Motivational strategies for returning patients with low back pain to usual activities: A survey of physiotherapists working in Australia.

Timely resumption of usual activities is integral to successful functional outcomes in individuals with low back pain (LBP). Little is known about how physiotherapists motivate their patients achieve this. This study examined physiotherapists' knowledge, reported usage and training in a set of 12 motivational strategies. The results of an online cross sectional survey of 170 Australian physiotherapists were compared descriptively, and potential associations between therapist training and strategy use, confidence and perceived effectiveness analysed. Participants considered it extremely important to motivate individuals with LBP to return to usual activities and most commonly reported managing this aspect of treatment exclusively. Active goal setting was the most recognised motivational strategy and transtheoretical based counselling the least recognised. Provision of verbal information and praise/encouragement were reported as the most frequently used strategies. The most common reasons for not using a familiar motivational strategy were time constraints and lack of training. Training in active goal setting was associated with greater use, confidence and perceived effectiveness and was most commonly perceived as moderately effective. Cognitive behavioural therapy was well recognised and training associated with greater use and confidence but not perceived effectiveness. Motivational interviewing was known to approximately half of respondents, consistent with its infancy in LBP and training was not associated with use, confidence or perceived effectiveness. Further research into clearly defined, time efficient and physiotherapy specific motivational interventions for individuals ambivalent to returning to usual activities following an episode of low back pain, may help address the issues identified by the current survey.