Why is behaviour change important in physiotherapy? 

Behaviour change sits at the heart of physiotherapy. 

Whether we’re helping someone recover from injury, manage chronic disease or improve function, behaviour change is about supporting people to change how they live for the betterment of their health. 

That’s no small task. It’s something we also engage in ourselves—improving our clinical practice through ongoing reflection and adaptation. 

Behaviour change is rarely straightforward. It’s shaped by a complex web of influences and requires an individualised approach. 

Physiotherapists are in a position to lead in this space. 

By embracing behaviour change as both a clinical and a professional competency, we can better support our clients and each other. 

Physiotherapists often see clients who know what they should do but struggle to follow through. What do you see as the biggest barriers to turning good intentions into action? 

It’s a familiar paradox.

Rather than feeling frustrated or defeated, we should pause and consider what is actually getting in the way. 

This is where the real work begins and it’s here that physiotherapists can have the greatest impact. 

The COM-B model developed by Susan Michie and colleagues offers a practical framework for understanding behaviour. 

It identifies three essential components: 

• capability—does the person have the physical and psychological ability to perform the behaviour? 

• opportunity—does their environment (social, physical and structural) support the behaviour? 

• motivation—are they emotionally and cognitively driven to act? 

This framework enables us to walk in our clients’ shoes and consider deeper, nuanced questions such as: are we overestimating a patient’s readiness to engage? 

Do our interventions align with their routines, environments and social contexts? 

Are we exploring the values, beliefs and emotional responses that truly drive change?

By engaging with these questions, we can begin to co-create interventions that are realistic, meaningful to the individual and sustainable. 

Several studies in the article collection on behaviour change highlight the importance of trust and collaboration between physiotherapist and patient. In your experience, what specific strategies help build that supportive relationship to enable behaviour change? 

The therapeutic relationship is a key active ingredient in supporting behaviour change. Nurturing it is an important clinical skill—one that demands curiosity, empathy and ongoing reflection and refinement. 

When we purposefully develop this skill, we build meaningful bonds with our clients that work to support behaviour change and improved outcomes. 

This means moving beyond the ‘what’ of treatment—the exercises, the protocols—and diving into the ‘how’ and ‘why’ of human behaviour. 

It’s a shift that, as described in the article collection, is beautifully articulated by self-determination theory, which identifies three psychological needs essential for behaviour change. 

To support self-determined motivation of our clients, we need to relate to them. 

There are countless ways we can go about this, such as approaching each interaction with curiosity, practising active listening, demonstrating genuine interest in their lived experience and seeking to understand their values, preferences and emotional landscape. 

When clients feel a therapeutic connection with us, they’re more likely to trust us, engage in shared decision-making and take meaningful ownership of their health journey. 

What are one or two practical steps that a physiotherapist who wants to get better at supporting behaviour change could start applying right away? 

A practical way to improve your ability to support client behaviour change is to reflect on how you show up for each of your clients. 

Consider your current approach—what has worked, what hasn’t and why—and seek constructive feedback from colleagues and clients. 

Another important step is to be purposeful in how you build strong, trusting relationships. 

Take the time to actively listen and understand each client’s individual needs, preferences and expectations. 

Recognising where each client sits within the stages of change is crucial; if they’re not ready, avoid pushing and instead help them explore the personal value of change by asking questions that tap into intrinsic motivation, eg, ‘What would be different for you if this pain improved?’ 

Roadblocks are part of the process and are okay. 

What matters is how you and your client acknowledge the setbacks and move forward together, as a team.

>>Sarah Hug APAM is an early-career researcher, teaching academic and physiotherapist. Sarah is passionate about improving the care delivered to people living with chronic respiratory disease and has a particular interest in understanding patient and clinician behaviour.

• References