Telehealth delivered motivational interviewing and cognitive behaviour therapy to support exercise-based rehabilitation for people with lower limb osteoarthritis: a pilot randomized control trial

Participants will receive a written explanation of the walking program. The program comprises walking for at least 30 minutes, at a minimum frequency of 3 times a week, for six weeks (Kolasinski et al., 2020; Loew et al., 2012; Van den Ende et al., 1998). Participants will be instructed to walk at a heart rate intensity of 55 to 70% of the maximum heart rate (MHR), as recommended by several authors (Brosseau et al., 1996; Loew et al., 2012). Therefore, MHR will be calculated based on the revised MHR equation (211 – 0.64 x age) to determine the target range of 55 to 70% MHR (Nes et al., 2013; Williams, 2017). Because we will not offer a heart rate monitor, participants will be trained to use a Borg Scale Exertion Scale as a reference to determine heart rate intensity of 55 to 70% MHR while walking (Borg, 1998; Norton et al., 2010). The intensity category 'moderate’ is equivalent to 55 to 70% MHR (Norton & Norton, 2011). Only at the baseline assessment, during the 6 minute walk test, participants will use a heart rate monitor and the Borg Rating of Perceived Exertion Scale to learn how to correlate the target intensity. A Borg Rating of Perceived Exertion Scale will be printed on a laminated card and given to participants to help them track their walking intensity during the intervention. Therefore, participants will be instructed to carry the Borg Rating of Perceived Exertion Scale card during their walking sessions as a reference reminder. During the six-week program, participants will be contacted over the phone once per week to collect information on adherence to the walking program (duration spent walking per session, distance covered and number of steps) and to deliver the social support intervention. In the MI-CBT group, MI-CBT techniques will be used by a trained therapist to provide individualised support, identify helpful and unhelpful beliefs regarding their ability to complete exercise program, and to increase engagement. In the Education only group, participants will be provided with advice regarding exercise maintenance in a directive way, without providing any specific MI-CBT based support. We foresee it taking about 5 minutes to collect information on adherence and up to 25 minutes to deliver either MI-CBT or Education only. The MI-CBT intervention will be delivered in two phases. In the first phase (three weeks), the researcher will deliver 3 sessions using MI only. The main objective of the first phase is to create a trustworthy relationship through the five MI general principles (empathy, develop discrepancy, avoiding argument, rolling with resistance and self-efficacy) (Miller & Rollnick, 2012). These principles will be delivered through open-ended questions, affirmations, reflections and summaries, encouraging the participant’s sense of the possibility of change (Miller & Rollnick, 2012). The second phase of MI-CBT intervention (three weeks) is designed to maintain behaviour change (Naar-King et al., 2013). The CBT component is focused on six theoretical determinants: outcome expectations, outcome experiences, values, barriers to self-efficacy, social support, and lapse prevention (Barrett et al., 2020; Michie et al., 2011).