Motivation to Return to Work Ross Iles Physiotherapist, Lecturer and PhD candidate School of Physiotherapy La Trobe University r.iles@latrobe.edu.au

Quick intro Who I am What I’m doing PhD on recovery expectations Project trialling coaching to encourage return to usual activities Focused on Primary Non Leisure Activity (PNLA) 83% of the people we spoke to that meant “work”

Background To see whether adding phone coaching improved outcomes Wanted people in sub-acute phase of back pain with low recovery expectations Randomly allocated people to usual physio care or physio plus coaching Measured outcomes 4 and 12 weeks later Patient Specific Functional Scale Oswestry Disability Index Recovery Expectation Pain Self Efficacy

The coaching A total of 5 telephone calls Based on the PSFS Once per week for 4 weeks Once more 3 weeks later Based on the PSFS PNLA and two other activities Heavily based on literature around change Motivational interviewing Importance of the change and Confidence to change are critical

Step 1 Of the three activities establish which one is most important It wasn’t always work Other activities people nominated included things like playing with the kids, being able to drive for more than 20 minutes Don’t assume the most important thing for the injured person is work

Defining Importance On a scale from 0 to 10, where 0 is not important at all and 10 is as important as it could be, how important is it for you to get back to _______ in four weeks? 0 1 2 3 4 5 6 7 8 9 10 Not important at all As important as it could be

Increasing importance If the score was below 7, the aim of the session was to increase importance Key strategies Motivational interviewing techniques Ask the person to look into the future Try to have the person identify the positives of being back at work When you are doing it well, you don’t say much!

Important to summarise! Make sure you repeat what the person has told you Summarise at the end and reassess the importance using the same question Be prepared for only a small change or no change at all Avoid giving advice, unless you have been given permission by the person to do so

Real examples Spent the night before sleeping in a shed Sorer the next day! Return to work not as important as getting back to the gym Nervous about RTW as boss unpredictable Later dealing with an unrelated unfair dismissal claim Brother has severe back pain and committed suicide Driving the kids to school important as had already relied on others too much

Your turn Think of a health behaviour that you would like to change Drink less Exercise more Get more sleep Lose weight

Importance On a scale from 0 to 10, where 0 is not important at all and 10 is as important as it could be, how important is it for you to get back to _______ in four weeks? 0 1 2 3 4 5 6 7 8 9 10 Not important at all As important as it could be

How did it feel? Any change to your importance? Different to a usual consultation? So, with that same health behaviour in mind…

Confidence On a scale from 0 to 10, where 0 is not confident at all and 10 is as confident as it could be, how confident are you that you will get back to _______ in four weeks? 0 1 2 3 4 5 6 7 8 9 10 Not confident at all As confident as you could be

Differences? Did you find rating your confidence was very different to rating importance? What things did you consider? Did you think of the barriers to making it happen? What would increase your confidence?

Increasing confidence If the score was below 7, the aim of the session was to increase confidence Key strategies Identifying individual strengths When in the past have they recovered? When in the past have they successfully managed change? What are the characteristics of someone they admire? What characteristics do they share?

Identifying barriers Ask the person what things they see could prevent them from succeeding What things do they think they can do to avoid them being a problem? Again, if you are doing it well, you don’t say much! If given permission, suggest some strategies that have worked for others

Don’t forget to summarise List off the things that are likely to make the person more confident Reassess with the same question Goal setting is important too SMART goals Let the person identify their goals, they will mean much more!

Real examples Confidence increasing from 5/10 to 8/10 in one session Phone call “inspired me to go for my walk today” “Now I remember all the yoga and things, probably a 6” “Normally I would stop at almost better” Regular contact and reinforcement very helpful

Outcomes of the research Coaching group were significantly better PSFS average score Recovery expectation Large effect (but not shown statistically) Oswestry score Primary Non-Leisure Activity Pain self efficacy

Summary Don’t assume work is the most important thing to the worker Being injured means change Importance + confidence make change much more likely The less you say, the more motivation will increase! Avoid giving advice!

Questions?