Development and Reliability of the Physical Therapy Healthy Lifestyle Appraisal: A New Assessment Tool to Guide Behavior Change

Abstract

Supplemental Digital Content is Available in the Text. Purpose: Physical therapists are well positioned to encourage their patients to live a healthy lifestyle. Physical therapists report barriers that limit their ability to practice health promotion counseling with their patients including the availability of a brief tool to gather information about their patient's current level of activity related to specific health behaviors. The purpose of this study was to describe the development and testing of the Physical Therapy Healthy Lifestyle Appraisal (PTHLA). Methods: The PTHLA is a patient self-report questionnaire that assesses stage of change, importance of changing, and confidence in engaging in 6 health behaviors. Physical Therapy Healthy Lifestyle Appraisal version 1 (106 items) was designed to compare different constructs for measuring stage of change and confidence in engaging in health behaviors. After pilot testing, 3 versions were tested to arrive at the 18 item PTHLA-version 3. Physical therapy patients in outpatient clinics in Michigan, Minnesota, and Texas were recruited for this multiphase study (version 1 n = 60, version 2 n = 65, and version 3 n = 28). Results: Physical Therapy Healthy Lifestyle Appraisal version 3 consists of 3 questions for each of 6 health behavior domains; a 3-option ordinal question for assessing stage of change and 11-point rulers for assessing importance of engaging in the behavior and confidence in engaging in the behavior. Unique items from version 1 and version 2 were retained in PTHLA-version 3, whereas those items that were somewhat redundant were excluded. Behavioral definitions for the “sleep” and “stress” domains were the only changes made from the first to the second versions. Across samples and behavioral domains, scores for the 18 items generally displayed satisfactory-to-high test–retest reliabilities (Cohen κw = 0.56–1.00, mean = 0.76; Spearman ρ = 0.53–1.00, mean = 0.77; intraclass correlation coefficient = 0.39–1.00, mean = 0.74). Confidence in behavior ruler scores displayed satisfactory-to-high convergent correlations with scores from lengthier multiple-item confidence in behavior measures (Pearson r validity coefficients = 0.33–0.90, mean = 0.63). The three-option stage of change items demonstrated satisfactory convergent validity with scores on the stage of change ruler (Pearson r validity coefficients = 0.16–0.86, mean = 0.61). Conclusions: The PTHLA-version 3 is a reliable and efficient tool for PT practice developed by physical therapists with expertise in prevention, health promotion, and wellness. Physical therapists can use the information provided from the PTHLA to initiate conversations about behavior change with their patients. Understanding the patient's current stage of change, level of interest in changing the behavior, and confidence for changing the behavior is important information for the PT to ensure a productive and respectful conversation about behavior change.