Development of The COMBINED approach: Integrating a brief behaviour change intervention supported by a physiotherapist for people with rotator cuff disorders

Julie Bury; Chris Littlewood; Clare Jinks; Gemma Mansell; Kristina Curtis; Gillian Yeowell

doi:10.1016/j.msksp.2026.103493

Development of The COMBINED approach: Integrating a brief behaviour change intervention supported by a physiotherapist for people with rotator cuff disorders

Julie Bury
, Chris Littlewood
, Clare Jinks
, Gemma Mansell
, Kristina Curtis
, Gillian Yeowell

Research output: Contribution to journal › Article › peer-review

Abstract

Background:
Modifiable lifestyle factors (smoking, inactivity, overweight) could contribute to the onset and persistence of rotator cuff disorders, yet physiotherapy practice rarely addresses them. Brief interventions (BIs) can support behaviour change but are not routinely embedded in musculoskeletal care.

Objectives:
To develop The COMBINED approach: a physiotherapist-supported intervention integrating BI's targeting modifiable health behaviours into routine consultations for people with rotator cuff disorders; and to explore how physiotherapists can be supported to deliver it.

Materials and methods:
A theory-, evidence-, and pragmatic-based development process incorporated stakeholder co-design, behavioural theory, and evidence across three workstreams: (1) narrative review of BIs targeting smoking, inactivity, and weight management; (2) four co-design workshops with 26 stakeholders (physiotherapists, patients, experts) to select and adapt a BI and identify key intervention features; (3) theoretical modelling using COM-B, TDF, and BCTTv1 to map barriers/facilitators, select behaviour change techniques, and develop prototype components.

Findings:
Fourteen BIs were identified; Moving Medicine had greatest utility. Barriers included time constraints, limited skills and confidence, and fear of offending patients, contrasting with patients' acceptability of lifestyle conversations. Recommendations included embedding the BI into routine care, scripts, infographics, patient resources, and training. Twelve TDF domains and 20 BCTs informed prototype development comprising: (1) patient-level intervention: a BI (adapted from Moving Medicine) embedded in routine consultations with tailored resources; (2) clinician-level implementation toolkit.

Conclusions:
The COMBINED approach is the first formally developed intervention supporting integration of BI's within routine consultations for people with rotator cuff disorders and is now ready for feasibility testing.

Original language	English
Article number	103493
Number of pages	10
Journal	Musculoskeletal Science and Practice
Volume	82
Early online date	2 Jan 2026
DOIs	https://doi.org/10.1016/j.msksp.2026.103493
Publication status	E-pub ahead of print - 2 Jan 2026

Bibliographical note

Funding

This work was funded by Health Education England (HEE)/National Institute for Health and Care Research (NIHR) as part of a Clinical Doctoral Research Fellowship (NIHR300541); this paper presents independent research supported by the NIHR. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Funders	Funder number
Health Education England
National Institute for Health and Care Research	NIHR300541

Keywords

Behaviour change
Brief intervention
Intervention development
Physiotherapy
Co-design
Rotator cuff disorders

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10.1016/j.msksp.2026.103493Licence: CC BY 4.0

J Bury et al_Development of The COMBINED approach_Integrating a brief behaviour change intervention supported by a physiotherapist for people w rotator cuff disorders
Copyright © 2026 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/).
Final published version, 5.62 MBLicence: CC BY 4.0

Cite this

Bury, J., Littlewood, C., Jinks, C., Mansell, G., Curtis, K., & Yeowell, G. (2026). Development of The COMBINED approach: Integrating a brief behaviour change intervention supported by a physiotherapist for people with rotator cuff disorders. Musculoskeletal Science and Practice, 82, Article 103493. Advance online publication. https://doi.org/10.1016/j.msksp.2026.103493

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abstract = "Background: Modifiable lifestyle factors (smoking, inactivity, overweight) could contribute to the onset and persistence of rotator cuff disorders, yet physiotherapy practice rarely addresses them. Brief interventions (BIs) can support behaviour change but are not routinely embedded in musculoskeletal care. Objectives: To develop The COMBINED approach: a physiotherapist-supported intervention integrating BI's targeting modifiable health behaviours into routine consultations for people with rotator cuff disorders; and to explore how physiotherapists can be supported to deliver it. Materials and methods: A theory-, evidence-, and pragmatic-based development process incorporated stakeholder co-design, behavioural theory, and evidence across three workstreams: (1) narrative review of BIs targeting smoking, inactivity, and weight management; (2) four co-design workshops with 26 stakeholders (physiotherapists, patients, experts) to select and adapt a BI and identify key intervention features; (3) theoretical modelling using COM-B, TDF, and BCTTv1 to map barriers/facilitators, select behaviour change techniques, and develop prototype components. Findings: Fourteen BIs were identified; Moving Medicine had greatest utility. Barriers included time constraints, limited skills and confidence, and fear of offending patients, contrasting with patients' acceptability of lifestyle conversations. Recommendations included embedding the BI into routine care, scripts, infographics, patient resources, and training. Twelve TDF domains and 20 BCTs informed prototype development comprising: (1) patient-level intervention: a BI (adapted from Moving Medicine) embedded in routine consultations with tailored resources; (2) clinician-level implementation toolkit. Conclusions: The COMBINED approach is the first formally developed intervention supporting integration of BI's within routine consultations for people with rotator cuff disorders and is now ready for feasibility testing.",

