The Role of Motivation and Positive Attitude on Recovery

We have all experienced the motivated and unmotivated patients across our careers as PT and OT’s.

Here we are going to delve into the mindset of an unmotivated patient, and formulate strategies to assist.

It can be especially frustrating when we notice the improvement that our patients are making, but they fail to recognize it.

It can also be aggravating when our patients compare themselves to other patients.

One article suggests that comparisons with other patients can lead to a self-reported feeling of depression at the fact they were not rehabilitating as well as other patients. (1) Therefore, it is important that we deter this kind of behavior and redirect the patient to their rehabilitation.

Another article looked at the motivated patient and discusses the importance of a combination of key factors. The article specifically discusses community-dwelling older adults of age 65 and older who sustained a hip fracture and received surgical repair and postacute rehabilitation. Data was collected 1 year after post-acute rehabilitation. Participants reported that rehabilitation services greatly facilitated their recovery. Participants also recognized the importance of their own motivation, and noted it was essential to maintain a positive attitude and fully engage in recommended rehabilitation activities. The keys to functional recovery were active participation in rehabilitation and following instructions from their care providers. In addition, self-determination, a positive attitude, and social support played significant roles in making rehabilitation work. (2)

As healthcare professionals, it's especially important to be sure that we are both motivating our patient’s and promoting an environment that fosters their own motivation. This can be achieved through communication and establishing goals at their initial examination. Expectations appear to be embedded in both hopes and fears, suggesting that clinicians should address both when negotiating realistic goals and educating patients. This can be especially important for cases of nonspecific musculoskeletal pain, where diagnoses are unclear and treatment may not completely alleviate pain. (3) Setting these goals and educating our patients on realistic expectations can reframe their mindset.

Another article which looks into the recovery of stroke patients suggests 6 key topics that should be covered during a patient’s initial examination:

● Confidence about making a good recovery

● Views about relationship with professionals

● Ideas about important factors in recovery

● Ideas about the patient’s role in rehabilitation

● Ideas about the nature and purpose of rehabilitation

● Feelings about what sort of life is desired after the recovery

What if we still aren’t getting a good response?

● Continue communicating with your patient to allow for a better understanding of what is hindering their ability to want to get better.

● Consider their plan of care and make adjustments where necessary, incorporating task-specific exercises and activities with their hobbies/interests in mind.

● We are involved in some of our patient’s health more than their Primary Care Physician. Look into their past medical history and medications. Do they have a history of depression or anxiety which could be contributing to their lack of motivation? Consider referring them to their Primary Physician, or Psychologist/Psychiatrist to assess.

● Incorporate family as necessary, or consider a referral to social worker

Having a motivated patient will both give us a sense of accomplishment and make our jobs more fulfilling while decreasing stress and burnout. As stated above, a patient's psyche plays an integral role in their optimal recovery and thus should be considered within their plan of care.

Resources:

(1): Maclean, N., Pound, P., Wolfe, C., & Rudd, A. (2000). Qualitative analysis of stroke patients’ motivation for rehabilitation. BMJ, 321.

(2):Young, Yuchi DrPH1; Resnick, Barbara PhD2. Don't Worry, Be Positive: Improving Functional Recovery 1 Year After Hip Fracture. Rehabilitation Nursing Journal 34(3):p 110-117, May 2009. | DOI: 10.1002/j.2048-7940.2009.tb00265.x

(3): Linda J. Carroll and others, How Well Do You Expect to Recover, and What Does Recovery Mean, Anyway? Qualitative Study of Expectations After a Musculoskeletal Injury, Physical Therapy, Volume 96, Issue 6, 1 June 2016, Pages 797–807, https://doi.org/10.2522/ptj.20150229