Implementing Motivational Interviewing Training for Physiotherapists Who Support Patients with Musculoskeletal Conditions: A Pilot Feasibility Study

Purpose:

Musculoskeletal (MSK) conditions are complex, affecting individuals across the UK. While physiotherapists (PTs) have increasingly adopted person-centred approaches, there remains a lack of clear implementation of behaviour change counselling in practice. Motivational Interviewing (MI), applied extensively in areas like substance misuse and education, has not been widely applied and researched in MSK physiotherapy. The purpose of this study was to develop and pilot an adapted MI training curriculum for PTs working with patients with MSK conditions (pwMSK), with a view to future refinement.

Patients and Methods:

This small single cohort pilot feasibility study co-created a 3.5-day MI curriculum which was utilised to train PTs without former MI experience. Eligible PTs worked in an NHS health board and held a caseload of pwMSK. Pre and post MI training, the MI Treatment Integrity 4.2.1. Tool was used as an outcome measure, alongside the Client Evaluation of MI, and Treatment Self-Regulation Questionnaires and Perceived Competence Scale, to evaluate implementation and impact in MSK physiotherapy. Threshold for feasibility was ten PTs screened, nine PTs recruited, 100% attendance at training, ≤ 20% drop out rate (DOR) for recorded consultation and 80% response rate (RR) to the post-training survey.

Results:

Pre-MI training, PTs were not MI-proficient yet were eager to learn. Delivering quality MI training was feasible, with 16 PTs screened and a convenience sample of nine recruited across three months in two sites. There was 100% attendance at the 3.5-day training, and 11% DOR for each post-training recorded consultation timepoint. At the final timepoint, one PT demonstrated full MI MITI proficiency, three PTs demonstrated MITI proficiency in three out of four subcomponents, one PT demonstrated proficiency in two subcomponents, one PT demonstrated proficiency in one subcomponent and one PT achieved improvement in technical skills below proficiency threshold. There was 100% RR to the post-training survey with 100% PTs rating improved confidence in MI adherence.

Conclusion:

A context-specific MI curriculum is feasible and improves PTs adherence to MI principles when working in the context of MSK care. This study had a small single cohort design, and a larger-scale cluster pre-post randomised controlled trial is recommended to establish the impact of MI training on patient health. Training should include reflective practice, focus on relational elements of MI and be tailored to clinical contexts. Long-term implementation strategies and patient involvement are essential for future research and practice.