Understanding Behaviour Change and the Role of Physiotherapists

Behaviour Change & Rehabilitation

Rehabilitation is a complex process that involves seeking out appropriate health care professionals and the development of goal-oriented treatment plans that are specific to our needs. As we discussed previously, successful treatment does not simply occur by showing up - we must be engaged, present and actively participate in the process. Additionally, we must be patient and give our bodies the opportunity and time to heal, strengthen and adapt. Clinically, I refer to this concept as trusting the process; trust that our bodies are resilient, commit to the treatment plan and elicit positive reinforcement and behaviour. 

Physiotherapists must understand behaviour and the unique circumstances of individuals to facilitate positive behaviour change, which in turn will lead to positive rehabilitation outcomes. Unfortunately, behavioural change is a complex process that is influenced by motivations, beliefs, attitudes and environmental influences. There is no simple exercise, treatment intervention or rehabilitation “hack” that can be ubiquitously used for people or conditions. As physiotherapists, we must be mindful of what stage individuals are located within their recovery process to provide effective care. The Stages of Change Model can be utilized to help physiotherapists determine where individuals are in their behaviour change process and thus provide truly patient-centred care.

The Stages of Change Model

There are five stages within the Stages of Change Model and individuals may move back and forth between stages before achieving lasting change. 

1. Pre-contemplation: Individuals have not yet considered behaviour change as a necessary step to accomplish their goal. Additionally, patients may lack information about the consequences of their behaviour or may have unsuccessfully attempted to change in the past. Through conversation and relationship building physiotherapists can learn about previous successes, failures and strategies used to date to help with recovery.
2. Contemplation: Individuals are aware of the need for change and seriously consider taking action within the next six months. Patients may weigh the pros and cons of changing their behaviour in addition to gathering information or seeking support to help them make a decision. This stage can be identified through action and the patient booking an assessment to make an informed decision on how physiotherapy may help. 
3. Preparation: Individuals intend to take action in the immediate future, typically within the next month. Patients may begin to take small steps toward behaviour change such as goal-setting, changes to their routines and seeking out resources. For example, a patient starts to attend classes at a yoga studio to incorporate flexibility and mobility in their exercise routine - something they have not done before.
4. Action: Individuals have recently changed their behaviour and are actively engaged in implementing their plan. This stage often involves the most effort and requires ongoing commitment to maintain the new behaviour. As physiotherapists, we can assist patients with developing realistic goals and educating on appropriate coping strategies to overcome challenges during this phase.
5. Maintenance: Once individuals have successfully maintained the new behaviour for an extended period (six months or more), they enter the maintenance stage. Throughout this stage, efforts are focused on both preventing relapse and consolidating gains. Patients may need to continue practicing strategies learned throughout physiotherapy treatment to sustain long-term results. 
   

Finally, we must acknowledge the possibility of setbacks that may occur throughout the treatment plan. Setbacks are a natural part of the change process and patients require continued reassurance and encouragement to trust in the treatment plan. In fact, recovery is a nonlinear process and as physiotherapists we need to communicate this appropriately with patients to set realistic expectations. Overall, by identifying where individuals are within their change process we can tailor our treatment to facilitate their success.