Database of Knowledge Translation Tools Intervention Summary

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1 Database f Knwledge Translatin Tls Interventin Summary 1. Mtivatinal Interviewing (MI) t Increase Physical Activity in Peple with Chrnic Health Cnditins Summary Authr: Egil Hvland, PT Date Published: Pending 2. Interventin Descriptin Brief summary: MI has evidence t supprt its use in practice fr treatment f addictin, depressin, and ther areas. Hwever, studies n increasing physical activity in peple with chrnic health cnditins are incnclusive. Fr this reasn, we cannt make a recmmendatin related t use f this practice fr this purpse at this time. We will cntinue t mnitr the research and prvide updates as they are available. Descriptin and Purpse f the Mtivatinal Interviewing (MI): 1,2 MI is a directive, client-centered, and gal-directed cunseling apprach used t elicit behavir change by helping clients t examine and reslve ambivalence Mst centrally defined as a facilitative style fr interpersnal relatinship The Nrwegian Health Authrities state that mtivatinal cnversatin is a cperative style f cnversatin with the purpse f strengthening a persn s mtivatin and engagement related t change. MI research cnsists f trials with a variety f interventin dses, ranging frm ne sessin by phne up t multiple sessins ver lnger perids f time. 3. Cnsideratins fr Clinical Use Knwledge Expert grup summary n ECM: There is a lack f evidence t supprt use MI in patients with chrnic health cnditins, therefre, we cannt make a recmmendatin at this time. Cnsideratins: Research in ther fields has demnstrated a significant effect fr reductin f bdy mass index, ttal bld chlesterl, systlic bld pressure, bld alchl cncentratin, and standard ethanl cntent. 3 This summary specifically lked at use f MI t increase physical activity, cardirespiratry fitness, r functinal exercise capacity. Specific articles reviewed included samples f adults (>18 years) with a chrnic health cnditin defined as a lng-term cnditin managed by a medical practitiner r allied health prfessinal. Outcmes assessed in the studies included physical activity, cardirespiratry fitness, and functinal exercise capacity Physical activity was measured by an accelermeter, pedmeter, questinnaire, r self-reprt Cardirespiratry fitness was measured by VO2 Max r VO2 peak Functinal exercise capacity was measured by walk tests The impact f the dse culd nt be determined. Details abut the duratin f sessins and adherence were ften nt prvided. Hwever, a larger effect was seen with higher levels f participatin in MI interventin. 4 Page 1 f 6

2 4. Overview f the Literature Brief verview f theretical basis fr MI: 3 Relies upn identifying and mbilising the client's intrinsic values and gals t stimulate behaviur change Mtivatin t change is elicited frm the client. Readiness t change is nt a client trait, but a fluctuating prduct f interpersnal interactin Resistance and denial is ften a signal t mdify mtivatinal strategies Eliciting and reinfrcing the client's belief in ability t carry ut and succeed in achieving a specific gal is essential The therapeutic relatinship is a partnership with respect f client autnmy Systematic reviews r meta-analysis n MI: Alperstein and Sharpe, 2016: 1 Meta-analysis and systematic review Assessed the effects f MI n imprving adherence t exercise, pain, and physical functin n patients with chrnic pain Included: 7 RCTs Cmpared individuals with chrnic pain wh received MI with an inactive cntrl grup (i.e. attentin, placeb r wait-list grup) Included studies f MI prvided in cnjunctin with ther treatments as lng as this was cntrlled fr in the ther arm. Adherence: Baseline t after interventin: Small t mderate effect (Hedges g =.441, 95% CI: , p =.017) Baseline t 6-mnth fllw-up: Nt significant (Hedges g =.235, 95% CI: