This state-of-the-art review aimed to determine an up-to-date understanding of the literature relating to patient motivation in physical rehabilitation. It examined recent studies for theory underlying patient motivation, and factors contributing to individual motivation.
Clinical and non-clinical literature relating to the concept of motivation in physical rehabilitation, published from 1999 onwards, was gathered from four databases (MEDLINE, CINAHL, Scopus and APA PsycINFO). Articles were divided into three groups, based on their overall understanding of patient motivation; extrinsic (including social and environmental influences, and reward-based motivation), intrinsic (and therefore more ingrained), or a mixture of both. These groups were devised as a continuation of the existing discussion on motivation theory. Articles were also analysed for their approach to patient motivation as regards exercise and rehabilitation, including links between motivation and outcomes, as well as factors in rehabilitation seen as contributing towards motivation.
Nineteen studies were included in the final review. Of these, two considered motivation to be an intrinsic trait, and the majority assumed motivation to be driven by a combination of internal and external factors. Furthermore, motivation was seen to have positive effects on exercise and rehabilitation, particularly extrinsic motivation. One study found that not only were individuals with higher intrinsic motivation more likely to be physically active, but also that an increase in intrinsic motivation following rehabilitation was associated with an increase in physical activity. Several studies used SDT to support their findings.
Recent literature shows a shift away from the trend for viewing motivation as solely influenced by extrinsic factors, towards a belief that both extrinsic and intrinsic factors have a role to play in physical rehabilitation. SDT is increasingly used and continues to be a useful framework through which to classify elements of motivation. Future research should examine the mechanisms underlying how people are motivated, in the context of physical rehabilitation, and more broadly speaking, of their approach to health.
The results of this state-of-the-art review have a positive implication for practice: as motivation is considered to be more intrinsic than previously thought, therapists could use this to help influence patients to make health and lifestyle changes in the long term, beyond the context of rehabilitation.
Rehabilitation
Self-determination theory
