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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

Compliance

Self-Efficacy

Motivation

Practicum Experience

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

www.asheville.va.gov

  • 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 VA

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.

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