Motivation in physiotherapy
Our motivation largely determines our behavior. Within the context of a rehabilitation process we, as therapists, also aim in a certain sense at an adaptation in health behaviour. Because of this motivation plays an important role within the therapy. Several studies showed that motivated patients show better results at the end of their rehabilitation process [1,2]. But which factors determine the motivation of an individual and what exactly makes an activity motivating or demotivating? And how can therapists make optimal use of this knowledge in their practice?
Self-determination theory
Within the scientific literature there are several frames of thought that try to define the fundamental building blocks of motivation. The self-determination theory is an example of such a theoretical framework. This theory is still under development and has extensive applications within various fields of research [3].
The core of the theory states that a person’s optimal functioning, growth and learning is optimally supported when three basic psychological needs are adequately met. These basic needs are also sometimes called ‘the ABC of motivation’:
Autonomy
This indicates a general feeling of freedom, independence and self-determination. It is very motivating to have the feeling that you are in control.
Connectedness
This indicates people’s need to interact with others, and the feeling that as an individual you are part of a greater whole.
Competence
Competence is understood to mean a sense of skill and growth. It is important for an individual to feel that he/she is capable of something, and that a skill that is being practiced actually improves.
In order to meet these basic needs, the self-determination theory also makes a distinction based on the source of motivation:
Intrinsic motivation
This form of motivation stems primarily from the individual pursuit of pleasure and lies entirely within the individual.
Extrinsieke motivatie
Dit type motivatie kent zijn oorsprong vanuit de omgeving van het individu. Iets of iemand zorgt voor een extern doel waarnaar het individu wilt/moet handelen.
A good form of autonomous and continuous motivation can be obtained when the right balance is achieved between these two types of motivation. A patient who has sufficient intrinsic motivation and a well internalized extrinsic motivation (e.g. knowledge of pathology) will generally be much more motivated and evolve faster throughout the therapy.
Flow
Another important concept that can apply within rehabilitation is the concept of Flow [4]. This term refers to a specific mental state in which an individual is completely absorbed in a certain activity. Activities that bring us into the ‘flow’ are almost always experienced as pleasurable and will be repeated more often.
The flow state is reached when an optimal balance is found between the difficulty of an activity and the skill of the performer. When the difficulty level is too high, the performer will experience frustration or anxiety, while with a low difficulty level there may be boredom. In order to make an activity engaging, it is therefore important to adjust the challenge according to the practitioner’s skill.
In practice
As a physical therapist it is recommended to take into account the above theoretical concepts and to implement them within the therapy. For example, we can:
Inform the patient
The knowledge and skill of the therapist acts as an extrinsic motivator within rehabilitation. By informing the patient about the condition and treatment in an easily accessible way, he/she will be able to internalize the need for rehabilitation more quickly. In this way, the care user will also get an idea of his/her own impact within the rehabilitation process faster (Competence).
Involving the patient in drawing up the treatment plan
There is nothing more frustrating than the feeling of complete powerlessness. By drawing up the therapy objectives in consultation with the patient, a sense of participation and self-determination can be developed (Autonomy). Thus, the hobbies/interests of a child or the specific sports discipline of an athlete can be taken into account when drawing up the exercise therapy.
Adapting the exercises to the patient’s skills
In order to involve the care user optimally during practice, it is important to adapt the exercises to the patient’s abilities. In this way frustration and boredom are avoided and the patient remains optimally motivated and challenged throughout the therapy.
Encouraging the patient
Receiving praise and support can be an important extrinsic motivator for a patient. An encouraging word or compliment can make the difference between biting through and giving up. By rewarding and encouraging the patient in this way, he/she gets the feeling of not being alone (Connectedness).
References:
[1] Meyns, P., Roman de Mettelinge, T., van der Spank, J., Coussens, M., & Van Waelvelde, H. (2017). Motivation in pediatric motor rehabilitation: A systematic search of the literature using the self-determination theory as a conceptual framework. Developmental Neurorehabilitation, 1–20.
[2] Carlson, J. L. (1997). Evaluating Patient Motivation in Physical Disabilities Practice Settings. American Journal of Occupational Therapy, 51(5), 347–351.
[3] Ryan, R. M., & Deci, E. L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. Guilford Press.
[4] Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York: Harper & Row.