Why did you choose to look at health coaching for chronic pain?

People with chronic pain who engage in regular physical activity have better outcomes than those who live a sedentary lifestyle.

Undertaking regular physical activity can reduce the severity of chronic pain, improve physical function and improve overall wellbeing.

Despite these benefits, research shows that people with chronic pain engage in less physical activity than those without chronic pain.

Current evidence indicates that providing general advice to keep active is insufficient to motivate people with chronic pain to engage in physical activity.

Effective interventions that encourage people with chronic pain to increase their physical activity are required.

Health coaching has been shown to be effective in improving physical activity among people with conditions such as cardiovascular disease, chronic obstructive pulmonary disease and type two diabetes.

However, there was a gap in the research regarding the benefits of health coaching for improving physical activity in people with chronic pain.

Considering the need for a better understanding of holistic approaches to pain management and the increasing popularity of health coaching, we felt that further research into the efficacy of health coaching for chronic pain was needed.

What does health coaching involve?

Health coaching is a patient-centred approach that uses behaviour change techniques, such as goal setting, motivational interviewing and positive psychology with the aim to facilitate healthier lifestyle choices and promote improved self-management of chronic conditions.

Simply, it involves using skilful conversation to support people to set goals, identify obstacles to success and develop strategies to overcome those obstacles.

Health coaching involves providing relevant knowledge and practical guidance in addition to encouraging self-discovery.

It also involves providing encouragement and positive reinforcement; supporting people to access their values and develop intrinsic motivation; and incorporate mechanisms for developing accountability in health behaviours.

How much data did you find for your review, and what types of health coaching were applied in the included trials?

Our literature search identified 1095 reports.

Following the removal of duplicates, 550 reports remained.

After screening the titles and abstracts of these reports, we obtained 110 full-text papers for consideration.

Screening of these led to the identification of 26 randomised controlled trials that fulfilled our inclusion criteria and were included in our review.

There was significant variability in the types of health coaching applied in the included trials.

The duration of the health coaching interventions ranged from five weeks to 24 months.

Intervention dose ranged from two sessions to 26 sessions, with each session ranging from five minutes to two hours.

We delivered health coaching face-to-face in five trials, remotely in 11 trials and through a combination of modes in 10 trials.

It was delivered through individual sessions in 21 trials, through group sessions in one trial and through a combination of individual and group sessions in four trials.

The person who delivered the health coaching also varied between trials and included physiotherapists, nurses and behaviour change counsellors, among others.

Do you think there is anything we can do to enhance the effects of health coaching in this population?

Physiotherapists and other health professionals who are looking to enhance the effects of any health coaching that they provide should focus on developing a strong therapeutic alliance with their patients.

This occurs by listening to their stories with empathy and setting goals that are important to their patients and align with their values.

For health professionals who do not feel confident using health coaching techniques, there are various online courses available that they can complete to become an accredited health coach.

To further enhance the effects of health coaching, more research is required to determine the most effective mode of health coaching delivery, the person who is best placed to deliver the health coaching and the optimal dose and length of health coaching interventions for people with chronic pain. An evidence-based assessment of the most effective intervention components would also be worthwhile.

What do you think research in this field should address next?

The long-term effects of health coaching on physical activity, disability and pain remain unclear among people with chronic pain.

Analysis of the long-term effects of health coaching was limited in our review as only five trials reported outcome data for a time point greater than 12 months after intervention completion.

Chronic pain is a long-standing condition, so it requires management strategies that facilitate lasting change.

Therefore, further investigation into the long-term sustainability of the effects of health coaching in people with chronic pain is warranted.

Course of interest:

Advanced clinical pain 

>> Talia Barnet-Hepples is a PhD student from the University of Sydney and physiotherapist at Wollongong Hospital. Her research focuses on lifestyle and psychological interventions for people with chronic musculoskeletal pain.