Table 4 Intervention map linking change objectives to methods and practical applications

 ▪ the benefits of physical activity (PA)

 ▪ recommended types and levels of PA

▪ how to perform selected PA

PO.1, PO.3PO.2, PO.3

1–2

What are the benefits of exercise?; the Get Ireland Active physical activity recommendations; the current activity levels of Irish population according to age and chronic pain condition; what are appropriate exercises/walking/other physical activities

Lecture; group discussion; programme handbook; picture handout of exercises for home practice

2.2, 2.7, 4.2, 5.1, 9.1

 ▪ SMART goals and its relevance for PA

PO.4

1

What is SMART goal-setting?; how to complete a weekly goal setting sheet, review weekly goals and action plans

Lecture; group discussion; programme handbook

2.2, 2.7, 4.2, 5.1, 9.1

 ▪ pacing and its relevance for PA

PO.5

2

What is pacing and how to use it?

Lecture; group discussion;

programme handbook

2.2, 2.7, 4.2, 5.1, 9.1

 ▪ tools for monitoring progress in PA

PO.6

1–2

How to use an activity plan; How to use a pedometer

Lecture; group discussion;

programme handbook

2.2, 2.7, 4.2, 5.1, 9.1

 ▪ typical challenges while engaging in PA

PO.7

1,2,4,5

Factors influencing PA including fear of pain exacerbation

Lecture; group discussion;

programme handbook

2.2, 2.7, 4.2, 5.1, 9.1

 ▪ available resources/facilities to support participation in PA

PO.8

6

What are the resources or facilities available to support long term PA participation

Local community resources handout

2.2, 2.7, 4.2, 5.1, 9.1

 ▪ Develops physical skills to engage in PA

PO.3

1–6

Participation in supervised exercise class; participation in PA outside of the class

Instruction and demonstration by physiotherapist; practice by participant; programme handbook to record progress; feedback from physiotherapist

2.2, 2.7, 4.1, 6.1, 8.1, 8.6, 8.7, 10.4, 12.6

 ▪ apply relevant SMART goal setting to selected PA

PO.4

1–6

Weekly review of PA progress utilising goal setting and action planning

Group discussion;

practice by participant during and outside of class;

programme handbook to record progress; feedback from physiotherapist

1.1, 1.3, 2.2, 2.7, 2.3, 4.1, 6.1, 8.1, 10.4

 ▪ apply pacing to selected PA

PO.5

2

Physiotherapist provides instructions on how to pace

Instruction by physiotherapist;

practice by participant outside of class; feedback from physiotherapist

1.2, 2.2, 2.7, 4.1, 6.1, 8.1, 8.6, 8.7, 10.4

 ▪ to monitor progress in increasing PA

PO.6

2–6

Weekly exercise diary in programme handbook; example of completed diary in programme handbook; pedometer provided to participants; demonstration of its use and written information in programme handbook

Instruction and demonstration by physiotherapist; practice by participant; programme handbook to record progress

1.1, 1.3, 2.3, 4.1, 6.1, 8.1

 ▪ to cope with the challenges encountered while engaging in selected PAs

PO.7

4–5

Practical relaxation session;

instruction on how to select and use alternative methods to cope with pain (e.g. ice, heat, TENS)

Instruction by physiotherapist;

practice by participant during and outside of class

4.1, 6.1, 8.1, 8.6

Improves self-efficacy in ability to:

 ▪ perform selected PAs

 ▪ engage in selected PAs

PO.2PO.3

1–6

Review of previous week’s physical activity; participation in supervised exercise class

Group discussion; programme handbook to review progress; support from other participants; practice by participant; feedback from physiotherapist

1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 8.1, 8.7, 10.4, 12.5, 15.1

 ▪ use SMART goal setting

PO.4

1–6

Review of previous week’s goal-setting; instruction on how to set SMART goals and complete goal setting worksheet

Group discussion; programme handbook to review progress; support from other participants; practice by participant; feedback from physiotherapist

1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 6.1, 8.1, 8.7, 12.5, 15.1

 ▪ use pacing

PO.5

2–6

Review participants’ attempts to pace; Instruction on how to pace

Group discussion; support from other participants; practice by participant; feedback from physiotherapist

