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Associations Between Basic Psychological Need Satisfaction and Motivation Underpinning Daily Activity Participation Among Community-Dwelling Survivors of Stroke: An Ecological Momentary Assessment Study

  • Stephen C.L. Lau
    Correspondence
    Corresponding author Stephen C.L. Lau, PhD, Program in Occupational Therapy, Washington University School of Medicine, 600 S. Taylor Ave 00163, St Louis, MO.
    Affiliations
    Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
    Search for articles by this author
  • Lisa Tabor Connor
    Affiliations
    Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO

    Department of Neurology, Washington University School of Medicine, St. Louis, MO
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  • Carolyn M. Baum
    Affiliations
    Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO

    Department of Neurology, Washington University School of Medicine, St. Louis, MO

    Brown School of Social Work, Washington University in St. Louis, St. Louis, MO
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Published:August 03, 2022DOI:https://doi.org/10.1016/j.apmr.2022.07.011

      Abstract

      Objective

      Grounded in the self-determination theory (SDT), this study aimed to examine the real-time associations between basic psychological need satisfaction and motivation underpinning daily activity participation among survivors of stroke.

      Design

      Repeated-measures observational study involving 7 days of ambulatory monitoring; participants completed ecological momentary assessment (EMA) surveys via smartphones 8 times daily. Multilevel models were used to analyze EMA data for concurrent (same survey) and lagged (next survey) associations.

      Setting

      General community.

      Participants

      Forty community-dwelling survivors of stroke (N=40).

      Interventions

      Not applicable.

      Main Outcome Measures

      EMA measures of basic psychological needs (autonomy, competence, relatedness) and motivation (autonomous motivation, controlled motivation).

      Results

      In concurrent analyses, increased autonomy (B=0.21; 95% confidence interval, 0.16-0.26; P<.001), competence (B=0.10; 95% confidence interval, 0.02-0.19; P=.021), and relatedness (B=0.10; 95% confidence interval, 0.06-0.13; P<.001) were momentarily associated with higher autonomous motivation. Conversely, increased autonomy (B=−0.19; 95% confidence interval, −0.27 to −0.10; P<.001) and competence (B=−0.09; 95% confidence interval, −0.17 to −0.01; P=.020) were momentarily associated with lower controlled motivation. Contrary to SDT, increased relatedness was momentarily associated with higher controlled motivation (B=0.10; 95% confidence interval, 0.05-0.14; P<.001). In lagged analyses, no momentary associations were detected between basic psychological needs and motivation (Ps>.05).

      Conclusions

      Findings suggest that basic psychological need satisfaction is momentarily associated with motivation for daily activity participation. Additional research is warranted to examine the associations of different orientations of relatedness with autonomous and controlled motivation. Supporting basic psychological needs may foster autonomous motivation of survivors of stroke to enhance daily activity participation after stroke.

      Keywords

      List of abbreviations:

      EMA (ecological momentary assessment), MLM (multilevel modeling), SDT (self-determination theory)
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      References

