Berdal Gunnhild, Kjeken Ingvild, Linge Anita Dyb, Aasvold Ann Margret, Tennebø Kjetil, Eppeland Siv Grødal, Hagland Anne Sirnes, Ohldieck-Fredheim Guro, Valaas Helene Lindtvedt, Bø Ingvild, Klokkeide Åse, Azimi Maryam, Dager Turid N, Sand-Svartrud Anne-Lene
Health Services Research and Innovation Unit, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
Muritunet Rehabilitation Centre, Valldal, Ålesund, Norway.
J Multidiscip Healthc. 2024 Jul 29;17:3649-3662. doi: 10.2147/JMDH.S472713. eCollection 2024.
To identify and describe behavior change techniques (BCTs) used in rehabilitation for patients with rheumatic and musculoskeletal diseases (RMDs), according to their own perceptions. Further, to examine patients' descriptions of their capability, opportunity, motivation, and readiness for health behavior change.
Patients were adults in need of specialized, multidisciplinary rehabilitation services due to inflammatory rheumatic disease, systemic connective tissue disease, or fibromyalgia / chronic widespread pain. Semi-structured interviews of 21 patients were analyzed with deductive qualitative content analysis applying three theoretical frameworks: the Behavior Change Technique Taxonomy, the transtheoretical model and stages of change, and the capability, opportunity, and motivation model of behavior.
Forty-six BCTs aggregated within 14 BCT groups were identified used by either patients, healthcare professionals (HPs), or both. Goals and planning, feedback and monitoring, social support, shaping knowledge, repetition and substitution were most frequently used to facilitate behavior change. Twenty patients had reached the action stage and made specific lifestyle changes concerning more than half of their goals. Concerning other goals, 6 of these patients reported to be contemplating behavior change and 15 to be preparing for it. The rehabilitation process appeared to strengthen capability, opportunity, motivation, and the desired behaviors. Patient-reported barriers to behavior change were connected with restrictions in physical capability resulting from an unpredictable and fluctuating disease course, weakened motivation, and contextual factors, such as lack of access to healthcare support and training facilities, and high domestic care burden.
The rehabilitation process seemed to strengthen individual and contextual prerequisites for behavior change and facilitate the use of required techniques and engagement in the desired behaviors. However, patients with RMDs may need prolonged support from HPs to integrate healthy lifestyle changes into everyday life. The findings can be used to optimize rehabilitation interventions and patients' persistent engagement in healthy behaviors.
根据风湿性和肌肉骨骼疾病（RMD）患者自身的认知，识别并描述其康复过程中所使用的行为改变技术（BCT）。此外，考察患者对自身健康行为改变的能力、机会、动机和准备情况的描述。
患者为因炎性风湿性疾病、系统性结缔组织病或纤维肌痛/慢性广泛性疼痛而需要专门多学科康复服务的成年人。采用行为改变技术分类法、跨理论模型和改变阶段以及行为的能力、机会和动机模型这三种理论框架，对21名患者进行的半结构化访谈进行了演绎性定性内容分析。
共识别出14个BCT组中的46种BCT，患者、医护人员（HP）或双方均使用过这些技术。目标与规划、反馈与监测、社会支持、塑造知识、重复与替代是最常用于促进行为改变的技术。20名患者已进入行动阶段，并针对一半以上的目标做出了具体的生活方式改变。对于其他目标，这些患者中有6人报告正在考虑行为改变，15人正在为此做准备。康复过程似乎增强了能力、机会、动机以及期望的行为。患者报告的行为改变障碍与疾病进程不可预测且波动导致的身体能力受限、动机减弱以及情境因素有关，如难以获得医疗支持和培训设施，以及家庭护理负担过重。
康复过程似乎增强了行为改变的个体和情境前提条件，并促进了所需技术的使用以及对期望行为的参与。然而，RMD患者可能需要医护人员长期的支持，以便将健康的生活方式改变融入日常生活。这些研究结果可用于优化康复干预措施以及患者对健康行为的持续参与。
