Communication style and exercise compliance in physiotherapy (CONNECT). A cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients’ adherence to physiotherapists’ recommendations: study rationale, design, and methods

Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist’s recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients’ autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists’ recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists’ autonomy-supportive communication on low back pain patients’ adherence to physical activity and exercise therapy recommendations. \ud \ud This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded. \ud \ud We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects. \ud \ud This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients’ adherence to rehabilitation recommendations. Current Controlled Trials ISRCTN63723433\u

Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis

Supported by F. Hoffmann–La Roche

Outcome one year post severe traumatic brain injury: About a Tunisian population

AimThe main objective of this study was to investigate the epidemiological characteristics, functional and socio-professional outcome of a population of individuals one year after a severe traumatic brain injury (TBI).MethodsThe following parameters were analysed: profession, mechanism of trauma, period of care in rehabilitation, initial GCS, imaging results, nature of neuro-orthopedic sequelae, cognitive disorders, and functional level assessed by the FIM (Functional Independence Measure). The handicap was evaluated by the Glasgow outcome scale (GOS).The socio-professional status after TBI (lifestyle, occupation and education) was also investigated.ResultsThe average age of the 50 patients included in the study was 28.1±15.3 years, mostly male (76%). Length of stay in functional rehabilitation averaged 8.7±14.7 months. All patients included in this study were socially active before the accident and lived with their family. Only 7 patients had returned to work and only 8 patients had resumed their schooling. Problems with memory, executive functions and thinking were reported in 42% of cases. The behavioural troubles (frontal syndrome and emotional problem health) were noted in 40% of cases. The average value of the FIM was 84.1±29. According to the GOS, 30% of patients had a good recovery, and 2 patients remained in persistent vegetative state.DiscussionOur study population is relatively young and predominantly male. Rehabilitation management takes place very late and the rate of socio-professional reintegration is very low. These findings highlight the importance of providing coordinated medical rehabilitation and intensive care unit to promote social outcomes after severe TBI