1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 6.1, 8.1, 8.7, 12.5, 15.1

 ▪ use tools to monitor progress

PO.6

2–6

Review participants’ attempts to use tools including pedometer; instruction on how to use monitoring tools

Practical demonstration of pedometer; practice by participant; programme handbook to review progress; feedback from physiotherapist

1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 6.1, 8.1, 8.7, 12.5, 15.1

 ▪ cope with challenges encountered during PA participation

PO.7

2–6

Factors influencing PA including fear of pain exacerbation; review participants’ attempts to select and use alternative methods to cope with pain (e.g. ice, heat, TENS); instruction on how to use alternative methods

Group discussion; practice by participant; feedback from physiotherapist

1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 6.1, 8.1, 8.7, 15.1

 ▪ engage in long-term PA

PO.8

6

Review participants progress over the course of the programme. Provide information regarding community resources to support activity maintenance

Group discussion; support from other participants; feedback from physiotherapist; community resource leaflet

1.2, 2.2, 2.3, 3.1, 3.2, 3.3, 6.1, 8.1, 8.7, 15.1

Reduce pain catastrophizing beliefs’ related to consequences of engaging in PA

PO.2, PO.3, PO.7, PO.8

1–6

Information on pain related to physical activity participation [wks 2,5]; review of previous week’s physical activity; participation in supervised exercise class

Lecture; group discussion; programme handbook to review progress; practice by participant; feedback from physiotherapist

2.2, 2.3, 2.7, 5.1, 5.6, 9.1, 10.4

Reduce fear related to engaging in selected PAs

PO.3, PO.7, PO.8

1–6

Information on pain related to physical activity; review of previous week’s physical activity; participation in supervised exercise class

Lecture; group discussion; social support from other participants, practice by participant; feedback from physiotherapist

2.2, 2.7, 2.3, 3.3, 5.1, 5.6, 8.1, 9.1, 11.2,

 ▪ Increase autonomous motivation to engage in selected PA

▪ Increase autonomous motivation to engage in long-term PA

PO.1, PO.2, PO.3PO.8

1–6

What are the benefits of exercise?; the Get Ireland Active physical activity recommendations; the current activity levels of Irish population according to age;

what are appropriate exercises/walking; review of weekly progress

Lecture; group discussion; social support from other participants; programme handbook to record physical activity goal; feedback from physiotherapist

1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.1, 3.2, 3.3, 5.1, 6.2, 9.1, 10.4

 ▪ to use SMART goal setting

PO.4

1–6

What is SMART goal-setting?; how to review weekly goals and action plans; review of weekly progress

Lecture; group discussion;

programme handbook; social support from other participants; feedback from physiotherapist

1.1, 1.2, 1.3, 1.4, 1.5, 1.7, 3.1, 3.2, 3.3, 5.1, 6.2, 9.1, 10.4

 ▪ to use pacing

PO.5

2

What is pacing and how to use it

Lecture; group discussion; feedback from physiotherapist

1.1, 1,2, 1.3, 1.4, 1.7, 3.1, 3.2, 3.3, 5.1, 6.2, 8.7, 9.1, 10.4,

 ▪ to use tools to monitor progress in PA

PO.6

2–6

How to use an activity plan; how to use a pedometer; review participants’ attempts to use tools

Lecture; group discussion;

programme handbook; feedback from physiotherapist

1.1, 1.2, 1.3, 1.4, 1.7, 1.8, 3.1, 3.2, 3.3, 5.1, 6.2, 9.1, 10.4

 ▪ to cope with challenges encountered during PA participation

PO.7

1–6

Factors influencing PA including fear of pain exacerbation; review participants’ attempts to select and use alternative methods to cope with pain (e.g. ice, heat, TENS); instruction on how to use alternative methods

Lecture; group discussion;

feedback from physiotherapist

1.1, 1.2, 1.3, 1.4, 1.7, 1.8, 3.1, 3.2, 5.1, 6.2, 8.7, 9.1, 10.4

 ▪ Develops ability to incorporate and monitor effects of PA into daily life

PO.3, PO.5

1–6

Weekly activity diary record

Programme handbook to record progress

2.3

 ▪ Develops ability to implement tools to monitor PA progress

PO.6

2–6

Weekly activity diary record

Programme handbook to record progress

2.3

Change objectives and determinants of behaviour from TDF domains

Self-management performance objectives (PO)

Class number

Content

Practical applications

[mode of delivery]

Behaviour change techniques as per behaviour change technique taxonomy v1 (Michie et al. [42, 44])

 ▪ the rationale for self-management

PO.9

1

Aims and structure of the programme;

prevalence, pathology and prognosis of OA and CLBP and their relevance to self-management.

