Exploring a new paradigm in outpatient musculoskeletal rehabilitation: chronic disease prevention and facilitating patient self-management

Chronic diseases are causing a higher rate of disability and mortality than ever before. Prevention is paramount to alleviate patient and societal burden. Effective communication from healthcare providers is essential to enable patients to self-manage their chronic diseases. Improving our understanding of self-management approaches for chronic disease in outpatient rehabilitation provides an opportunity for hand therapists to integrate these approaches into practice. A scoping review manuscript examined the current use of motivational interviewing and synthesized the available evidence for motivational interviewing by healthcare professionals in the promotion of self-management behaviors in patients seeking various treatments for musculoskeletal conditions. A thematic analysis manuscript examined thematic patterns describing hand therapists' experiences through guided interviews of hand therapists. Finally, a feasibility and pilot study examined how a chronic disease screen and a brief motivational interview can be integrated into a busy hand therapy clinic and if brief motivational interviewing and written education material results in greater type 2 diabetes self-management program attendance than written educational material alone. These results suggest that motivational interviewing has been utilized by physical therapists (PTs) and occupational therapists (OTs) with success in the self-management of musculoskeletal conditions. The loci of the challenges hand therapists face when addressing self-management of chronic disease have been identified and range from externally imposed to internally imposed challenges. Identifying screens and behavioral interventions to encourage patients at-risk of type 2 diabetes to attend self-management programs are feasible in a hand therapy clinic. The findings of the pilot objective, however, did not demonstrate an additive effect of motivational interviewing above written educational material alone on type 2 diabetes prevention self-management program attendance. Insufficient patient concern, suboptimal patient/provider relationship, insufficient brief motivational interviewing sessions and programs costs may have contributed to the attenuated effect. There remains a need to explore these issues through behavioral interventions with the treating hand therapist. There remains a need to further explore hand therapists' barriers and poor attendance issues through behavioral interventions with the treating hand therapist. iv