Patient motivation and adherence to post-surgery rehabilitation exercise recommendations: The influence of physiotherapists’ autonomy supportive behaviors
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NOTICE: this is the author’s version of a work that was accepted for publication in Archives of Physical Medicine and Rehabilitation. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Archives of Physical Medicine and Rehabilitation, Vol. 90, No. 12 (2009). DOI: 10.1016/j.apmr.2009.05.024
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.
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