Enhanced medical rehabilitation: Effectiveness of a clinical training model

BACKGROUND: Patient engagement in medical rehabilitation can be greatly influenced by their provider during therapy sessions. We developed Enhanced Medical Rehabilitation (EMR), a set of provider skills grounded in theories of behavior change. EMR utilizes 18 motivational techniques focused on providing frequent feedback to patients on their effort and progress and linking these to patient goals. OBJECTIVE: To examine the effectiveness of a clinical training protocol for clinicians to do EMR, as measured by clinician adherence. METHODS: A physical therapist, physical therapist assistant, occupational therapist, and certified occupational therapist assistant were trained in EMR. Training consisted of five formal training sessions and individual and group coaching. Adherence to EMR techniques was measured during two phases: Pre-Training and Maintenance, with an a priori target of 90 adherence by clinicians to each EMR technique. RESULTS: With training and coaching, clinician adherence per therapeutic activity significantly improved in 13 out of 18 items (p<0.05). The target of 90 adherence was not achieved for many items. CONCLUSIONS: Our training and coaching program successfully trained clinicians to promote patient engagement during therapeutic service delivery, although not typically to 90 or greater adherence. Ongoing coaching efforts were necessary to increase adherence.