Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 12 , Pages 1977-1982, December 2009

Patient Motivation and Adherence to Postsurgery Rehabilitation Exercise Recommendations: The Influence of Physiotherapists' Autonomy-Supportive Behaviors

  • Derwin K. Chan, BSSc

      Affiliations

    • Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
    • The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Shatin, Hong Kong, China
    • ,
  • Chris Lonsdale, PhD

      Affiliations

    • University College Dublin, Dublin, Ireland
    • Corresponding Author InformationCorrespondence to Chris Lonsdale, PhD, School of Public Health, Physiotherapy and Population Science, Health Sciences Bldg, University College Dublin, Belfield, Dublin 4, Ireland
    • ,
  • Po Y. Ho, MD

      Affiliations

    • Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
    • The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Shatin, Hong Kong, China
    • ,
  • Patrick S. Yung, MD

      Affiliations

    • Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
    • The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Shatin, Hong Kong, China
    • ,
  • Kai M. Chan, MD

      Affiliations

    • Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
    • The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Shatin, Hong Kong, China

Abstract 

Chan DK, Lonsdale C, Ho PY, Yung PS, Chan KM. Patient motivation and adherence to postsurgery rehabilitation exercise recommendations: the influence of physiotherapists' autonomy-supportive behaviors.

Objective

To investigate the impact of physiotherapists' autonomy-supportive behaviors on patients' motivation and rehabilitation adherence after anterior cruciate ligament (ACL) reconstruction surgery.

Design

Retrospective study.

Setting

Outpatient orthopedic clinic of a university medical center.

Participants

Postsurgery ACL reconstruction patients (N=115; minimum postsurgery interval, 6mo; mean ± SD postsurgery interval, 1.77±0.8y).

Interventions

Not applicable.

Main Outcome Measures

Questionnaires measuring autonomy support from physiotherapists (Health Care Climate Questionnaire), treatment motivation (Treatment Self-Regulation Questionnaire), and rehabilitation adherence (adapted from the Sport Injury Rehabilitation Adherence Scale and the Patient Self-Report Scales of Their Home-Based Rehabilitation Adherence).

Results

Structural equation modeling analyses revealed that patients' treatment motivation mediated the relationship between physiotherapists' autonomy-supportive behaviors and rehabilitation adherence. Autonomy-supportive behavior positively predicted autonomous treatment motivation (β=.22, P<.05). Rehabilitation adherence (R2=.28) was predicted positively by autonomous motivation (β=.64, P<.05) and negatively predicted by controlled motivation (β=−.28, P<.05).

Conclusions

These preliminary findings are promising and provide an empirical basis for further research to test the efficacy of autonomy support training designed to increase patients' rehabilitation adherence.

Key Words: Anterior cruciate ligament, Motivation, Rehabilitation

List of Abbreviations: ACL, anterior cruciate ligament, CFI, comparative fit index, HCCQ, Health Care Climate Questionnaire, RMSEA, root mean squared error of approximation, SDT, self-determination theory, SEM, structural equation modeling, SRMR, standardized root mean square residual, TLI, Tucker-Lewis index, TSRQ, Treatment Self-Regulation Questionnaire

 

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

 Reprints are not available from the author.

PII: S0003-9993(09)00675-3

doi:10.1016/j.apmr.2009.05.024

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 12 , Pages 1977-1982, December 2009

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