        • Toglia J
        • Askin G
        • Gerber LM
        • Jaywant A
        • O'Dell MW
        Participation in younger and older adults post-stroke: frequency, importance, and desirability of engagement in activities.
        Front Neurol. 2019; 10: 1108
        • Fougeyrollas P
        • Noreau L
        • Bergeron H
        • Cloutier R
        • Dion SA
        • St-Michel G.
        Social consequences of long term impairments and disabilities: conceptual approach and assessment of handicap.
        Int J Rehabil Res. 1998; 21: 127-141
        • Perenboom RJ
        • Chorus AM.
        Measuring participation according to the International Classification of Functioning, Disability and Health (ICF).
        Disabil Rehabil. 2003; 25: 577-587
        • Law M.
        Participation in the occupations of everyday life.
        Am J Occup Ther. 2002; 56: 640-649
        • Mayo NE
        • Wood-Dauphinee S
        • Côté R
        • Durcan L
        • Carlton J.
        Activity, participation, and quality of life 6 months poststroke.
        Arch Phys Med Rehabil. 2002; 83: 1035-1042
        • Egan M
        • Davis CG
        • Dubouloz CJ
        • Kessler D
        • Kubina LA.
        Participation and well-being poststroke: evidence of reciprocal effects.
        Arch Phys Med Rehabil. 2014; 95: 262-268
        • Hoyle M
        • Gustafsson L
        • Meredith P
        • Ownsworth T.
        Participation after stroke: do we understand all the components and relationships as categorised in the ICF?.
        Brain Impair. 2012; 13: 4-15
        • Eriksson G
        • Carolyn Baum M
        • Wolf TJ
        • Connor LT
        Perceived participation after stroke: the influence of activity retention, reintegration, and perceived recovery.
        Am J Occup Ther. 2013; 67: e131-e138
        • Silva SM
        • Corrêa JCF
        • Pereira GS
        • Corrêa FI.
        Social participation following a stroke: an assessment in accordance with the International Classification of Functioning, Disability and Health.
        Disabil Rehabil. 2019; 41: 879-886
        • Palstam A
        • Sjödin A
        • Sunnerhagen KS.
        Participation and autonomy five years after stroke: a longitudinal observational study.
        PLoS One. 2019; 14e0219513
        • Nicholas ML
        • Burch K
        • Mitchell JR
        • Fox AB
        • Baum CM
        • Connor LT.
        Self-perception of physical function contributes to participation in cognitively- and physically-demanding activities after stroke.
        Front Neurol. 2020; 11: 474
        • Ho A
        • Nicholas ML
        • Dagli C
        • Connor LT.
        Apathy, cognitive impairment, and social support contribute to participation in cognitively demanding activities poststroke.
        Behav Neurol. 2021; 20218810632
        • Lee Y
        • Nicholas ML
        • Connor LT.
        Identifying emotional contributors to participation post-stroke.
        Top Stroke Rehabil. 2021; : 1-13
        • Graves R
        • Connor LT
        • Nicholas ML.
        Apathy and residual neurological impairment are associated with community reintegration after mild stroke.
        Neuropsychol Rehabil. 2021 Dec 21; ([Epub ahead of print])
        • van Dalen JW
        • Moll van Charante EP
        • Nederkoorn PJ
        • van Gool WA
        • Richard E
        Poststroke apathy.
        Stroke. 2013; 44: 851-860
        • Nicholson S
        • Sniehotta FF
        • van Wijck F
        • et al.
        A systematic review of perceived barriers and motivators to physical activity after stroke.
        Int J Stroke. 2012; 8: 357-364
        • Rimmer JH
        • Wang E
        • Smith D.
        Barriers associated with exercise and community access for individuals with stroke.
        J Rehabil Res Dev. 2008; 45: 315-322
        • Reeve J.
        Understanding motivation and emotion.
        7th ed. Wiley, Hoboken, NJ2014
        • Deci EL
        • Ryan RM.
        The general causality orientations scale: self-determination in personality.
        J Res Pers. 1985; 19: 109-134
        • Morris J
        • Oliver T
        • Kroll T
        • Macgillivray S.
        The importance of psychological and social factors in influencing the uptake and maintenance of physical activity after stroke: a structured review of the empirical literature.
        Stroke Res Treat. 2012; 2012195249
