An educational model of becoming a teacher in basic body awareness therapy - pedagogical challenges in teaching movement quality from an awareness perspective

Background:Patients with hip osteoarthritis tend to develop stereotype and energy demanding movement strategies with potential negative effects on disease progression and daily life functioning. A multi-perspective view on movement quality is applied in the physiotherapy modality Basic Body Awareness Therapy (BBAT), with its movement awareness learning pedagogy. BBAT has been found beneficial for functional movement quality, symptoms, and psychological aspects of health in patients with various long-lasting conditions.Objectives:To investigate the short-term (6 months) effects of BBAT, added to Patient Education (PE) compared with PE only in patients with hip osteoarthritis.Methods:A block-randomized controlled trial with 6 months follow-up was conducted. Patients were allocated to 3.5 hours of PE plus 12 weekly sessions of BBAT, each lasting 90 minutes (intervention group), or to PE only (comparison group). Primary outcomes: Numeric Rating Scale (NRS) for pain during walking and Hip Osteoarthritis Outcome Score, subscale Activities of Daily Life (HOOS A). Secondary outcomes included physical capacity tests: Chair test, Stairs test, six-minutes walking test (6MWT), movement quality evaluation: Body Awareness Rating Scale – Movement Quality and Experience (BARS-MQE), and self-reported measures: Activity level (UCLA), function (HOOS subscales P, S, SP, QL and Harris Hip Score (HHS), self-efficacy (Arthritis Self-efficacy Scale, ASES), and health (EuroQol, EQ-5D-5L).Patient Global Impression of Change (PGIC) on pain and function was registered at 6 months.ANCOVA of change was used in intention-to-treat and per protocol analysis.Results:101 patients were included, average age 63 years, 80% female. There was no difference in change between the groups on the primary outcomes at 6 months. However, movement quality (BARS-MQE) improved more (p<0.001) in the intervention group, and the patients reported more improvement in pain (PGIC) than the comparison patients (p=0.031). In per protocol analysis, including 30 patients who attended at least 10 BBAT sessions, intervention patients had statistically significant better scores on self-efficacy (ASES pain, p=0.049), health (EQ5D5L VAS, p=0.037) and function (HHS, p=0.029) than the comparison patients.Conclusion:Patients with hip osteoarthritis were not found by the primary outcome measures to improve more by BBAT added to PE than by PE alone. Movement quality improved, however, significantly more in the intervention group. With sufficient compliance to BBAT, significant more improvement in additional health indicators was demonstrated.References:[1] Egloff C, Hugle T, Valderrabano V. Biomechanics and pathomechanisms of osteoarthritis. Swiss Med Wkly. 2012;142:w13583.[2] Smith TO, Purdy R, Lister S, Salter C, Fleetcroft R, Conaghan P. Living with osteoarthritis:Systematic review and meta-ethnography. Scand J Rheumatol. 2014;43(6):441-452.[3] Skjaerven LH, Kristoffersen K, Gard G. An eye for movement quality: a phenomenological study of movement quality reflecting a group of physiotherapists’ understanding of the phenomenon. Physiother Theory Pract. 2008;24(1):13-27.Acknowledgments:The authors thank the funding institution; The Norwegian Fund for Post-graduate training in Physiotherapy.Disclosure of Interests:None declared

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