Exercise promotion in physiotherapy: A qualitative study providing insights into German physiotherapists' practices...

Although exercise promotion is a central task of physiotherapists, there is limited evidence about physiotherapists' experiences with exercise promotion and their promotion practices.

To investigate how physiotherapists working in outpatient settings in Germany promote exercise and to explore their experiences with and views on exercise promotion.

Qualitative study with semi-structured interviews.

We conducted qualitative semi-structured interviews with a purposive sample of physiotherapists. Data were analysed following Mayring's content analytical approach using deductive and inductive methods. Physiotherapists' methods of exercise promotion were classified using the behaviour change technique (BCT) taxonomy by Michie and colleagues. Further categories were formed in an inductive manner.

Six female and three male physiotherapists (age: 21-55 years, professional experience: 0.5-31 years) were interviewed. We identified the use of 17 distinct BCTs across the interviews (6-13 per interview), most commonly goal setting (behaviour), instruction on how to perform a behaviour and behavioural practice/rehearsal. Four inductive main categories were formed: "barriers and challenges", "facilitators", "responsibilities" and "dealing with setbacks". Lack of patient interest and motivation was named as a main challenge. While the therapists feel responsible for instructing exercise, not all of them regard it as their role to motivate patients. Resistance or lacking compliance lead therapists to either apply strategies to proceed or quit exercise promotion.

Our research implies substantial individual differences in exercise promotion between therapists. A more consistent approach, more competencies to support unmotivated patients as well as a clearer definition of physiotherapists' role in exercise promotion might be needed.