Motivational Strategies Motivating patients to become active participants in the therapy Motivational Strategies

Guide Behavior Changes Motivation Guide Behavior Changes Positive Outcomes The nature of physical therapy requires that you explore what motivates your patients in addition to determining what may be a barrier to performance or adherence. Typically, motivation involves guiding changes in patient behavior to achieve positive outcomes. Whether that means carrying out an exercise routine on a regular schedule to improve performance in the long term, or checking positioning to prevent skin breakdown in the short term, physical therapy professionals have long been asking their patients to change some of their behaviors, for reasons that will improve their function, quality of life, or prevent decline.

Models of Behavior Change Health Belief Model Transtheoretical Model Many theories or models of behavior change are applied in healthcare. Basic knowledge of a few of these models can help you know when to adjust therapeutic approaches, modify patient education, and provide appropriate support as you work through the continuum of care with patients. This video will look at the Health Belief Model, the Transtheoretical Model and Motivational Interviewing. Motivational Interviewing

Health Belief Model Health Belief Model Create image like this one: http://www.ohprs.ca/hp101/mod4/fig4-1.gif The Health Belief Model is based upon an individual’s perceptions and attitudes about the threat that an illness or condition poses, the benefits of following a prescribed treatment or changing behavior, and the barriers that prevent a patient from doing so. According to this model, adherence is more likely to occur when a patient perceives that his health or function will decline if he does not adhere to prescribed therapy, and that the benefits outweigh the barriers he might be facing.

Transtheoretical Model Create image like this one: http://www.prochange.com/images/stages.jpg Transtheoretical Model The Transtheoretical Model (TTM) is a five-stage model that explains the cognitive and psychological processes involved when it becomes necessary for a person to change his or her behavior: Precontemplation: The patient has no thought or intention of making any change and may be seen as unmotivated or noncompliant Contemplation: The patient is aware of an issue that may require a change in behavior, is open to information but has not made any move to change behavior Preparation. The patient knows what needs to happen and formulates a plan to take action. She may ask questions, purchase exercise equipment, or rearrange her work schedule to attend appointments Action: The patient takes specific and measurable actions to address the issue and work toward goals. In this stage, the patient is viewed as highly motivated Maintenance: At this point, the patient has fully adopted the change and integrated it as a regular part of her life. The patient is seen as achieving the goals for a successful outcome. By recognizing which stage a patient may be in, you can select appropriate strategies and adapt interventions to provide the right kind of support for the patient at the right time, rather than “butting heads” and risk frustration for all.

Motivational Interviewing Motivational Interviewing is a valuable communication strategy that can enhance adherence and motivation. MI is a guiding approach of helping a patient change a behavior. It is opposite the directive approach that many PT professionals take—we assume the role of expert and tell our patients why they should change. MI facilitates and encourages patients to discuss their issues and identify their own reasons why change is important. Key elements for the provider include expressing empathy; accepting resistance rather than arguing; gently pointing out discrepancies between current behavior and goals; and supporting the patient’s belief and confidence in his ability to change. Motivational Interviewing

The Case of Mr. C Use picture of an older guy, I didn’t have one. Let’s see how the models of change apply to the clinical example of Mr. C. Mr. C is a 65-year-old man who is seen at your outpatient physical therapy clinic six months after right middle cerebral artery infarct. Following his stroke, he spent 1 week in acute care, 6 weeks in in-patient rehabilitation, and 4 weeks receiving home health physical therapy. His past medical history includes hypertension and hyperlipidemia. He is a retired grandfather who adores his grandchildren and enjoys gardening. His goal is to improve his walking. He says he is having difficulty with his walking because his balance is ‘‘not quite there’’ and he tires easily. Mr. C arrives walking with a single-point cane. The evaluating physical therapist provided Mr. C with a specific balance and walking program which included home exercises. You, the PTA, instructed Mr. C in the exercises and he was able to demonstrate them safely. You are now seeing Mr. C 1 week later. When Mr. C arrives for his appointment, he states that he has not had the time to practice his walking.

According to the Health Belief Model, which of the following factors is most likely to improve Mr. C’s adherence to his home program? Mr. C perceives that his walking will decline if he does not adhere to his therapy (correct)→(The Health Belief Model is based upon an individual’s perception of further loss of function if he doesn’t change his behavior) Mr. C wants to comply with his therapy because he perceives that you are a “great therapist.” You scold Mr. C and tell him his walking will get worse if he doesn’t do his exercises Mr. C falls and injures himself.

Using the Transtheoretical Model, which stage of change is Mr Using the Transtheoretical Model, which stage of change is Mr. C most likely in? Pre-contemplation Contemplation(correct answer)→(he recognizes his poor balance is an issue and has a goal to improve his walking, but hasn’t taken any action) Preparation Action

If you were implementing Motivational Interviewing with Mr If you were implementing Motivational Interviewing with Mr. C, what would be an appropriate statement or question? “You really need to do these exercises twice per day in order for your balance to improve.” “Could you do your exercises just after breakfast and just before dinner?” “If you do these exercises to improve your walking, you could go on walks with your grandkids.” “If your balance was better, how might it allow you to spend more time with your grandkids?” (correct answer—you are pointing out a discrepancy between what he is doing and what is important to him and inviting him to express his own reason for change)

Summary Motivating patients to become active participants in the therapy process and adhere to recommended therapy regimens requires a multi-factorial approach that takes into consideration the barriers to motivation, internal factors involving patient beliefs and values, and a therapist’s ability to meet patients where they are in their therapy journey. You can be instrumental in this process by following a plan of care that challenges a patient yet does not overwhelm, that enables the patient to experience regular success, and by being empathetic and providing encouragement when needed. Recognizing when to modify the therapeutic approach and patient education to facilitate improved adherence and motivation is a valuable skill for competent clinicians.