Behaviour change techniques to promote self-management and home exercise adherence for people attending physiotherapy with musculoskeletal conditions: a scoping review and mapping exercise

Review written by Dr Sandy Hilton info

Key Points

  1. Only 44% of patients report having an effective self-management program.
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Musculoskeletal dysfunction is a key cause of time lost for work and for the persistent global cost of healthcare (1). The evidence supports self-management programs as part of physiotherapy intervention, yet there is also evidence that only 44% of patients have effective self-management programs (2,3).

The authors of this paper aimed to identify the modifiable determinants of adherence to exercise and self-management programs including the therapeutic relationship. The paper was clear that this is not blaming patients for not being compliant, rather it seeks to operationalize Behavior Change Techniques (BCTs) for physiotherapists to better match their treatment to priorities and needs of the individual (4).

The authors used The Behavior Change Taxonomy (BCCTv1) as a reference list of modifiable behaviors that physiotherapists can use to identify the specific meaningful determinants for their individual patients and implement those behaviors into treatment plans (5). While there is no physiotherapy guide for BCTs, there are two international models that the authors proposed can be utilized to help physiotherapists increase adherence - the Capability, Opportunity, Motivation - Behavior model (COM-B) and the Theoretical Domains Framework (TDF) (5,6).

Only 44% of patients have effective self-management programs.
A key to successful self-management is having the program be pertinent to the patient’s goals, fit their lifestyle, and have a measurable outcome that is meaningful to the individual.


  • The search was from inception through December 2022 for quantitative and mixed method studies of musculoskeletal conditions treated by physiotherapists with individuals over 18 years of age.
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