Michael Vianin
Patients suffering from musculoskeletal disorders often exhibit negative health behaviors that influence their symptoms and clinical outcomes. The recognition and confrontation of such risk factors is a central part of musculoskeletal care.
Clinicians involved in musculoskeletal care have the opportunity to create behavior change in their patients to reduce the burden of their disorders and to promote self-management strategies. In order to achieve such changes, clinicians need to shift paradigm from a disorder fixer mindset to a health coaching function.
The definition of a health coach, according to the National Board for Health and Wellness Coaching, is one who "partner(s) with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being". Furthermore, health coaches "display unconditional positive regard for their clients and a belief in their capacity for change, and honoring that each client is an expert on his or her life, while ensuring that all interactions are respectful and non-judgmental ".
The underlying core assumption of a health coaching paradigm is that patients are the experts on their situation and motivation. In turn, the foundation of that paradigm is a respect for patient autonomy, guided facilitation, and solutions generated by the patient.
Clinicians acting as health coaches can help patients in discovering, clarifying, and aligning with what they want to achieve, encouraging patient self-discovery, eliciting collaborative and patient-generated solutions and strategies, and offering a measure of accountability.
Self-management is an integral part of overall management strategies for musculoskeletal disorders and includes, similar to health coaching, behavior change support. However, health coaching is different from self-management in that it focuses not only on supporting the management of disorders, but on overall wellness as well.
The role of clinicians caring for patients with musculoskeletal disorders in these paradigms goes from experts in supporting patients with the management of specific disorders to partners guiding patients to better overall wellness and health.
References
1. Rethorn, Z., Bezner, J., & Pettitt, C. (2021). From expert to coach: health coaching to support behavior change within physical therapist practice. Physiotherapy Theory And Practice, 1-16. doi: 10.1080/09593985.2021.1987601