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While physical therapy is rooted in optimizing movement, facilitating meaningful and long-term patient outcomes often comes down to the adoption of behavioral and lifestyle changes. An integral part of any physical therapy plan of care is identifying a patient's readiness for change and providing them with the appropriate guidance in navigating how to create the behavioral change necessary for them to reach their goals – this goes beyond exercise prescription. It’s viewing the patient through a holistic lens and creating a powerful therapeutic alliance to support them on their journey for long-term health outcomes.
Create a powerful therapeutic alliance with a holistic patient view
The therapeutic alliance is foundational to successful treatment. Establishing a trusting rapport built on active listening and inclusion of the patient in their own treatment will help the clinician not only connect with the patient but identify important factors that will guide decision-making when creating the plan of care.
What is the “why” behind the goal?
First and foremost, it’s always a good idea to ask the patient why they are coming to physical therapy so they can explain to you their reasoning in their own words. It’s easy to fall into the habit of making assumptions based on a referral or patient chart, but the patient may actually reveal completely different expectations. Take the time to sit with the patient and understand their hobbies, how they use their body every day, and what specific activities they want to be able to participate in. Additionally, ask them what they hope to achieve at the end of their treatment. This gives context to the goal from the perspective of the patient and helps you not only select more specific exercises and educational resources but identify early on what other behavior and lifestyle changes might need modifying.
Ultimately, even if your plan of care is evidence-based for the patient’s diagnosis and impairments if it doesn’t align with the patient’s expectations and they don’t understand how they will reach their specific goal, they are less likely to stay engaged. Furthermore, if you only focus on the impairment level without considering the patient’s lifestyle, you could potentially miss important opportunities for behavior change that will limit success.
How ready is the patient for change?
The Transtheoretical Model of Behavioral Change (TTM), or the Stages of Change Model, outlines six stages that people go through before making a behavioral change. Essentially, this model suggests that behavioral change is not immediate and is more cyclical in nature. The six stages are as follows:
- Precontemplation: people in this stage are not considering taking action to change in the near future and are often unaware that their behavior can be problematic. They may also believe that the cons of behavior change outweigh the pros.
- Contemplation: people in this stage are thinking about starting a healthy behavior in the near future (within the next six months) and are able to recognize the consequences of a particular behavior. They are more neutral toward pros and cons though they still may not be fully convinced to take action.
- Preparation (Determination): people in this stage are ready to take action (within 30 days) and start taking initiative toward change. They see the value in changing their behavior and believe it can help their health.
- Action: people in this stage have taken recent action toward behavioral change with the intention of continued action toward their goal/new behavior. This can be altering a problematic behavior or adding healthy behaviors to their lifestyle.
- Maintenance: people in this stage have demonstrated sustained behavior change (for greater than six months) with continued intentions of maintaining this new behavior in the future. These people may also battle with relapsing to earlier stages.
- Termination: people in this stage continue with their new behavior and do not have the desire to return to the prior behavior or relapse. This stage is challenging to reach, with many people remaining in the maintenance stage for prolonged periods.
Using this model, you can identify which stage of change your patient is in currently and provide them with the appropriate support for that stage. Although this is often overlooked, it is important because your approach should vary depending on the patient’s readiness for change. Listen for specific cues from the patient to help. The acronym “DARN CAT” can be helpful in identifying the patient's desire, perceived ability for change, commitment level, and if they’ve already taken steps towards making a change. More specifically DARN CAT stands for:
- Desire
- Ability
- Reason
- Need
- Commitment
- Activation
- Taking steps
Using this information, you can emphasize helpful beliefs the patient already holds while being mindful of more limiting mindsets and areas where further education and nurturing would help create a suitable environment for change. Then, you can use this same principle when encouraging patients to elicit further change talk.
Use motivational interviewing and elicit change talk
Once you’ve identified which stage of change your patient is at, be honest while exhibiting empathy. It is perfectly acceptable to meet the patient where they are and explain to them that they may not be ready to commit to therapy at this point in their life for a variety of reasons, and then offer them solutions that work for them while planting the seed for behavioral change in the future. Never do so in a condescending way as this might deter them from taking steps toward change in the future.
Using principles of motivational interviewing and change talk, you can collaborate with the patient and encourage them to talk about why this change is important to them, how this change will benefit their life, how they will feel when they achieve their goal, and how confident they are in changing their behavior. This can help the patient progress through the stages of change and keep them from losing interest or getting discouraged throughout the process. Additionally, using positively framed messages as opposed to emphasizing negative consequences of a behavior has been shown to be more effective at facilitating open communication and health behavior change.
Provide patients with the tools they need to be autonomous
It is also important to recognize as the provider the patient may not always agree with you. Instead of asserting authority, default to collaboration and understanding the patient’s point of view and concerns. Provide them with unbiased education so they can come to their own informed conclusions. Behavioral change should be the patient’s autonomous decision – meaning that they understand the benefits and have chosen to commit to change for themselves, including what actions to take first. Autonomous decision help boost engagement for the long-term.
Leverage technology for behavioral change
One of the best ways to keep patients motivated toward behavioral change is to provide them with a way to monitor their own progress. Often times patients feel discouraged because they are unable to recognize the smaller milestones and begin to see their efforts as futile. While praise is helpful, objective feedback offers better insight and the ability to track progress. Luckily, today’s technology, like OneStep, makes this easier than ever.
OneStep’s all-in-one remote physical therapy solution turns any smartphone into a clinically-validated gait and motion analysis lab – so patients and clinicians can view progress in real-time without any wearables. Patients receive immediate feedback on how they are performing and view their objective progress over time, keeping them motivated and more active in their own journey. Additionally, clinicians can customize video exercise programs that fit into the patient’s daily life and are easily adaptable to the patient’s feedback and performance. Since everything the patient needs to complete their plan of care is at their fingertips, they feel more autonomous and better informed throughout their journey. Plus, they can reach out to their therapist at any time for guidance and support within the app via chat and video messaging, improving the continuity of care and strengthening true collaboration.
Clinicians can view patient data within the OneStep clinic and use this information to not only guide their clinical decision-making but also their discussion with the patient to offer objective insight into their progress and adherence to their program. OneStep drives behavioral change through actionable and motivational motion feedback, a meaningful therapeutic alliance that fosters trust and accountability, and easy-to-follow daily routines that build long-lasting habits.
Want to learn more about how you can leverage OneStep’s digital health technology to encourage behavioral change and long-term outcomes in your patients? Get in touch today!
