Psychological processes of ACL-patients' post-surgery rehabilitation: A prospective test of an integrated theoretical model

Alfred S.Y. LEE, Patrick Shu-Hang YUNG, Kam-Ming MOK, Martin S. HAGGER, King Chung Derwin CHAN

Research output: Contribution to journalArticle

Abstract

Objectives: The aim of this prospective study was to examine the utility of an integrated model comprising constructs from self-determination theory (SDT) and the theory of planned behavior (TPB) in predicting adherence to a post-surgery rehabilitation program in patients receiving anterior cruciate ligament (ACL) reconstruction. Constructs of the integrated model measured at baseline were expected to predict patients' rehabilitation adherence two months later.

Method: Patients (N = 121, M age = 27.62, range = 18–53; 36.66% female) scheduled to have ACL reconstruction surgery within two months were recruited from a Hong Kong public hospital. At baseline and two-month follow-up, patients completed measures of perceived autonomy support from doctors and physiotherapists and treatment motivation from SDT, social cognition constructs from the TPB factors, and adherence to the postsurgery rehabilitation program recommended by their surgeon.

Results: Path analysis displayed good goodness-of-fit of the proposed model with the data (χ2 = 11.47 (df = 9), CFI = 0.98, TLI = 0.93, RMSEA = 0.06 [90% CI = 0.00; 0.10]) after controlling for age, gender, time of surgery, post-surgery rehabilitation, and injury severity. Consistent with hypotheses, perceived autonomy support from physiotherapist and autonomous treatment motivation directly and indirectly predicted the TPB constructs and treatment adherence. However, there was no association between perceived autonomy support from doctors and autonomous motivation.

Conclusion: The integrated model was effective in explaining the psychological processes that relate to medical adherence. Findings also highlight the importance of the autonomy support from physiotherapists and provide evidence for potential intervention targets. Copyright © 2019 Elsevier Ltd. All rights reserved.
Original languageEnglish
Article number112646
JournalSocial Science & Medicine
Early online dateOct 2019
DOIs
Publication statusE-pub ahead of print - Oct 2019

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Anterior Cruciate Ligament
surgery
rehabilitation
Physical Therapists
physiotherapist
Theoretical Models
Rehabilitation
Psychology
Motivation
Personal Autonomy
Anterior Cruciate Ligament Reconstruction
autonomy
self-determination
reconstruction
Public Hospitals
Hong Kong
Patient Compliance
Cognition
social cognition
path analysis

Citation

Lee, A. S. Y., Yung, P. S.-H., Mok, K.-M., Hagger, M. S., & Chan, D. K. C. (2019). Psychological processes of ACL-patients' post-surgery rehabilitation: A prospective test of an integrated theoretical model. Social Science & Medicine. Advance online publication. doi: 10.1016/j.socscimed.2019.112646

Keywords

  • Self-determination theory
  • Theory of planned behavior
  • Treatment motivation
  • Behavioral compliance
  • Social cognitive variables
  • Rehabilitation adherence
  • Anterior cruciate ligament rupture