Putting psychology into telerehabilitation: Coping planning as an example for how to integrate behavior change techniques into clinical practice

Background: Behavioral interventions based on psychological theory can facilitate continued recovery after discharge from cardiac or orthopedic rehabilitation. For example, health professionals can encourage patients to engage in coping planning to support the maintenance of physical activity. Telephone-based interviews or web-based interventions are two promising delivery modes to provide such after-care services from a distance (telerehabilitation). However, previous evaluations of such behavioral interventions lack a detailed description of the specific content, and its connection to psychosocial antecedents and health outcomes. Therefore, the primary aim of this study was to (i) describe the content of user-specified coping plans. Second, we aimed to identify (ii) coping plan characteristics associated with health outcomes post-rehabilitation and (iii) socio-demographic and psychosocial variables associated with coping plan characteristics. Methods: This was a secondary analysis from a larger behavioral intervention study, using remote delivery modes, within orthopedic and cardiac rehabilitation. Two raters evaluated the content, quality and number of coping plans from 231 participants. Physical activity and quality of life (health outcomes) were measured via self-reports at the end of rehabilitation and six months after discharge. We used linear regression analyses to examine the relationship between plan characteristics and health outcomes. Results: Content analyses of participants’ coping plans emphasized that physical barriers such as pain or other health limitations presented major obstacles for engagement in physical activity post-rehabilitation. The most frequently identified external barriers to physical activity were workload, family obligations or bad weather. There was a statistically significant difference in quality of life and physical activity for participants who formulated highly instrumental coping plans (higher quality of life and activity) compared with participants with coping plans of lower quality (lower quality of life and activity). The number of plans (quantity) was not related with outcomes. Conclusion: Generating coping plans can be a useful theory-based approach for inclusion in telerehabilitation to facilitate the maintenance of physical activity and quality of life. It is important to encourage adults and older adults to engage in coping planning and, specifically, to formulate strategies that support tenacious plan pursuit.