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Table 3 Tailored health coaching content for chronic LBP

From: Effectiveness of a coordinated support system linking public hospitals to a health coaching service compared with usual care at discharge for patients with chronic low back pain: protocol for a randomised controlled trial

Tailored health coaching content for chronic LBP
Goal-setting:
• Mutually establish a physical activity goal with the participant at commencement of the health coaching program. Where relevant, this will include ongoing adherence to the exercise program prescribed by their hospital physiotherapist prior to discharge from treatment.
• Establish other health-related goals that are meaningful to the participant (i.e., reducing weight, achieving a healthy diet, reducing alcohol consumption).
Promotion of exercise and physical activity:
• Explore barriers to exercise and physical activity participation (e.g., time, access, financial resources, social comfort).
• Promote participant-led problem-solving skills to encourage overcoming perceived and real barriers to exercise or physical activity participation.
Support:
• Empower patients to foster self-efficacy and take charge of their own health, including monitoring their own symptoms and capacity to adhere to goals.
• Encourage involvement of family members, partners, or friends for social support with achieving goals.
• Provide continual motivation, encouragement, and support for the use of positive self-management strategies (e.g., physical activity, exercise).
Interpersonal skills:
• Build report, trust, and commonality with the participant.
• Directly involve the participant in the problem-solving and decision-making processes.
Educate and advise participants that the presence of pain does not always equal to harm.
Education:
Educate and advise participants that many findings on imaging are common and do not necessarily identify the exact cause of pain. Further, imaging should only be carried out when consideration of serious pathology is clinically indicated.
• Identify and address unhelpful beliefs about their condition or progress.
Educate and advise participants on the benefits of exercise and the consequences of inactivity such as prolonged bed rest (i.e., muscle weakness).
Assist participants in navigating decision-making processes surrounding whether additional care from hospital, medical, or health services for LBP is necessary.
Pacing and activity modification:
Encourage participants to maintain engagement in usual activities (e.g., occupational, leisure).
Promote activity modification when required (i.e., regress the difficulty of an exercise or activity, perform alternative exercises or tasks that do not elicit painful symptoms, minimise sustained repetitive postures and activities, minimise excessive loads when sitting, bending, or twisting).
• Educate and advise participants on incidental opportunities to increase physical activity levels when exercise may not be feasible (e.g., use public transportation, walk to the shops, stand at work, spend less time sitting at home).
Encourage activity pacing when required, according to the participant’s physical capacity and goals.
Identifying and addressing psychological factors:
Screen and address common psychological factors in chronic LBP populations (e.g., fear avoidance, catastrophising, familial and social stress, work pressures, financial pressures).
• De-escalate potential perceived threats.
• Ask simple and unambiguous questions.
Avoid using catastrophising terms when discussing pain (e.g., bulging disc, crumbling discs, degenerated discs).
• Use positive, supportive, and empathetic language.
Reframing:
• Focus problem-solving on the participant’s functional ability (i.e., improved ability to complete certain tasks or activities), instead of drawing attention to their pain.
• Focus on activities that the participant can perform and what they are willing to try.
Encourage participants to continue safe participation in exercise, even in the presence of acute symptoms (i.e., flare-ups of LBP).
• Focus on activities that the participant has been able to perform successfully and provide ongoing encouragement for future success.
  1. Items in italics indicate content which has been tailored specifically for chronic LBP