Darcy Ummels

Using an activity tracker in daily clinical practice | 129 6 diagnosing the coping mechanism of a patient and opt for treatment strategies such as graded activity. The diagnosis of the coping mechanism can be supported by the activity tracker, since part of the diagnosis is the agreement between the objective physical activity level (i.e., how physically active somebody actually is) and the subjective physical activity level (i.e., how physically active somebody thinks he/she is). They also noticed that the objective measurement provided insight for patients into their own coping mechanisms. ‘ It is important to objectively know how physically active they [patients] are. They tell you they are very active but, if they aren’t active, that is non ‐ accepting pain ‐ coping. Therapist 3 (reflection session) Therapists also observed that some patients did not want to talk about their physical activity level. Therapists suspected that this was because the objective measurement revealed the actual problem for the patient (i.e., coping mechanism). During the last reflection session, therapists indicated that they would like to guide the conversation more towards the activity tracker data even when patients do not want to talk about it. ‘They don’t want to talk about the activity tracker, because it is the core of their problem; they keep being too active and keep being chaotic. It really can be good to reflect on that’ Therapist 1 (reflection session) During the first and second reflection sessions, therapists expressed their difficulties in deciding on an appropriate physical activity goal (i.e., number of steps or active minutes) for their patients during the assessment period. During the second reflection session, therapists decided that the standard goal during the assessment period should be zero steps and zero active minutes for everybody so that patients would not feel the pressure of the standard physical activity goals during the assessment period. ‘You never know how physically active somebody is, so you always have to guess a goal. For example, with patient two, I thought he wasn’t active so I set his goal in the assessment period at 1,000 steps but he walked 9,000 steps.’ PS Therapist 1 (reflection session) Both therapists and patients explained that there was sufficient time to discuss the data of the activity tracker. Patients valued these conversations but would like more guidance on how to reach their physical activity goals. Patients indicated that it was important that the time interval between measuring their physical activity or goal setting and discussing the data was not too long (>1 week) otherwise, they started to self ‐ interpret the data. They felt the need for reassurance that their goal was sufficient. During the last reflection session, therapists noted that patients did try to achieve the physical activity goals (number of steps) during the intervention period but often did not manage to do so and often changed their goals independently. Patients indicated that due to the experienced lack of guidance by their therapists during the intervention