The Effect of Physiotherapy Integrated Motivational Interviewing and Smartphone Technology to Increase Physical Activity in Patients with Low Back Pain: A Cluster Randomised Controlled Trial

Participants will receive 6, 30 minute weekly sessions of usual physiotherapy care, the physiotherapy content of which will be at the discretion of the treating therapist. This will be in addition to their initial physiotherapy session, during which they will be recruited for the trial. Throughout each session the physiotherapist will communicate with patients in a style consistent with Motivational Interviewing (MI). Physiotherapists will be trained on how to communicate in an MI consistent style via two 4 hour training sessions prior to the commencement of the study. Training will be provided by two of the study coordinators who are both trained in the use of MI. One of the study coordinators is a PhD candidate and current practicing physiotherapist and the other an academic and current practicing psychologist. As part of training physiotherapists will participate in an audio recorded role play with one of the study coordinators. Therapists will be provided with a copy of this recording to reflect and improve on their MI techniques. Physiotherapists will practice learned MI techniques until patient recruitment commences. Prior to patient recruitment physiotherapists will receive a 3 hour training session to review learned MI techniques. To establish a measure of MI proficiency, physiotherapists will participate in a 20-30 minute role play with one of the study coordinators following this review session. This will be audio recorded and reviewed by a third party assessor not otherwise associated with the study. The assessor will use the Motivational Interviewing Treatment Integrity scale to assess the interaction and provide a measure of therapist proficiency in MI. This will be repeated 6 weeks into patient recruitment to establish any change in MI proficiency. Between sessions, patients will access a newly developed MI app. The app will endeavor to replicate face to face MI and help participants to formulate their own reasons for increasing their activity levels though a question and answer format. The majority of questions will be open ended and focus on building the importance of increasing activity levels and the confidence the participant has in being able to achieve this. Finally an activity related goal will be developed in conjunction with the physiotherapist and the smartphone application. Participants will access the app two to three times per week. The amount of time required for each log in will vary between participants and depend on how skilled they are at using smartphones, however each session has been designed to last no longer than 15 minutes. Participants will then access the smartphone application for a further 6 weeks after physiotherapy has ceased. There will be a central web server accessible to physiotherapists from intervention clusters and the study coordinators. This will allow app usage to be monitored and the answers participants provide may be reviewed. A review of the answers may take place if the therapist wishes to use this information to plan upcoming sessions. The app will contain a feature, whereby if the participant gets stuck on a certain module, an email will be generated to one of the study coordinators, a current practicing psychologist who has extensive training in MI. The participant and the study coordinator will converse via email to problem solve why the participant is not progressing though the application. This will be done in an MI consistent manner. Once the study coordinator establishes that the participant is ready to recommence the app they will be instructed to do so.