self-monitoring and feedback to appropriate modes of intervention delivery (i.e. continued education meetings and audit and feedback focused coaching). Initial pilot-testing revealed the acceptability of the intervention to recipients and highlighted key areas for refinement prior to scaling up for a definitive trial.
  
  
  CONCLUSIONS
  The development process utilised in this study ensured the intervention was theory-informed and evidence-based, with recipients signalling its relevance and benefit to their clinical practice. Future research should consider additional intervention strategies to address barriers of social support and those beyond the clinician level.
authors.affiliation: Institute for Sport and Health, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland. james.matthews@ucd.ie.
authors.forename: James
authors.initials: J
authors.lastname: Matthews
authors.affiliation: The George Institute for Global Health, Nuffield Department of Population Health, The University of Oxford, Oxford, UK. amanda.hall@georgeinstitute.ox.ac.uk.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Hall
authors.affiliation: Institute for Sport and Health, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland. marian.hernon@ucdconnect.ie.
authors.forename: Marian
authors.initials: M
authors.lastname: Hernon
authors.affiliation: Institute for Sport and Health, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland. aileen.murray@ucdconnect.ie.
authors.forename: Aileen
authors.initials: A
authors.lastname: Murray
authors.affiliation: School of Sport Science, Exercise and Health, University of Western Australia, Perth, WA, Australia. ben.jackson@uwa.edu.au.
authors.forename: Ben
authors.initials: B
authors.lastname: Jackson
authors.affiliation: School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK. I.M.Taylor@lboro.ac.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Taylor
authors.affiliation: Department of Sport, Health and Exercise Science, University of Hull, Cottingham Road, Hull, HU6 7RX, UK. John.Toner@hull.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Toner
authors.affiliation: School of Psychology, University College Dublin, Belfield, Dublin, Ireland. Suzanne.guerin@ucd.ie.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Guerin
authors.affiliation: Institute for Positive Psychology and Education Faculty of Health, Australian Catholic University, Strathfield, NSW, Australia. Chris.Lonsdale@acu.edu.au.
authors.forename: Chris
authors.initials: C
authors.lastname: Lonsdale
authors.affiliation: Institute for Sport and Health, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland. deirdre.hurleyosing@ucd.ie.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Hurley
mesh_terms: D001521:Behavior Therapy; D003142:Communication; D005246:Feedback; D017144:Focus Groups; D006801:Humans; D017116:Low Back Pain / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D026684:Personal Autonomy; D026761:Physical Therapy Specialty; D011320:Primary Health Care; D015203:Reproducibility of Results; D012648:Self Care