A review of behaviour change theories and techniques used in group based self-management programmes for chronic low back pain and arthritis

• We investigated behaviour change theories in physiotherapy self-management.
• Overall, behaviour change theories are unreported or unused in this population.
• Behaviour change techniques reflect the delivery of programmes.
• A lack of evidence based techniques was demonstrated in interventions.
• Physiotherapy led programmes should incorporate theory in practice.

BackgroundMedical Research Council (MRC) guidelines recommend applying theory within complex interventions to explain how behaviour change occurs. Guidelines endorse self-management of chronic low back pain (CLBP) and osteoarthritis (OA), but evidence for its effectiveness is weak.ObjectiveThis literature review aimed to determine the use of behaviour change theory and techniques within randomised controlled trials of group-based self-management programmes for chronic musculoskeletal pain, specifically CLBP and OA.MethodsA two-phase search strategy of electronic databases was used to identify systematic reviews and studies relevant to this area. Articles were coded for their use of behaviour change theory, and the number of behaviour change techniques (BCTs) was identified using a 93-item taxonomy, Taxonomy (v1).Results25 articles of 22 studies met the inclusion criteria, of which only three reported having based their intervention on theory, and all used Social Cognitive Theory. A total of 33 BCTs were coded across all articles with the most commonly identified techniques being ‘instruction on how to perform the behaviour’, ‘demonstration of the behaviour’, ‘behavioural practice’, ‘credible source’, ‘graded tasks’ and ‘body changes’.ConclusionResults demonstrate that theoretically driven research within group based self-management programmes for chronic musculoskeletal pain is lacking, or is poorly reported. Future research that follows recommended guidelines regarding the use of theory in study design and reporting is warranted.