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Motivational interviewing empowers patients

At a glance:
This paper demonstrates the manner in which a consultation can promote confidence within the patient, reassuring them that work related duties are attainable through a comfortable platform for action. How a patient responds to a return to work is knowledge based.
Perspectives:
Employee
This paper is mainly for treating practitioners. It discusses a way is of dealing with consultations that may help patients understand a particular situation and make positive choices. The technique is to help the patient understand the difficulties inherent in the situation, and what is likely to happen if they do or do not change. This assists them to work out ways of dealing with particular situations, so that they feel they are capable of changing.
Employer
Motivational interviewing is not a complicated process. It clarifies areas that are not clear, and provides employees with the knowledge to make decisions.

Motivational interviewing is a technique that has been used in other areas of medicine, and is starting to be used in vocational
vocational
Related to work or career. Vocational rehabilitation focuses on the process of returning to the workforce.
 rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 and return to work systems.
Treater
Motivational interviewing has been used in a broad variety of long-term health problems, where the outcomes depend upon the individual's self-management. With regards to return to work and musculoskeletal
musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 problems motivational interviewing is relevant when a patient with chronic
chronic
continuing a long time or recurring frequently
 low back pain needs to understand that remaining active is important, for example.

Other examples may be when a person has remained off work longer then medically necessary, where they are back at reduced hours, or remain at work but on restricted duties. All of these scenarios have consequences. An interview in which the patient is led to an understanding of the negative consequences of their present situation, together with the benefits of change and its consequences, will help people see clearly and make decisions.

Motivational interviewing takes time, and may need to occur over a number of sessions. It is directed at the patient's understanding and beliefs about the situation, and how they can achieve their goals based on an understanding of the options.
Insurer
These studies show that when people have a deeper understanding of the pros and cons of various options, they are better placed to make positive choices. The technique has been used for a range of long-term health problems where the focus needs to be on self-management. There have been a substantial number of studies that consistently show benefit from this approach, rather than simply providing advice, or telling the individual what to do in terms of their treatment.
Original Article, Authors & Publication Details:
K. Resnicow, C. DiIorio, J. E. Soet, B. Borrelli, J. Hecht and D. Ernst (2002).

Motivational interviewing in health promotion: It sounds like something is changing. Health Psychology; 21(5):444-451.

S Rubak, MD, research fellow, Department and Research Unit of General Practice; A Sandbæk, MD, PhD, associate professor; T Lauritzen, MD, DMSc, professor; B Christensen, MD, PhD, associate professor and director, Department of General Practice, University of Aarhus, Denmark.
Background, Study Objectives, How It Was Done:
Motivational interviewing is a tool to help individuals manage a medical or health-related matter. It is a process designed to help people deal with issues through discussion and understanding, rather than an approach that dictates how to behave.

The theory behind motivational interviewing is that if the individual understands the issues, and makes positive decisions about change, they are more likely to sustain that change, and achieve their desired outcomes.

Motivational interviewing has been particularly helpful in areas such as weight loss, adherence to treatment and follow-up, increasing physical activity, and in the management of long-term health issues where patient's self-management is important.

Motivational interviewing has been used by various health-care providers, including psychologists, doctors, nurses, and rehabilitation providers.

The authors of this study aimed to review the literature, and summarise the findings of other research studies that have used motivational interviewing.

They note the characteristics of motivational interviewing as:

1. Identifying and mobilising the person's internal values and goals as a fundamental way of promoting change
2. Motivation to change comes from the individual
3. Motivational interviewing is about helping the person clarify and resolve uncertainty and confusion. It is also about understanding the benefits of change, and the down side things staying the same
4. Readiness to change is not static, and changes over a period of time depending on interaction
5. Resistance and avoidance of change is often a signal to modify the discussions and strategies
6. Having the individual see, believe, and achieve a specific goal is essential
7. The therapeutic relationship between the person and the professional is a partnership that respects the person's autonomy
8. Motivational interviewing combines techniques as well as counselling style
9. Motivational interviewing is directive and focused on the person

The authors of this paper searched for all journal articles of relevance. Of 15,000 articles, they found 72 that matched their criteria. Randomised controlled trials
randomised controlled trial
A research study that groups participants into "treatment" and "control" groups. The treatment group is given an intervention
intervention
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 while the control group is not. Outcomes for the groups are compared to see the difference made by the intervention. This ensures that the study results are valid and not influenced by another factor. Example: In a randomised controlled trial of treating back pain with anti-inflammatory tablets 60% of people improved over two weeks. However, if 60% of the control group who were given a placebo
placebo
A substance containing no active drug, administered as a control to a patient participating in a research study. Using a placebo helps researchers assess whether the treatment under study is actually responsible for any improvement or worsening of the problem.
 also improved over two weeks the results indicate the tablets did not help overall. It is important participants to be given the medication are chosen randomly. If there was a reason for putting those people in that group, such as worse pain, it might alter the results.
  which compared the effect of motivational interviewing to traditional advice. This includes the practitioner advising the patient about treatment. For studies to be included in this review they needed to adequately describe the methods of motivational interviewing and how the motivational interviewing was delivered.

The authors of this study brought together data from the other studies, and analysed the information using complex statistics known as mentor and analysis.
Study Findings:
An effect of motivational interviewing was demonstrated in 74% of the randomised controlled trials.

None of the publications reported any negative effects of motivational interviewing.

94% of the trials used one-on-one individual interviews. Of the four studies that did not use one-on-one interviews, three used group therapy and one chose daily telephone interviewing. These four studies did not demonstrate a beneficial effect from motivational interviewing.

The average duration of the motivational interviewing encounter was approximately 60 minutes. The range was from 10 minutes to 120 minutes. Of the studies using a 60 minute meeting time, 81% showed a beneficial effect. Of the studies using less than 20 minutes per meeting, only 64% showed a positive effect.

The likelihood of the benefit rose with the number of meetings. An effect was demonstrated in 40% of the studies with one meeting, but 87% of the studies with more than five encounters.

The average follow-up period was 12 months. A longer follow-up period was associated with an increased likelihood of the study showing a beneficial effect. 36% of the studies with a three month follow-up showed a benefit of motivational interviewing over traditional treatment, were as studies with a 12 month or longer follow-up had an 81% chance of showing a beneficial effect when compared to standard treatment.

The study showed that all health care providers were able to obtain an effect with motivational interviewing.
Conclusions:
The review demonstrated that motivational interviewing helps change behaviour, and out performs traditional advice giving methods in approximately 80% of studies.

The longer term follow-up studies showed a greater benefit, suggesting that traditional advice giving has a positive impact, but is not long-lasting when compared to the motivational interviewing approach.
References:
PubMed Abstract
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