t.581; p =.153) Pain intensity Baseline t after interventin: Small t mderate effect (Hedges g =.270, 95% CI: , p =.022) Baseline t 6-mnth fllw-up: Nt significant (Hedges g =.100, 95% CI: t.259; p =.214) Physical functining: Nt significant frm baseline t immediately fllwing MI, r baseline t fllw-up in any studies Kunnskapssenteret 2015 (The Nrwegian center fr knwledge; O Hallran et al ): A summary featured by Kunnskapssenteret stated: 5 MI may increase shrt-term physical activity in persns with lng-term health related challenges (Small effect, SMD 0.19, 95% CI: 0.6 t 0.32) MI prbably has minimal t n effect n functinal training capacity in MS and Fibrmyalgia (SMD =.13; 95% CI: 0.08 t 0.34) Very few studies assessed the impact f MI n Cardirespiratry capacity, thus nt reprted. Primary studies included in Alperstein and Sharpe and O Halleran et al, described belw Chrnic Pain Habib et al, 2005, Chrnic pain 6 : Significant changes in adherence nly Quality Rating 13 (Pr, determined by Alperstein and Sharpe 1, 2016) Adherence t attendance t pain management prgram (n= 39, cntrls n=39) Experimental: 2 sessins f MI, including 1-1,5 hurs assessment based and 1,5 hurs feedback Page 2 f 6

3 Cntrl interventin: Tw sessins 1:1 treatment, 5 hurs standard pain assessment and feedback interviews Adherence changes baseline t pst-test, Mderate t Large change (hedges g = 0.649, 95% CI: , p =.007) Miller et al, 2013, (Chrnic Pain) 7 : N significant changes in pain intensity Quality rating 12 (pr, determined by Alperstein and Sharpe 1, 2016) Interventins: MI-based feedback f the ral histry interview Insignificant changes in pain intensity Lw Back Pain: Basler et al, 2007, lw back pain 8 : N significant changes in functining Quality Rating 28 (Excellent, determined by Alperstein and Sharpe, ) Adherence t prescribed physical activity (average duratin f physical activity per day) measured by an exercise lg bk Interventins prvided: (MI: n=86, Cntrl: n=84) MI: 10 Trans-Theretical Mdel (TTM-based) standardized cunseling befre each physitherapy sessin; 20 minutes standardized PT ver 5 weeks with hmewrk Cntrl: Placeb ultrasund with inactive device; 20 minutes standardized PT ver 5 weeks with hmewrk Functining: changes were nt significant Vng et al, 2011, lw back pain 9 : Significant change in adherence, N significant change in functin and pain Quality rating 24 (excellent, determined by Alperstein and Sharpe 1, 2016) Interventins prvided: (MI: n=45, Cntrls: n=43) Mtivatinal enhancement therapy (MET) delivered during PT (10, 30-min sessins ver 8 weeks) Cntrl interventin, usual cmmunicatin skills during PT (10, 30-min sessins ver 8 weeks) Adherence t prescribed physical activity, measured by an exercise lg bk: Significant imprvements Baseline t Pst, Large change (Hedges g 1.216, 95% CI: ) Functining, measured by Rland-Mrris Disability Questinnaire: insignificant effect Pain intensity: insignificant effect Lenhardt et al, 2008, lw back pain 10 : N significant changes in adherence, functin, and pain intensity Quality rating 20 (excellent, determined by Alperstein and Sharpe 1, 2016) Interventins prvided: (MI: n=101, cntrls n=104) MI: 1 t 3 TTM-based sessins (15 t 20 min) Cntrl interventin, general PR actiner delivered guidelines Adherence t physical activity measured by the Freiburger Questinaire: Insignificant changes Physical functining measured by the Hannver Functinal Disability Questinnaire: Insignificant changes Pain intensity: Insignificant changes Rheumatid Arthritis Zwikker et al, 2012, Rheumatid Arthritis 11 : Significant change in pain intensity, n significant change in adherence and physical functining Quality rating 28 (excellent, determined by Alperstein and Sharpe 1, 2016) Interventins prvided (MI: n=57, Cntrls n=60) MI: Tw MI-based grup sessins, 5-7 peple per grup, 1wk apart Cntrls: Recipient f cnjunct treatment Results Page 3 f 6

