Study design and data source
Data was collected as part of the Movement Coaching research project (German Clinical Trials Register (DRKS)-ID: DRKS00004878). In brief, this randomised controlled trial evaluated the effectiveness of two interventions that promote physical activity for patients with low back pain: a multicomponent intervention (Movement Coaching) compared to a low level intensity intervention (control intervention) [18]. The trial had three measuring points (T0=start of inpatient rehabilitation; T1=six month follow-up; T2=twelve month follow-up). Participants answered a questionnaire on sociodemographic variables, usage and acceptance, physical activity and clinical variables. The outcome data at six month (T1) and twelve months (T2) were collected using questionnaire, which was sent by letter [19].
To assess the recruitment strategy and the feasibility in the inpatient rehabilitation a pilot study was conducted.
The present secondary analysis was conducted as a cross-sectional study based on T1 data of the Movement Coaching intervention group. The study protocol, with the description of the intervention, has already been reported elsewhere [18].
Study population
Participants were aged 18 to 65 years of age with a documented history of low back pain who were recruited through an inpatient centre in Germany from May 2013 to April 2014. Exclusion criteria included cognitive disorders, difficulty understanding German, surgery within the last twelve weeks, posttraumatic conditions, a current state pension claim and refusal of participating in the study.
The centre invited eligible patients to an informative meeting about the study. This meeting was held during the first week of inpatient rehabilitation. The patients had the possibility to participate in the study by giving informed consent until the first unit of the intervention [19].
Sample description
The consort flow chart of the main study has already been published [19,20]. At baseline (T0) 201 participants were randomised in the Movement Coaching intervention group.
Participant characteristics are presented in table 1. At six months follow-up (T1), 92 (46%) participants replied to the follow-up questionnaire [19,20].
Intervention
All patients received three weeks of inpatient rehabilitation. In addition, the participants randomised to the intervention group were provided support by health coaches and received the theory-based multicomponent Movement Coaching intervention [18]. The intervention is based on the “Rubicon Model of Action Phases” [21] and the “MoVo Process Model” [22]. Additionally, contextual needs are considered within the concept of the intervention [23]. Concerning coaching methods and principles, the coach does not give any rules, concrete suggestions or solutions. The coach emphasizes the patient’s self-efficacy and individual resources to elaborate individual strategies on physical activity promotion [24].”
The intervention combined three approaches:
(1) A personalised, guideline-based telephone coaching which comprised of at least two calls with the aim of providing support to the participants to integrate physical activity in daily life. If a participant could not be reached in the designated week, the coach attempted to contact the patient within the next two weeks. If a patient could not be reached within the period of three weeks, the phone coaching was deleted without replacement.
(2) The opportunity to use an interactive web 2.0 online platform with further specific information on the benefits of physical activity and advice on how it helps manage low back pain, which was explained during the inpatient rehabilitation. Additionally, the patients had the opportunity to communicate with the coach or other patients on the web platform.
The participants could contact the coach via telephone or Internet whenever they wanted.
(3) Two face-to-face contact sessions of 60 minutes in small groups with a maximum of eight people during the inpatient rehabilitation. The main goal of these sessions was to plan the participant’s physical activity for once they had completed the inpatient rehabilitation. The face-to-face meetings were integrated in the official therapy plan of the rehabilitation centre and all patients of the Movement Coaching intervention group had face-to-face contact.
The health coaches were male and female with a master´s degree in the field of “prevention, rehabilitation and health management” and additional training [18-20].
Table 2 shows a summary of the three approaches; a more detailed description of the approaches has been published previously [18].
Measures
Sociodemographic variables were collected at baseline.
For assessing the usage of the telephone coaching, the health coaches noted whether the participants answered the first and second call in a log. Moreover, call duration, number of call attempts until the patient was reached and reasons why the coaching did not take place were noted. For assessing the participant-related acceptance, non-standardised questions were used (see table 3).
Regarding the web coaching, the participants were asked if they had internet access and how often they accessed the internet. Table 4 shows non-standardised questions for the subjective usage and the acceptance of the web platform. Moreover, login-data can be used to analyse the objective usage (if and how often the platform was visited).
To assess the acceptance of the face-to-face coaching, the COHEP-questionnaire (Comprehensibility of Health Education Programs) was used [25]. This questionnaire consists of four scales and comprises 30 Items (five-point Likert scale) which can be summed up to a value from 0 to 100:
- Scale: Comprehension-fostering behaviour of program trainers=11 Items
- Scale: Transferability to everyday life=9 Items
- Scale: Comprehensibility of medical information=6 Items
- Scale: Amount of information=4 Items.
Higher values indicate a higher parameter value.
Statistical analysis
Means, standard deviations and frequencies were used for sample description and for describing the usage and acceptance. The researchers tested differences in characteristics of the repliers and non-repliers within the Movement Coaching intervention group using t-test and the Pearson Chi-squared test.
For all statistical tests, the significance level was set to p<0.05. All analyses were run with IBM SPSS Statistics 25.