Patient Motivation in Physical Therapy

They say that physical therapy is part art, part science, and today I'll be focusing on the artistic half of that fraction. Specifically, the question of patient motivation, and getting clients to "buy in" to their own therapy and recovery process. 

First, what is motivation anyway? Google defines it as follows:

mo·ti·va·tion /ˌmōdəˈvāSH(ə)n/

noun
    1. the reason or reasons one has for acting or behaving in a particular way.
      "escape can be a strong motivation for travel"
    2. the general desire or willingness of someone to do something.
      "keep staff up to date and maintain interest and motivation"
The English word "motivation" stems from the Latin movere, meaning "to move". So in essence, motivation is whatever moves one towards a goal or objective. According to Maclean et al., "certain conceptualizations of motivation can have negative effects on patient care[...] when motivation is regarded as a quality of the patient’s personality and when this interpretation is communicated to patients, feelings of self-blame can occur when recovery is incomplete. These feelings can negatively affect quality of life after discharge" (1).

As for how to instill and maintain a patient's motivation, there is no universal cure-all that will motivate every patient in all circumstances. Each patient is a separate individual with unique life-experiences, and therapists will need to customize their technique for each patient. That said, there are some general guidelines which apply to most patients, or at least to a large percentage of them:
  1. Stay Positive. Therapists often treat patients at their most vulnerable, shortly after their lives have been changed radically, often by forces largely outside of their control. Depression and pain catastrophizing are common in many PT patients, and PTAs must often be cheerleaders as well as therapists. Maintaining professional optimism and a gentle courage in spite of setbacks is vital to achieving favorable long-term outcomes.
  2. Set Realistic-But-Challenging Goals. The overload principle teaches us that in order to achieve growth, we must work outside our comfort zone and attempt tasks which we're not 100% certain we can complete successfully. This is not only a physiological principle, but a psychological one as well: patients must constantly be challenged to complete more difficult tasks, more quickly, with fewer mistakes, against greater resistance. Granted, there is always a point of diminishing returns, but until a patient's gains plateau, the therapist must gently but firmly encourage the patient to do more, with less help. As with all medicine, our goal is to make ourselves obsolete, unnecessary.  
  3. Be Flexible In Your Methods, But Steadfast In Your Goals. There may be many paths to the same mountain peak, but that's not an excuse to quit halfway up the mountain. Unless a given goal is truly unrealistic for the patient (a judgement call which is beyond a PTA's scope of practice), a therapist must strive to find a way to help the patient to achieve said goal. 
  4. Gamify Recovery. As Mary Poppins once said, "In every job that must be done, there is an element of fun. You find the fun and - SNAP! - the job's a game." No one enjoys monotony, especially not if it's painful and exhausting as well. Instead, help take the patient's mind off their pain and their sore muscles by turning therapy into a game. Consider setting up a points system and challenging the patient to beat their own high score or best time. Offer praise or other motivators whenever the patient achieves a goal, even a small one, and be sure to remind them of how far they've come and how much they've improved.  
In addition to keeping one's patient(s) motivated, a therapist must also maintain his or her own motivation as well. Burnout can be a serious hazard for both therapists and their patients, resulting in (according to Wolfe, as quoted in Wandling and Smith) "at least three ways: decreased time devoted to each patient, inadequate treatment given to each patient, and failure to meet patient goals" (2). A future installment of this blog will cover PT/PTA burnout, how to recognize it, and how it can be alleviated.

Resources

1. Maclean N, Pound P, Wolfe C, Rudd A. The Concept of Patient Motivation: A Qualitative Analysis of Stroke Professionals’ Attitudes. Stroke. 2002;(33):444-448. https://www.ahajournals.org/doi/pdf/10.1161/hs0202.102367. Accessed December 7, 2020.

2. Wandling B, Smith B. Burnout in Orthopaedic Physical Therapists. Journal of Orthopaedic & Sports Physical Therapy. 1997;26(3):124-130. doi:10.2519/jospt.1997.26.3.124

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