Purpose: Physical activity counselling is effective at increasing physical activity when delivered in healthcare but is not routinely practised. Part 1 of the Brief Physical Activity Counselling by Physiotherapists (BEHAVIOUR) study aimed to determine: 1) current use of physical activity counselling by physiotherapists working within publicly funded hospitals in a local health district in Australia; 2) influences on this behaviour.

Methods: Cross-sectional survey as part of pre-implementation work to inform the development of implementation strategies to be tested in a planned hybrid type II implementation-effectiveness cluster randomised controlled trial. The survey investigated physiotherapists’ frequency of incorporating 15 different elements of physical activity counselling into their usual healthcare interactions, and 53 potential influences on their behaviour framed by the Capabilities, Opportunities, Motivation- Behaviour (COM-B) behaviour change theoretical model.

Results: The survey sample comprised 84 physiotherapists (79% female, 48% <5 years of experience). Physiotherapists reported using on average 5 (SD:3) elements of physical activity counselling with at least 50% of their patients who could be more active. 70% of physiotherapists raised or discussed overall physical activity, but less than 10% measured physical activity or contacted community physical activity providers. Physiotherapists generally indicated good motivation in acknowledging their role in providing physical activity counselling in routine care (only 1% agreed this was not part of a physiotherapist’s job). The most common barriers were related to “opportunity”, with 57% indicating difficulty locating suitable community physical activity opportunities and >90% indicating their patients lacked financial and transport opportunities. Barriers related to capability were also reported including lack of knowledge of evidence supporting physical activity counselling (62%) and what local physical activity opportunities exist (61%), and lack of skills in how to measure physical activity, make action plans and locate and make referrals to community services.

Conclusions: Survey findings confirm that key elements of physical activity counselling are not routinely incorporated in physiotherapy practice and that barriers to this behaviour relate to physiotherapists’ opportunity, capability and to a lesser extent motivation. Implementation strategies should include both education and training as well as tailored strategies to support local team solutions to enhance community physical activity referral. 

Purpose: Insufficient physical activity (PA) is a critical public health issue especially in the context of COVID-related deconditioning. Health professionals are well placed to promote community-based PA but there is little supporting implementation research. We aimed to explore physiotherapists’ knowledge, views, attitudes and experiences regarding the promotion of physical activity, exercise and sport within daily clinical practice in order to guide development of strategies to support implementation of PA promotion by physiotherapists, in particular those treating older people, and adults and children with a disability.

Methods: We conducted a cross-sectional survey of physiotherapists working in public hospitals in Sydney, Australia.  We followed this with a qualitative study with interviews and focus groups with 39 physiotherapists. Two researchers coded transcripts with an iterative coding approach. Thematic analysis involved a reflective approach with the use of “critical friends” to challenge interpretations.

Results: Survey data was collected from 84 physiotherapists from six hospitals.  Half of the physiotherapists promoted physical activity frequently or often. Advice regarding participation in structured sport and exercise was less frequent. Those working with children and who were more experienced were more likely to promote PA.
Qualitative analysis returned five main themes: putting principles into practice; working with conflicting priorities; multiple client barriers; connections build confidence; and the battle for information. The physiotherapists accepted their legitimate role in PA promotion. Limited clinical and administrative time and acute treatment priorities often superseded PA promotion but the lack of updated information regarding suitable community-based PA opportunities and lack of trust in community providers were the biggest barriers.

Conclusions: Strategies to enhance PA promotion by physiotherapists should address time and information constraints and build partnership connections between health professionals and community-based PA providers.

Purpose: Therapeutic alliance is a pivotal component of person-centred healthcare. It can enhance program engagement and adherence, and improve treatment outcomes and satisfaction, but it is poorly operationalised. We aimed to develop an empirical model that describes how therapeutic alliances can be operationalised in clinical and research settings, and used this model to enhance our evaluation of the Coaching for Healthy Ageing (CHAnGE) trial.  

Methods: We conducted a literature scan followed by secondary analysis of interviews with participants in the CHAnGE trial (n=32) who were purposively recruited for maximum variability, plus a focus group with the physiotherapists who delivered health coaching in that trial (n=3). Analysis was inductive (thematic) and deductive (using a therapeutic alliance model derived from a literature review and informed by earlier analyses).

Results: Therapeutic alliance is founded on four ‘building blocks’: 1. Collaborative decision-making between clients and practitioners involving negotiated goals and activities, and open exchange of information and views, 2. Trusting person-centred relationships underpinned by practitioner credibility, benevolence, dependability and authenticity, 3. Professional practitioner skills incorporating technical and relational skills, positivity and reflective practice, and 4. Structural supports ensuring responsivity, privacy and resourcing. Findings indicated that health coaching in our intervention built highly effective therapeutic alliances, powerfully influencing participants to engage with and sustain physical activity. Four CHAnGE intervention components were identified as strengthening this alliance: empowerment-focused health coaching training; home visits; the coaching format (the duration and intensity of phone coaching with a dedicated coach), and provision of free activity monitors.

Conclusion: This study identifies key concepts and practical ‘building blocks’ of therapeutic alliance, showing how these were successfully operationalised within an intervention. This may help those in clinical and research settings to recognise the importance and characteristics of therapeutic alliance and put it into practice as a core strategy for optimising engagement and outcomes.