        • Rapolienė J
        • Endzelytė E
        • Jasevičienė I
        • Savickas R.
        Stroke patients motivation influence on the effectiveness of occupational therapy.
        Rehabil Res Pract. 2018; 20189367942
        • Deci EL
        • Ryan RM.
        The “what” and “why” of goal pursuits: human needs and the self-determination of behavior.
        Psychol Inq. 2000; 11: 227-268
        • Michalovic E
        • Rocchi M
        • Sweet SN
        Motivation and participation in daily and social activities among adults with spinal cord injury: applying self-determination theory.
        Disabil Health J. 2019; 12: 489-494
        • Sebire SJ
        • Jago R
        • Fox KR
        • Edwards MJ
        • Thompson JL.
        Testing a self-determination theory model of children's physical activity motivation: a cross-sectional study.
        Int J Behav Nutr Phys Act. 2013; 10: 111
        • McBride C
        • Zuroff DC
        • Ravitz P
        • et al.
        Autonomous and controlled motivation and interpersonal therapy for depression: moderating role of recurrent depression.
        Br J Clin Psychol. 2010; 49: 529-545
        • Dysvik A
        • Kuvaas B
        • Gagné M.
        An investigation of the unique, synergistic and balanced relationships between basic psychological needs and intrinsic motivation.
        J Appl Soc Psychol. 2013; 43: 1050-1064
        • Brown KW
        • Ryan RM.
        Multilevel modeling of motivation: a self-determination theory analysis of basic psychological needs.
        in: Ong AD van Dulmen MHM Oxford handbook of methods in positive psychology. Oxford University Press, Oxford2007: 530-541
        • Ramsey AT
        • Wetherell JL
        • Depp C
        • Dixon D
        • Lenze E.
        Feasibility and acceptability of smartphone assessment in older adults with cognitive and emotional difficulties.
        J Technol Hum Serv. 2016; 34: 209-223
        • Solhan MB
        • Trull TJ
        • Jahng S
        • Wood PK.
        Clinical assessment of affective instability: comparing EMA indices, questionnaire reports, and retrospective recall.
        Psychol Assess. 2009; 21: 425-436
        • Reis HT
        • Sheldon KM
        • Gable SL
        • Roscoe J
        • Ryan RM.
        Daily well-being: the role of autonomy, competence, and relatedness.
        Pers Soc Psychol Bull. 2000; 26: 419-435
        • La Guardia JG
        • Ryan RM
        • Couchman CE
        • Deci EL
        Within-person variation in security of attachment: a self-determination theory perspective on attachment, need fulfillment, and well-being.
        J Pers Soc Psychol. 2000; 79: 367-384
        • Moskowitz DS
        • Young SN.
        Ecological momentary assessment: what it is and why it is a method of the future in clinical psychopharmacology.
        J Psychiatry Neurosci. 2006; 31: 13-20
        • Shiffman S
        • Stone AA
        • Hufford MR.
        Ecological momentary assessment.
        Annu Rev Clin Psychol. 2008; 4: 1-32
        • Brott T
        • Adams Jr, HP
        • Olinger CP
        • et al.
        Measurements of acute cerebral infarction: a clinical examination scale.
        Stroke. 1989; 20: 864-870
        • van Swieten JC
        • Koudstaal PJ
        • Visser MC
        • Schouten HJ
        • van Gijn J.
        Interobserver agreement for the assessment of handicap in stroke patients.
        Stroke. 1988; 19: 604-607
        • Foley EL
        • Nicholas ML
        • Baum CM
        • Connor LT.
        Influence of environmental factors on social participation post-stroke.
        Behav Neurol. 2019; 20192606039
        • Vanbellingen T
        • Kersten B
        • Van de Winckel A
        • et al.
        A new bedside test of gestures in stroke: the apraxia screen of TULIA (AST).
        J Neurol Neurosurg Psychiatry. 2011; 82: 389-392
        • Friedman PJ.
        The Star Cancellation Test in acute stroke.
        Clin Rehabil. 1992; 6: 23-30
        • Bailey IL
        • Lovie JE.
        New design principles for visual acuity letter charts.
        Am J Optom Physiol Opt. 1976; 53: 740-745
        • Schow RL
        • Nerbonne MA.
        Communication screening profile: use with elderly clients.
        Ear Hear. 1982; 3: 135-147
        • Jessup G
        • Bian S
        • Chen Y
        • Bundy A.
