TTM-based counselling in physiotherapy does not contribute to an increase of adherence to activity recommendations in older adults with chronic low back pain – A randomised controlled trial

• Published in: European journal of pain 2007-01, Vol.11 (1), p.31-37
• Main Authors: Basler, Heinz-Dieter, Bertalanffy, Helmut, Quint, Sabine, Wilke, Axel, Wolf, Udo
• Format: Article
• Language: English
• Subjects: Activities of Daily Living - psychology; Adherence; Age Factors; Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Counseling - statistics & numerical data; Counseling - trends; Elderly; Exercise Therapy - statistics & numerical data; Exercise Therapy - trends; Exercise Tolerance - physiology; Female; Humans; Low back pain; Low Back Pain - diagnostic imaging; Low Back Pain - psychology; Low Back Pain - therapy; Male; Models, Psychological; Pain Medicine; Patient Compliance - psychology; Patient Compliance - statistics & numerical data; Physical activity; Physical Therapy Modalities - psychology; Physical Therapy Modalities - statistics & numerical data; Physical Therapy Modalities - trends; Placebo Effect; Prospective Studies; Transtheoretical model; Treatment Outcome; Ultrasonography
• ISSN: 1090-3801; 1532-2149
• DOI: 10.1016/j.ejpain.2005.12.009

Abstract Aims The present study examines the outcome of counselling in physiotherapy based on the Transtheoretical Model (TTM) in a sample of elderly individuals with chronic low back pain. Methods In a prospective randomised trial with concealed assignment, elderly individuals with chronic low back pain were allocated to two treatment conditions. Both contained 10 sessions of physiotherapy, each of 20 min duration. In addition, the experimental group (EG) received 10 min counselling prior to every session based on the TTM, also provided by the physiotherapist, and the control group (CG) underwent a placebo ultrasound treatment with an inactivated device to control for the additional attention given to the EG. Assessments took place prior to the treatment (t1), immediately after termination of the treatment (t2), and at a 6-months follow-up. Outcome measures were physical activity calculated from one-week activity diaries, self-reported functional capacity, and range of motion measured by ultrasound topometry. Results A total of 170 individuals (64% female) with a mean age of 70.3 years (SD = 4.4, range 65–84) participated in the study. The retention rate was 90%. At t3, both EG and CG showed increased physical activity and functional capacity, but no change in range of motion. Effect sizes were large. Contrary to our hypothesis, however, motivational training did not result in a better outcome compared with placebo treatment. Conclusion The study does not provide evidence that a short TTM-based motivation programme is superior to placebo treatment regarding adherence to activity recommendations.