Physiotherapists’ fidelity to delivery of a self-determination theory based, group self-management programme: needs supportive communication

Abstract

Background:According to self-determination theory (SDT), provider communication may influence patient’s self-regulation of self-management behaviours. Prior to delivering the SDT based, Self-Management of Osteoarthritis and Low back pain though Activity and Skills (SOLAS) group-based intervention, within the SOLAS cluster randomized controlled feasibility trial (Hurley et al., 2016), physiotherapists were trained to deliver the intervention using needs supportive communication. This study aimed to assess the fidelity of physiotherapists’ delivery of the SOLAS intervention using this needs supportive style overall and between individual physiotherapists. Methods:Eight physiotherapists were audio-recorded delivering all six SOLAS intervention classes (n=48). Two raters independently analysed recordings (50%; n=24) using an adapted version of the Health Care Climate Questionnaire (HCCQ). Mean and standard deviations (SD) were computed for the HCCQ. Intra-class correlation coefficients (ICC) evaluated inter-rater reliability. Differences in mean results across classes and between physiotherapists were calculated using linear mixed-effects modeling. Spearman’s rank correlation coefficients assessed the impact the following variables had on fidelity; class size, years qualified, group experience, previous communication training. Results:Physiotherapists were needs supportive during delivery (mean HCCQ (SD)= 5.4 (0.7)). All physiotherapists (n=8; 100%) demonstrated acceptable fidelity (mean HCCQ>4/7) with variability between them (range=4.5-6.2). Inter-rater agreement was excellent (ICC=0.81). Selected variables did not correlate with needs supportiveness. Discussion:Physiotherapists were fidelitous to the SOLAS intervention communication style. Fidelity was not affected by class size, years qualified, group experience or previous communication training. The effects of the SOLAS training programme on fidelity, and the evaluation of specific SDT intervention strategies are being undertaken to further explore fidelity.