Acquiring skills in motivational interviewing (MI) to enhance adherence to pulmonary rehabilitation (PR)

Background: MI has potential to improve PR engagement and adherence. The integrity of MI delivery is known to influence patient outcomes, but the extent to which PR clinicians can learn to deliver this complex counselling method is unknown. Aim: To evaluate the impact of a tailored training package on the integrity of MI delivered by PR clinicians. Method: 24 PR clinicians (16 physiotherapists, 6 nurses, 1 physiotherapy technician, 1 exercise specialist) from 4 NHS organisations participated. MI training involved a 2-day workshop and 5 individualised coaching sessions, with a manual (PREAMP) to guide the integration of MI into PR. MI skill was measured through MI Treatment Integrity coding (MITI 3.1.1) of audio-recorded PR consultations at baseline, post-workshop, post-coaching and at 4 months. Results: MI integrity increased following training. Mean scores on most MITI components surpassed competency targets at 4-months. No participant achieved all thresholds simultaneously. Training did not alter the relative frequency and depth of reflective listening sufficiently, which may explain why patient language seldom showed patterns predictive of change in MI. Participant drop-out was a problem at each stage, with only 15 clinicians completing all training activities, and 12 contributing to the 4-month follow-up. Service issues rather than negative perceptions of MI were responsible. Conclusion: Prior to widespread adoption of MI as part of PR, it is essential to ensure that physiotherapists and other clinicians responsible for MI delivery can do so competently. A sub-set of clinicians from this study have been interviewed to identify how training may be optimised.