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author = "Julie Bury and Chris Littlewood and Clare Jinks and Gemma Mansell and Kristina Curtis and Gillian Yeowell",

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AU - Bury, Julie

AU - Littlewood, Chris

AU - Jinks, Clare

AU - Mansell, Gemma

AU - Curtis, Kristina

AU - Yeowell, Gillian

PY - 2026/1/2

Y1 - 2026/1/2

N2 - Background: Modifiable lifestyle factors (smoking, inactivity, overweight) could contribute to the onset and persistence of rotator cuff disorders, yet physiotherapy practice rarely addresses them. Brief interventions (BIs) can support behaviour change but are not routinely embedded in musculoskeletal care. Objectives: To develop The COMBINED approach: a physiotherapist-supported intervention integrating BI's targeting modifiable health behaviours into routine consultations for people with rotator cuff disorders; and to explore how physiotherapists can be supported to deliver it. Materials and methods: A theory-, evidence-, and pragmatic-based development process incorporated stakeholder co-design, behavioural theory, and evidence across three workstreams: (1) narrative review of BIs targeting smoking, inactivity, and weight management; (2) four co-design workshops with 26 stakeholders (physiotherapists, patients, experts) to select and adapt a BI and identify key intervention features; (3) theoretical modelling using COM-B, TDF, and BCTTv1 to map barriers/facilitators, select behaviour change techniques, and develop prototype components. Findings: Fourteen BIs were identified; Moving Medicine had greatest utility. Barriers included time constraints, limited skills and confidence, and fear of offending patients, contrasting with patients' acceptability of lifestyle conversations. Recommendations included embedding the BI into routine care, scripts, infographics, patient resources, and training. Twelve TDF domains and 20 BCTs informed prototype development comprising: (1) patient-level intervention: a BI (adapted from Moving Medicine) embedded in routine consultations with tailored resources; (2) clinician-level implementation toolkit. Conclusions: The COMBINED approach is the first formally developed intervention supporting integration of BI's within routine consultations for people with rotator cuff disorders and is now ready for feasibility testing.

AB - Background: Modifiable lifestyle factors (smoking, inactivity, overweight) could contribute to the onset and persistence of rotator cuff disorders, yet physiotherapy practice rarely addresses them. Brief interventions (BIs) can support behaviour change but are not routinely embedded in musculoskeletal care. Objectives: To develop The COMBINED approach: a physiotherapist-supported intervention integrating BI's targeting modifiable health behaviours into routine consultations for people with rotator cuff disorders; and to explore how physiotherapists can be supported to deliver it. Materials and methods: A theory-, evidence-, and pragmatic-based development process incorporated stakeholder co-design, behavioural theory, and evidence across three workstreams: (1) narrative review of BIs targeting smoking, inactivity, and weight management; (2) four co-design workshops with 26 stakeholders (physiotherapists, patients, experts) to select and adapt a BI and identify key intervention features; (3) theoretical modelling using COM-B, TDF, and BCTTv1 to map barriers/facilitators, select behaviour change techniques, and develop prototype components. Findings: Fourteen BIs were identified; Moving Medicine had greatest utility. Barriers included time constraints, limited skills and confidence, and fear of offending patients, contrasting with patients' acceptability of lifestyle conversations. Recommendations included embedding the BI into routine care, scripts, infographics, patient resources, and training. Twelve TDF domains and 20 BCTs informed prototype development comprising: (1) patient-level intervention: a BI (adapted from Moving Medicine) embedded in routine consultations with tailored resources; (2) clinician-level implementation toolkit. Conclusions: The COMBINED approach is the first formally developed intervention supporting integration of BI's within routine consultations for people with rotator cuff disorders and is now ready for feasibility testing.

KW - Behaviour change

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KW - Intervention development

KW - Physiotherapy

KW - Co-design

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SN - 2468-8630

VL - 82

JO - Musculoskeletal Science and Practice

JF - Musculoskeletal Science and Practice

M1 - 103493

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Development of The COMBINED approach: Integrating a brief behaviour change intervention supported by a physiotherapist for people with rotator cuff disorders

Abstract

Bibliographical note

Funding

Keywords

Access to Document

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