Application of self-management strategies

Written patient information leaflet; programme handbook; lecture; group discussion

Group discussion

2.2, 2.7, 4.2, 5.1, 9.1

 ▪ evidence-based pharmacological and non-pharmacological pain management strategies relevant to their pain condition

PO.10

2, 4

Factors influencing pain;

pain gate theory;

safe application of ice, heat. Evidence for TENS, acupuncture. Drug pyramid of analgesic, anti-inflammatory, opioid and steroid medication; rationale for selection of approaches

Lecture; programme handbook

Group discussion

2.2, 2.7, 4.2, 5.1, 9.1, 11.1

 ▪ pain coping strategies

PO.11

2, 5

Factors influencing pain;

anxiety, mood and pain;

relaxation techniques;

progressive muscular relaxation

Lecture, group discussion, programme handbook, practical relaxation session

2.2, 2.7, 4.2, 5.1, 5.6, 9.1

 ▪ healthy eating guidelines and healthy weight

PO.12

3

Prevalence of obesity in Ireland; relationship to joint and back pain, life expectancy; balanced weight, waist size for low, moderate, high risk, relationship to physical activity and its measurement; healthy eating guidelines; food pyramid, eatwell plate, portion size, food and exercise

Lecture; group discussion; programme handbook; practical demonstration of waist measurement

2.2, 2.7, 4.2, 5.1, 9.1

 ▪ how to perform selected specific exercises

PO.13

1–6

Types of specific exercises and their effects

Lecture, programme handbook, practical demonstration of exercises

2.2, 2.7, 4.2, 5.1, 9.1

 ▪ select and use evidence-based pharmacological and non-pharmacological pain management strategies relevant to their pain condition

PO.10

4–6

Reflection on ability and outcome of previous weeks selection and use of pharmacological and non-pharmacological pain management approaches relevant to their pain condition

Group discussion; feedback from the physiotherapist

1.2, 2.2, 2.7, 4.1, 6.1, 10.4, 11.1

 ▪ select and use pain coping strategies

PO.11

5–6

Reflection on ability and outcome of selection and use of pain coping strategies

Group discussion, programme handbook

Feedback from the physiotherapist

Practical class in relaxation skills

1.2, 2.2, 2.7, 4.1, 6.1, 8.1, 10.4, 13.2

 ▪ follow healthy eating guidelines and monitor weight

PO.12

3–4

Reflection on ability and outcome of monitoring healthy eating and weight

Group discussion; programme handbook

1.2, 2.3, 4.1, 6.1, 8.1

 ▪ engage in specific exercises

PO.13

1–6

Supervised group exercise class

Participation in exercise class and peer observation;

discussion with physiotherapist during exercise session, group discussion

1.1, 1.2, 2.2, 2.3, 2.7, 4.1, 6.1, 8.1, 8.7, 12.6

 ▪ use evidence-based pharmacological and non-pharmacological pain management strategies relevant to their pain condition

PO.10

4–6

Reflection on ability and outcome of previous weeks selection and use of pharmacological and non-pharmacological pain management approaches relevant to their pain condition

Group discussion and feedback from physiotherapist

1.2, 2.2, 2.7, 3.1, 3.2, 3.3, 10.4, 15.1

 ▪ apply pain coping strategies

PO.11

5–6

Reflection on ability and outcome of selection and use of pain coping strategies

Group discussion and feedback from physiotherapist

1.2, 2.2, 2.7, 3.1, 3.2, 3.3, 8.1, 10.4, 15.1

 ▪ follow healthy eating guidelines and monitor healthy weight

PO.12

3–4

Reflection on ability and outcome of monitoring healthy eating and weight and use of tools to support this