4 Adherence t prescribed medicatin measured by the Cmpliance Questinnaire Rheumatlgy: Insignificant Physical functining measured by Health Assessment Questinnaire Disability Index: Insignificant Pain intensity: Significant, small t mderate changes (Hedges g.488, 95% CI: t.509) Neurlgic Rehabilitatin Ppulatins Ang et al. 2013, Fibrmyalgia 12 : N significant changes in physical activity r cardirespiratry capacity Interventins: bth grups received an aerbic exercise prescriptin and 2 individuals supervised exercise sessins; Exercise intensity (40-50% f heart rate reserve), duratin (10-12 minutes/sessin), frequency (2-3 times/day) MI: 6 telephne calls ver 12-weeks (n=107) Cntrl: Didactic health infrmatin n a variety f tpics (n=109) N significant differences in physical activity and cardirespiratry capacity (measured by accelermeter ver 7 days, CHAMPS (typical day), 6 min walk test immediately fllwing (p =.13) r 6- mnths pst (p =.40) Bmbardier et al. 2013, Multiple Sclersis 13 : Significantly greater physical activity in MI grup Interventin: MI: Single in-persn sessin (60-90 min), fllwed by 5 telephne sessins (30-min, weeks 1,2,3,8, 12) (n=44) Cntrl: N treatment (n=48) Adherence nt measured Health Prmting lifestyle prfile: Significantly greater physical activity in MI grup Obesity Befrt et al. 2008, Obesity 14 : N significant difference between grups Interventin: Weight lss prgram + MI r Weight lss + health educatin MI: Sessins delivered at 0 (in-persn), 3 (by phne), 8 (in-persn), and 13 (by ph ne) weeks (n=21) Cntrl: Health educatin using the same delivery frmat as MI (n = 23) Results Adherence measured by sessin adherence, self-mnitring lgs: N significant difference between grups Physical activity measured by CHAMPS: Mderate effect (SMD 0.5; 95% CI: t 0.64 at 95% CI); Hwever, n significant difference between grups Carels et al 2007, Obesity 15 : Significant imprvements in MI grup n physical activity lgs Interventin grups: MI: 20-sessin weight lss prgram + Stepped care (included MI weekly x minutes) (n=19) Cntrl: 20-sessin weight lss prgram (n=16) Adherence nt measured Physical activity: Physical Activity lgs: Significant imprvements in MI grup (58 min mre) Submaximal graded exercise test: N significant differences Greaves et al 2008, Obesity 16 : N significant differences Interventin grups: Infrmatin leaflets (n=36) Results Behaviral cunselling (MI): ~11 sessins ver 6 mnths, Cmbinatin f 1:1 meetings and telephne cntact, mean 34 minutes per cntact (n=49) Physical activity measured by Mdifiable Activity Questinnaire: N significant differences Page 4 f 6

5 Cardiac Rehabilitatin Ppulatins Hardcastle et al, 2008, besity-, verweight-, hypertensin-, hyperchlesterlemia- patients 4 : Significant differences in ttal physical activity and walking minutes/week Interventin grups Experimental: Standard exercise and nutritin infrmatin + up t 5 face-t-face sessins (20-30 minutes) ver 6-mnths (n=203) Cntrls: Standard infrmatin prvided (n=131) Results Adherence: 2.0 cunselling sessins attended Physical activity measured by Shrt interview versin f the IPAQ Vigrus t mderate vigrus activity: N significant differences Ttal physical activity: Significant difference Walking minutes/week: Significant difference (114 min/week mre) Reid et al, 2011, acute crnary syndrmes 17 : N t minimal effect Interventins MI: ne face-t-face and 8 telephne cntacts ver 52 weeks delivered by PT (n=69) Cntrl: written infrmatin abut a walking prgram and physical activity advice (n=72) Adherence t MI sessin attendance: 100% at first sessin t 83% at last sessin Physical activity 7 day recall interview: N t minimal effect at 6 mnths (Chen s d = -.40) and 12 mnths (Chen s d = -.27) Gdin leisure time physical activity questinnaire: N t minimal effect at 6 mnths (Chen s d = -.44) and 12 mnths (Chen s d = -.36) Pedmeter ver 7 days: N t minimal effect at 6 mnths (Chen s d = -.05) and 12 mnths (Chen s d = -.15) 5. Links t ther relevant resurces: Websites: 6. References: Literature 1. Alperstein D, Sharpe L. The Efficacy f Mtivatinal Interviewing in Adults With Chrnic Pain: A Meta-Analysis and Systematic Review. The jurnal f pain : fficial jurnal f the American Pain Sciety. 