1. Motivation to Return to Work
Ross Iles
Physiotherapist, Lecturer and PhD candidate
School of Physiotherapy
La Trobe University

2. 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”

3. 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

4. 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

5. 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

6. 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?
Not important at all
As important as it could be

7. 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!

8. 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

9. 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

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

11. 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?
Not important at all
As important as it could be

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

13. 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?
Not confident at all
As confident as you could be

14. 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?

15. 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?

16. 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

17. 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!

18. 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

19. 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

20. 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!

21. Questions?