Group discussion and feedback from physiotherapist

1.2, 2.2, 2.3, 3.1, 3.2, 3.3, 10.4, 12.5, 15.1

 ▪ engage in specific exercises

PO.13

1–6

Supervised group exercise class

Practice of selected exercises at home; provision of theraband to support exercises at home

Participation in self-selected exercises and progressions with support and feedback from physiotherapist. Peer observation and discussion. Completion of weekly exercise diary in class

1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 8.1, 8.7, 10.4, 12.5, 15.1

 ▪ Reduce pain catastrophizing beliefs’ associated with pain condition by using pain coping strategies

PO.10, PO.11

2–6

Review of previous week

Group discussion; discussion with physiotherapist

2.2, 2.3, 2.7, 5.1, 5.6, 9.1, 10.4

 ▪ Reduce pain catastrophizing beliefs’ related to consequences of engaging in specific exercises

PO.13

1–6

Supervised group exercise class

Participation in exercises, peer observation and group discussion

Review of outcome of previous weeks home exercises programme; discussion with physiotherapist

2.2, 2.3, 2.7, 5.1, 5.6, 6.1, 8.1, 9.1

 ▪ Reduce fear associated with pain condition by using pain coping strategies

PO.10, PO.11

2–6

Pain and factors influencing it;

review of previous week

Lecture;

group discussion and feedback

2.2, 2.3, 2.7, 3.3, 5.6, 9.1, 11.2

 ▪ Reduces fear related to engaging in selected specific exercises

PO.13

1–6

Supervised group exercise class

Participation in exercises; peer observation and group discussion

2.2, 2.3, 2.7, 3.3, 5.6, 8.1, 9.1, 11.2

 ▪ self-manage their pain condition

▪ use evidence-based pharmacological and non-pharmacological pain management strategies relevant to their pain condition

PO.9, PO.10

2–6

Factors influencing and easing pain;

review of previous week; planning for subsequent week to select and use relevant approaches

Lecture; group discussion led by physiotherapist

1.2, 3.1, 3.2, 3.3, 5.1, 6.2, 9.1, 10.4

 ▪ to use pain coping strategies

PO.9, PO.11

2–6

Factors influencing and easing pain;

review of previous week; planning for subsequent week to select and use relevant approaches

Lecture; group discussion led by physiotherapist

1.2, 3.1, 3.2, 3.3, 5.1, 6.2, 8.7, 9.1, 10.4

 ▪ to follow healthy eating guidelines and to monitor healthy eating and weight

PO.9, PO.12

3

Effect of diet and weight on pain

Review of previous week, planning for subsequent week to select and use relevant strategies

Lecture; programme handbook;

group discussion led by physiotherapist

1.1, 1.2, 1.3, 1.4, 1.5, 1.7, 3.1, 3.2, 3.3, 5.1, 6.2, 9.1, 10.4

 ▪ to perform selected specific exercises

PO.9, PO.13

1–6

Effect of specific exercise on joint and back pain;

supervised group exercise class; home exercise programme

Lecture; programme handbook; group discussion;

participation in group exercise class and home exercise programme; peer observation and discussion

1.1, 1.2, 1.3, 1.4, 3.1, 3.2, 3.3, 5.1, 6.2, 8.7, 9.1, 10.4

 ▪ Develop ability to monitor pain condition to select and apply evidence-based pharmacological and non-pharmacological pain management strategies relevant to their pain condition

PO.10

2–6

Weekly activity diary; record of pain-related symptoms

Programme handbook

2.3

 ▪ Develop ability to monitor pain condition to select and apply appropriate pain coping strategies

PO.11

2–6

Weekly activity diary; record of pain-related symptoms

Programme handbook; use of relaxation CD at home

2.3

 ▪ Develop ability to monitor healthy eating and weight

PO.12

3–6

Food and exercise diary

Measurement of waist size demonstrated by physiotherapist

Programme handbook

Tape measure provided

2.3

 ▪ Develop ability to incorporate and monitor effects of specific exercise in daily life

PO.13

1–6

Weekly specific exercise diary

Programme handbook

Completion of weekly exercise diary in class

2.3