Questions?
Optimizing Health Outcomes: Self-Efficacy and Compliance in Physical Therapy
Sophie Willihnganz
Compliance in Medicine
- Compliance describes the degree to which a patient follows prescribed medical advice
- Patient compliance can mean the difference between...
- being satisfied with their progress or not
- recovering fully from an injury
- completing therapy
Self-Efficacy in Medicine
- People's beliefs about their capabilities to produce designated levels of performance that exercise influence over events that affect their lives
-Bandura, 1994
- Self-efficacy can strongly influence treatment outcomes via...
- translation of intention into action
- whether or not a behavioral change is initiated
- how much effort is expended
- how long the change is maintained
Motivation
Barriers to Compliance
Self-Determination Theory- distinguishes between types of motivation based on reasons or goals behind one's action or deed
-Deci and Ryan, 2000
Charles George VA Medical Center
- Low self-efficacy
- Low adherence to exercise
- Mental health problems
- Low social support
- Greater perceived barriers to exercise
- Increased pain during exercise
-Jack, McLean, Moffett, & Gardiner, 2011
- Intrinsic motivation - "doing something because it is inherently enjoyable to the person"
- Satisfies psychological need for competence and autonomy
- Extrinsic motivation- "doing something because it results in an independent outcome"
- Can undermine intrinsic as reward shifts locus of causality from internally generated to externally generated
- Must address barriers or reduce their impact during treatment
Mirror Therapy
- Mirror therapy can affect rehabilitation by giving visual feedback about proprioceptive sensations
- VA: mirrors were used in their short-term rehabilitation clinic for neurological patients to improve motor function and reduce neglect
- AVL PT: mirrors were used for exercise and postural correction; more of a self-correction technique than brain remodeling or neuropathway remodeling
Patient Populations
- Noticeable motivational differences
- VA: less baseline functionality to return to, VA health benefits
- AVL PT: recovering from higher baseline, less extrinsic motivation
- Both placement sites had difficulties with compliance and adherence to treatments, regardless of population
Social Facilitation
Therapy gym: ideal setting for coaction or audience effect in either practicum location
Asheville Physical Therapy
Asheville Physical Therapy
Social Facilitation
Improvement in performance on a task produced by the mere or imagined presence of other people
-Zajonc, 1965
Fear Avoidance Behaviors
Learning Objectives
- Career development
- Difference in physical therapy settings
- Connecting knowledge
- Apply biological, anatomical, and psychological knowledge from classes
- Personal skills
- Professionalism and communication
- Effective leadership
- Applying clinic mission statements
- FAB can be defined as catastrophized cognitive-behavioral responses to anticipated pain
- Audience Effect- behaviors occurring while in the presence of passive spectators
- Unmastered task = poor performance
- Mastered task = facilitates performance
- Coaction Effect- behaviors occurring in the presence of individuals involved in the same activity
- Unmastered task = induce errors
- Mastered tasks = fewer errors
- Muscle guarding via anticipation of pain can lead to physical pathology
- Resultant perceived inability can decrease compliance, decrease self-efficacy, and affect mental health
- Interfere with activities of daily living
www.ashevillephysicaltherapy.com
Acknowledgments
- Dr. Martha Knight-Oakley
- Everyone at the AVL VA's Physical Medicine and Rehabilitation Department
- Brian Lawler and John Gilliam at Asheville Physical Therapy
- My mom for getting me into physical therapy in the first place
www.physio-pedia.com/Fear_Avoidance_Model
References
Bandura, A. (1994). Self-efficacy. In V.S. Ramachaudran (Ed.),
Encyclopedia of Human Behavior, 4. 71-81. New York: Academic Press.
Deci, E. and Ryan, R. (2000). Intrinsic and extrinsic motivations:
Classic definitions and new directions. Contemporary Educational Psychology, 25, 54-67.
Jack, K., Mclean, S.M., Moffett, J.K., and Gardiner E. (2011). Barriers
to treatment adherence in physiotherapy outpatient clinics: A systematic review. Manual Therapy, 15(5), 220-228.
Zajonc, R. (1965). Social facilitation. Science, 149(3681). 269-274.