        Manual of PIEL survey application. (iPhone/iPod Touch/iPad/iPad mini application).
        University of Sydney, Sydney, Australia2012
        • Chapman JJ
        • Fraser SJ
        • Brown WJ
        • Burton NW.
        The feasibility and acceptability of questionnaires and accelerometry for measuring physical activity and sedentary behaviour in adults with mental illness.
        J Ment Health. 2015; 24: 299-304
        • Pruitt LA
        • Glynn NW
        • King AC
        • et al.
        Use of accelerometry to measure physical activity in older adults at risk for mobility disability.
        J Aging Phys Act. 2008; 16: 416-434
        • Giné-Garriga M
        • Sansano-Nadal O
        • Tully MA
        • et al.
        Accelerometer-measured sedentary and physical activity time and their correlates in European older adults: The SITLESS Study.
        J Gerontol A Biol Sci Med Sci. 2020; 75: 1754-1762
        • Dunton GF
        • Leventhal AM
        • Rothman AJ
        • Intille SS.
        Affective response during physical activity: within-subject differences across phases of behavior change.
        Health Psychol. 2018; 37: 915-923
        • Moore RC
        • Kaufmann CN
        • Rooney AS
        • et al.
        Feasibility and acceptability of ecological momentary assessment of daily functioning among older adults with HIV.
        Am J Geriatr Psychiatry. 2017; 25: 829-840
        • Kanning M
        • Hansen S.
        Need satisfaction moderates the association between physical activity and affective states in adults aged 50+: an activity-triggered ambulatory assessment.
        Ann Behav Med. 2017; 51: 18-29
        • Wilson PM
        • Rogers WT
        • Rodgers WM
        • Wild TC.
        The Psychological Need Satisfaction in Exercise Scale.
        J Sport Exerc Psychol. 2006; 28: 231-251
        • Markland D
        • Tobin V.
        A modification to the Behavioural Regulation in Exercise Questionnaire to include an assessment of amotivation.
        J Sport Exerc Psychol. 2004; 26: 191-196
        • Sheldon KM
        • Elliot AJ.
        Goal striving, need satisfaction, and longitudinal well-being: the self-concordance model.
        J Pers Soc Psychol. 1999; 76: 482-497
        • Gunnell KE
        • Crocker PRE
        • Mack DE
        • Wilson PM
        • Zumbo BD.
        Goal contents, motivation, psychological need satisfaction, well-being and physical activity: a test of self-determination theory over 6 months.
        Psychol Sport Exerc. 2014; 15: 19-29
        • Rabe-Hesketh S
        • Skrondal A.
        Multilevel and longitudinal modeling using Stata.
        Stata Press, College Station, TX2008
        • Curran PJ
        • Bauer DJ.
        The disaggregation of within-person and between-person effects in longitudinal models of change.
        Annu Rev Psychol. 2011; 62: 583-619
        • Tang M
        • Wang D
        • Guerrien A.
        The contribution of basic psychological need satisfaction to psychological well-being via autonomous motivation among older adults: a cross-cultural study in China and France.
        Front Psychol. 2021; 12734461
        • Milyavskaya M
        • Koestner R.
        Psychological needs, motivation, and well-being: a test of self-determination theory across multiple domains.
        Pers Individ Dif. 2011; 50: 387-391
        • Bureau JS
        • Howard JL
        • Chong JX
        • Guay F.
        Pathways to student motivation: a meta-analysis of antecedents of autonomous and controlled motivations.
        Rev Educ Res. 2021; 92: 46-72
        • Russell KL
        • Bray SR.
        Self-determined motivation predicts independent, home-based exercise following cardiac rehabilitation.
        Rehabil Psychol. 2009; 54: 150-156
        • Rahman RJ
        • Hudson J
        • Thøgersen-Ntoumani C
        • Doust JH.
        Motivational processes and well-being in cardiac rehabilitation: a self-determination theory perspective.
        Psychol Health Med. 2015; 20: 518-529
        • Ryan RM
        • Deci EL.
        Overview of self-determination theory: an organismic-dialectical perspective.
        University of Rochester Press, Rochester, NY2002: 3-33 (Handbook of self-determination research)
        • Vallerand RJ
        • Reid G.
        On the causal effects of perceived competence on intrinsic motivation: a test of cognitive evaluation theory.
