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Table 5 Description of the video observations based on the assessments of red and yellow flags, analyses and BCTs. Cases 1-4 were selected to illustrate the clinical variation

From: Physical therapists’ assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: direct observations in primary health care

PT Red flags Yellow flags Pain site Functional behavioral analysis Biopsycho- social analysis Biomedical analysis BCTsa Time for consultation (minutes)
Assessment Identification Assessment Identification
1 Red flags were assessed but not identified No Yes Passive coping strategies Headache No Yes, the analysis included yellow flags in relation to symptoms/pain problem but not to a specific behavior. Included in the functional behavioral analysis 1.1: Behavior goal setting
Regular physical activity (walking)
4.1: Instruction on to perform the behavior
Home exercise for headache
5.1: Info about health consequences
Physical exercise with headache, how muscle tension leads to headache
24
2 Red flags were assessed but not identified No Yes Negative thoughts, avoiding behavior related to physical activity and the shoulder Shoulder No No Yes, short analyses during the consultation with focus on the shoulder pain. Yellow flags were not included in the analysis 4.1: Instruction on how to perform the behavior
Exercises for the shoulder
5.1: Info about health consequences
Effect on pain and physical function of the exercises
51
3 Red flags were assessed but not identified No No No Hip joint No No Yes, short analyses during the consultation 2.2: Feedback on behavior
Performance of a specific exercise for the hip, walking pattern
4.1: Instruction on how to perform the behavior Exercise for the hip, circulation exercises, walking with crutches
5.1: Info about health consequences
How exercise affects the hip, pain and function
7.1: Prompts/cues
Connect the exercise with another daily activity
8.1: Behavioral practice/rehearsal
PT asked the patient to repeat the exercises she had instructed her in so that she would better remember them.
25
4 Red flags were assessed but not identified No No No Shoulder and elbow No No No analysis related to the patient’s problem was performed, but there was a general explanation of the physical findings 4.1: Instruction on to perform the behavior
Stretching of elbows, home exercises, posture, micro pauses
5.1: Info about health consequences
Factors that increase pain in the shoulder and elbow, how specific work tasks can affect shoulder pain and function
61
5 Red flags were assessed but not identified No Yes No Low back No No Yes, a summarizing analysis related to the patients pain problem. Commentaries about the assessments and findings during the consultation. 1.1: Outcome goal setting
Lose weight to decrease back pain
4.1: Instruction on to perform the behavior
Exercise for home-training
5.1: Info about health consequences
How physical activities may affect back pain, pain coping strategies, including exercises
28
6 No No Yes Thoughts and worries regarding other possible causes of pain. Hip joints No No Yes, short analysis based on biomedical examination and the interview with the patient. 2.2:Feedback on behavior
Discussion with the patient about how to adjust the intensity of the aquatic exercise following overuse. 2.7: Feedback on outcome
Feedback on improving hip flexibility compared with earlier physical function and exercise
4.1:Instruction on to perform the behavior
Exercise for lower extremities
5.1: Info about health consequences
Consequences for hip and back of wearing high heels
39
7 Yes No No No Low back No No Yes, analyses including online commentaries and a summary analysis. 5.1: Info about health consequences
Factors that causes back pain and what the patient can do by herself to manage the pain
25
8 Yes No Yes No Low back and leg No No Yes, short analyses during the examination and a summary analysis at the end. 4.1: Instruction on to perform the behavior
Stretching exercises and posture
5.1: Info about health consequences
How running can affect back pain and general health how bad body position/posture behavior can affect back-pain
19
9 No No Yes No Hip joints No No Yes, short analysis of hip pain during the examination and a summary analysis 4.1: Instruction on to perform the behavior
Walking on stairs, exercises for hips
5.1: Info about health consequences
Effects of exercise and bicycling in osteoarthritis
69
10 Yes No Yes Avoiding dancing and fear of increased pain in the shoulder Shoulder No No Yes, short analysis of shoulder pain during the examination and a summary analysis 4.1: Instruction on how to perform the behavior
Exercise for shoulders
5.1: Info about health consequences
How heavy lifting and other work tasks affect shoulder pain
47
11 No No No No Feet and low back No No Yes, analysis related to the patient’s foot pain 5.1: Info about health consequences
How exercise and body weight affect foot problems, changes in foot status due to ageing and injuries have consequences in pain and medicine consumption 15.1: Verbal persuasion about capability
Benefits of physical exercise, patients capabilities for exercise
39
12 Yes No Yes No Hip joints No No Yes, a summary analysis at the end and a short online commentaries during the consultation 2.2: Feedback on behavior
How to do yoga exercises
4.1: Instruction on how to perform the behavior
Stretching of hip muscles, home exercises
5.1: Info about health consequences
How physical exercise and activity affect the cartilage in the hip
7.1: Prompts/cues
How to use daily activities as a cue to action (home exercises)
36
  1. PT physical therapist. aBCT behavior change technique presented in specific codes