2016;17(4): O'Hallran PD, Blackstck F, Shields N, et al. Mtivatinal interviewing t increase physical activity in peple with chrnic health cnditins: a systematic review and meta-analysis. Clinical rehabilitatin. 2014;28(12): Rubak S, Sandbaek A, Lauritzen T, Christensen B. Mtivatinal interviewing: a systematic review and metaanalysis. The British jurnal f general practice : the jurnal f the Ryal Cllege f General Practitiners. 2005;55(513): Hardcastle S, Taylr A, Bailey M, Castle R. A randmised cntrlled trial n the effectiveness f a primary health care based cunselling interventin n physical activity, diet and CHD risk factrs. Patient educatin and cunseling. 2008;70(1): Kurtze N, Sprstøl Fønhus M. Blir man mer fysisk aktiv av mtiverende samtale? 2018; 6. Habib S, Mrrissey S, Helmes E. Preparing fr pain management: a pilt study t enhance engagement. The jurnal f pain : fficial jurnal f the American Pain Sciety. 2005;6(1): Miller LR, Can A, Wurm LH. A mtivatinal therapeutic assessment imprves pain, md, and relatinship satisfactin in cuples with chrnic pain. The jurnal f pain : fficial jurnal f the American Pain Sciety. 2013;14(5): Basler HD, Bertalanffy H, Quint S, Wilke A, Wlf U. TTM-based cunselling in physitherapy des nt cntribute t an increase f adherence t activity recmmendatins in lder adults with chrnic lw back pain--a randmised cntrlled trial. Eurpean jurnal f pain (Lndn, England). 2007;11(1): Vng SK, Cheing GL, Chan F, S EM, Chan CC. Mtivatinal enhancement therapy in additin t physical therapy imprves mtivatinal factrs and treatment utcmes in peple with lw back pain: a randmized cntrlled trial. Archives f physical medicine and rehabilitatin. 2011;92(2): Page 5 f 6

6 10. Lenhardt C, Keller S, Chent JF, et al. TTM-based mtivatinal cunselling des nt increase physical activity f lw back pain patients in a primary care setting--a cluster-randmized cntrlled trial. Patient educatin and cunseling. 2008;70(1): Zwikker H, van den Bemt B, van den Ende C, et al. Develpment and cntent f a grup-based interventin t imprve medicatin adherence in nn-adherent patients with rheumatid arthritis. Patient educatin and cunseling. 2012;89(1): Ang DC, Kaleth AS, Bigatti S, et al. Research t encurage exercise fr fibrmyalgia (REEF): use f mtivatinal interviewing, utcmes frm a randmized-cntrlled trial. Clin J Pain. 2013;29(4): Bmbardier CH, Ehde DM, Gibbns LE, et al. Telephne-based physical activity cunseling fr majr depressin in peple with multiple sclersis. Jurnal f cnsulting and clinical psychlgy. 2013;81(1): Befrt CA, Nllen N, Ellerbeck EF, Sullivan DK, Thmas JL, Ahluwalia JS. Mtivatinal interviewing fails t imprve utcmes f a behaviral weight lss prgram fr bese African American wmen: a pilt randmized trial. Jurnal f behaviral medicine. 2008;31(5): Carels RA, Darby L, Cacciapaglia HM, et al. Using mtivatinal interviewing as a supplement t besity treatment: a stepped-care apprach. Health Psychl. 2007;26(3): Greaves CJ, Middlebrke A, O'Lughlin L, et al. Mtivatinal interviewing fr mdifying diabetes risk: a randmised cntrlled trial. The British jurnal f general practice : the jurnal f the Ryal Cllege f General Practitiners. 2008;58(553): Reid RD, Mrrin LI, Higginsn LA, et al. Mtivatinal cunselling fr physical activity in patients with crnary artery disease nt participating in cardiac rehabilitatin. Eurpean jurnal f preventive cardilgy. 2012;19(2): Page 6 f 6