Research in Focus: What is the Effect of Health Coaching Delivered by Physical Therapists?

  •   December 5, 2019

Citation: Rethorn ZD, Pettitt CD. What is the Effect of Health Coaching Delivered by Physical Therapists? A Systematic Review of Randomized Controlled Trials. Phys Ther 2019; 99:1354-1370.1

Background

Non-communicable diseases are prevalent health conditions that are related to the presence of health behaviour risk factors such as lack of physical activity, smoking, unhealthy eating, and harmful use of alcohol.2 Health coaching aims to modify health behaviours to improve patient outcomes. To date, research into health coaching has demonstrated positive effects,1 however; there is limited research into the effectiveness of health coaching delivered by physiotherapists, and no authors have previously summarized this body of literature.

Methods

  • Study Objective
    • “To identify the characteristics of studies that demonstrate implementation of health coaching most effectively.”1
    • Employed the following definition of health coaching: “a client-centered process to facilitate and empower the client to achieve self-determined goals related to health and wellness.”3
  • Systematic Review
    • Conducted and reported in accordance with PRISMA guidelines
  • Inclusion Criteria:
    • Adults >18 years of age
    • Randomized controlled trials comparing
      • Intervention group – coaching intervention, by a physiotherapist, “with the goal of health behavior change.”1
      • Comparison group – receiving usual care, other (non-coaching) intervention expected to lead to behavior change, or no-treatment control group.
    • Outcomes of interest – physiological, behavioural or psychological
  • Exclusion Criteria:
    • Intervention not provided by a physiotherapist
    • Intervention consisted of health education or advice without meeting the definition of health coaching
  • Literature Search:
    • Databases:     
      • Cochrane, MEDLINE, CINAHL, PEDro, PsychINFO, Web of Science
      • Hand searching of reference lists
    • Search terms: physical therapy, health coaching, wellness coaching, behavior change and combinations and synonyms of the keywords
    • Methodological quality of included studies assessed using PEDro scores
    • Risk of bias assessed using the Cochrane Collaboration risk-of-bias tool
    • 11 studies met all inclusion criteria
  • Outcomes were summarized but no meta-analysis was performed due to heterogeneity

Study Characteristics

  • 2225 participants total
  • 9/11 studies cited identified the theoretical basis of the intervention
    • Transtheoretical model (TTM) of behavior change was used most frequently
    • Social cognitive theory, self-regulation theory, and the ecological model of physical activity were used in addition to TTM in one study each
  • Coaching was delivered using a variety of methods
  • Average PEDro score was 6.7
  • Two studies were judged as having low risk of bias, four studies had high risk of bias in one domain, and eight studies had indeterminate risk of bias in at least one domain
  • Risk of bias most commonly related to length of follow up and sample size

Outcomes

Health Behaviour Change:

  • Investigated by 11 studies
  • Changes studied included physical activity, smoking, and diet
  • Physical Activity Outcomes:
    • Six studies reported statistically significant improvements in physical activity at follow up among the following patient populations: older adults, adults with non-specific low back pain, adults with rheumatoid arthritis, adults following cardiac events who did not enroll in cardiac rehabilitation, adults post-hip fracture and adults with Parkinson’s disease.
    • However, five studies reported no statistically significant change in physical activity among patients receiving health coaching following stroke, and adults with back pain, rheumatoid arthritis, type 2 diabetes, or schizophrenia with obesity.
  • Physiological Outcomes:
    • Investigated by 9/11 studies
    • Studies assessed physical function, mobility, strength, exercise capacity and cardiovascular disease risk
    • Mixed findings
    • Four studies reported statistically significant improvements in at least one physiological outcome measured
  • Psychological Outcomes:
    • Investigated by 7/11 trials
    • Studies assessed self-efficacy, recovery expectation, mental health, quality of life, motivation and fatigue
    • Mixed findings
    • 2/3 studies reported statistically significant improvements in self-efficacy
    • 2/5 studies reported significant improvements in quality of life
    • 1/2 studies reported improvements in depression symptoms

Discussion

  • Results were mixed, however 7/11 included studies reported positive outcomes compared with a control group in physical activity, physiological, or psychological outcomes.
  • “…characteristics of those studies demonstrating positive effects on patient outcomes as a result of health coaching do not reveal commonalities when compared with those studies that were not significant.”1
  • The authors were not able to identify common characteristics of studies that implemented health coaching by physiotherapists effectively.

Limitations

  • Heterogeneity of study populations, outcomes, and interventions meant that meta-analysis was not possible.
  • The use of self-report measures in many included studies may have led to response and recall bias.
  • Relative lack of training of physiotherapists in providing health coaching, uncertain fidelity of intervention to underlying theories, variation in provider training and competence to provide health coaching, and variation in treatment delivery may have also impacted reported findings of the systematic review.

Relevance to physiotherapy practice in Alberta

Health coaching is a strategy that physiotherapists can choose to employ as an intervention strategy when working with people with non-communicable diseases or those demonstrating risk factors for the development of non-communicable diseases. When implementing any new intervention, physiotherapists need to be aware of the evidence available in support of the intervention.

Physiotherapists should also be aware of the potential impact that identifying an underlying theory of intervention, fidelity of the intervention to that theory, and competence to provide the intervention may have on the outcomes achieved and employ measures to ensure the quality of their health coaching interventions.

Disclaimer: The purpose of this summary is to highlight recently published research findings that are not openly accessible. Every effort is made to ensure accuracy and clarity of the summary. Readers are encouraged to review the published article in full for further information.


  1. Rethorn ZD, Pettitt CD. What is the Effect of Health Coaching Delivered by Physical Therapists? A Systematic Review of Randomized Controlled Trials. Phys Ther 2019; 99:1354-1370.
  2. Physiotherapy Alberta. Introduction to Health Coaching for Physiotherapists. 2019. Available at https://www.physiotherapyalberta.ca/xchange/continuing_professional_development/elearning_center/introduction_to_health_coaching_for_physiotherapists/.  Accessed November 22, 2019.
  3. Jordan M, Wolever RQ, Lawson K, Moore M. National training and education standards for health and wellness coaching: the path to national certification. Glob Adv Health Med. 2015;4:46–56.