Adding Behaviour-Change Counselling to an Exercise Program for Adults Preparing for Hip and Knee Arthroplasty Improves Psychological and Physical Wellness: Focus Group Reflections

Marie-Louise Bird; Jonathan Mulford; Andrew Daffyd Williams; Michael Cheney; Jane O'Brien

doi:10.3390/ijerph20206960

Adding Behaviour-Change Counselling to an Exercise Program for Adults Preparing for Hip and Knee Arthroplasty Improves Psychological and Physical Wellness: Focus Group Reflections

Int J Environ Res Public Health. 2023 Oct 23;20(20):6960. doi: 10.3390/ijerph20206960.

Authors

Marie-Louise Bird^{1

2}, Jonathan Mulford³, Andrew Daffyd Williams¹, Michael Cheney¹, Jane O'Brien^{4

5}

Affiliations

¹ School of Health Sciences, University of Tasmania, Launceston, TAS 7250, Australia.
² Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
³ Launceston General Hospital, Launceston, TAS 7250, Australia.
⁴ School of Nursing and Midwifery, University of Tasmania, Launceston, TAS 7250, Australia.
⁵ School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia.

Abstract

Purpose: To explore participant experiences for people on an arthroplasty waitlist, randomised to an exercise and behaviour-change counselling program (ENHANCE). The ENHANCE program for arthroplasty patients was led by an accredited exercise physiologist who delivered an individually tailored and structured exercise program. Included in the exercise program were up to five in-person counselling sessions, based on the Health Action Process Approach (HAPA) applied specifically to people with osteoarthritis. Nine adults (mean 69.4 years) who were on the waiting list for a total hip or knee arthroplasty and who had completed a 12-week program (ENHANCE) as part of a randomised controlled trial were recruited for this study.

Methods: Two focus groups were conducted to explore participant experiences of ENHANCE. Data were analysed using inductive thematic analysis with constructs of the HAPA (motivational and volitional factors) as a framework.

Results: We identified three themes (1) 'The structured program addressed inactivity and improved feelings of wellness and preparation for the operation'. The benefits were not only physical, but psychological and were contextualised in terms of preparation for the upcoming surgery. (2) 'People as enablers of participation': Participants identified that the attitude, and skill of the experienced instructor were supportive and motivating, especially in tailoring the intervention. Within the program, the support of the group was considered a positive attribute (3) 'Improved awareness changed attitudes to self-efficacy and perceived self-control'. Participants described an increased awareness of their condition and a better understanding of health expectations. They felt more control and ownership over their health journey.

Conclusion: Goal setting and social support were identified factors in a behaviour-change counselling program, delivered in conjunction with structured exercise that led to a positive experience. Improved psychological and physical health were described. Participants were better prepared for their upcoming surgery, with increased self efficacy and mastery to support long-term physical-activity engagement.

Keywords: benefits; clinical rehabilitation; hip and knee waitlist; osteoarthritis; physical exercise.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Arthroplasty, Replacement, Knee*
Counseling
Exercise Therapy
Focus Groups
Humans
Osteoarthritis, Knee* / psychology

Grants and funding

This research was funded by The Clifford Craig Medical Research Trust, grant number B0024656.