        J Sport Psychol. 1984; 6: 94-102
        • Ryan RM
        • Deci EL.
        Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being.
        Am Psychol. 2000; 55: 68-78
        • Lavigne GL
        • Vallerand RJ
        Crevier-Braud L. The fundamental need to belong: on the distinction between growth and deficit-reduction orientations.
        Pers Soc Psychol Bull. 2011; 37: 1185-1201
        • Neubauer AB
        • Voss A
        • Ditzen B.
        Exploring need dynamics within and across days in everyday life: a three-level analysis.
        J Res Pers. 2018; 77: 101-112
        • Pelletier LG
        • Dion SC
        • Slovinec-D'Angelo M
        • Reid R
        Why do you regulate what you eat? Relationships between forms of regulation, eating behaviors, sustained dietary behavior change, and psychological adjustment.
        Motiv Emot. 2004; 28: 245-277
        • Behzadnia B
        • Mohammadzadeh H
        • Ahmadi M.
        Autonomy-supportive behaviors promote autonomous motivation, knowledge structures, motor skills learning and performance in physical education.
        Curr Psychol. 2019; 38: 1692-1705
        • Standage M
        • Duda JL
        • Ntoumanis N.
        A model of contextual motivation in physical education: using constructs from self-determination and achievement goal theories to predict physical activity intentions.
        J Educ Psychol. 2003; 95: 97-110
        • Deci E
        • Ryan RM.
        Intrinsic motivation and self-determination in human behavior.
        Springer, Boston, MA1985
        • 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.
        Arch Phys Med Rehabil. 2009; 90: 1977-1982
        • Amorose AJ
        • Anderson-Butcher D
        Autonomy-supportive coaching and self-determined motivation in high school and college athletes: a test of self-determination theory.
        Psychol Sport Exerc. 2007; 8: 654-670
        • Kayser JW
        • Cossette S
        • Alderson M.
        Autonomy-supportive intervention: an evolutionary concept analysis.
        J Adv Nurs. 2014; 70: 1254-1266
        • Patrick H
        • Williams GC.
        Self-determination theory: its application to health behavior and complementarity with motivational interviewing.
        Int J Behav Nutr Phys Act. 2012; 9: 18
        • Silva MN
        • Markland D
        • Vieira PN
        • et al.
        Helping overweight women become more active: need support and motivational regulations for different forms of physical activity.
        Psychol Sport Exerc. 2010; 11: 591-601
        • Teixeira PJ
        • Carraça EV
        • Markland D
        • Silva MN
        • Ryan RM.
        Exercise, physical activity, and self-determination theory: a systematic review.
        Int J Behav Nutr Phys Act. 2012; 9: 78
        • Podlog LW
        • Brown WJ.
        Self-determination theory: a framework for enhancing patient-centered care.
        J Nurse Pract. 2016; 12: e359-e362
        • Pritchard-Wiart L
        • Thompson-Hodgetts S
        • McKillop AB.
        A review of goal setting theories relevant to goal setting in paediatric rehabilitation.
        Clin Rehabil. 2019; 33: 1515-1526
        • Wolf TJ
        • Baum CM
        • Lee D
        • Hammel J.
        The development of the Improving Participation After Stroke Self-Management Program (IPASS): an exploratory randomized clinical study.
        Top Stroke Rehabil. 2016; 23: 284-292
      1. Mugford A, Cremades JG. Sport, exercise, and performance psychology: theories and applications. New York, NY: Taylor & Francis; 2018.

        • Ryan RM
        • Deci EL.
        Self-determination theory: basic psychological needs in motivation, development, and wellness.
        Guilford Publications, New York2017
        • Huhtiniemi M
        • Sääkslahti A
        • Watt A
        • Jaakkola T.
        Associations among basic psychological needs, motivation and enjoyment within Finnish physical education students.
        J Sports Sci Med. 2019; 18: 239-247
        • Kratz AL
        • Murphy SL
        • Braley TJ.
        Pain, fatigue, and cognitive symptoms are temporally associated within but not across days in multiple sclerosis.
        Arch Phys Med Rehabil. 2017; 98: 2151-2159
        • Abelson RP.
        A variance explanation paradox: when a little is a lot.
        Psychol Bull. 1985; 97: 129-133