Patient motivation and adherence to postsurgery rehabilitation exercise recommendations: The influence of physiotherapists' autonomy-supportive behaviors

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. Copyright © 2009 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.