Wrong focus. How the hell do you motivate stroke doctors, hospitals and association to actually solve stroke? Rather than have them blame the patient for not recovering? THIS IS TOTALLY THE WRONG FOCUS. Or you could just give them EXACT STROKE PROTOCOLS WITH NUMBER OF REPETITIONS. This would work themselves to exhaustion knowing that at the end they would recover.
Motivational Strategies for Stroke Rehabilitation: A Descriptive Cross-Sectional Study
Kazuaki Oyake
Makoto Suzuki
Yohei Otaka
Satoshi Tanaka- 1Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan
- 2Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
- 3Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
- 4Laboratory of Psychology, Hamamatsu University School of Medicine, Shizuoka, Japan
Background: The addition of
motivational strategies to a rehabilitation program is thought to
enhance patient adherence and improve outcomes. However, little is known
about how rehabilitation professionals motivate stroke patients during
rehabilitation. The primary objective of this study was to provide a
comprehensive and quantitative list of motivational strategies for
stroke rehabilitation. In addition, we aimed to examine (1) whether
professionals with more clinical experience used a higher number of
motivational strategies, (2) the purpose for using each strategy, and
(3) the information considered when choosing strategies.
Methods: This descriptive,
cross-sectional study was conducted using a web survey with a
convenience sample of 407 rehabilitation professionals including
physicians, nurses, physical therapists, occupational therapists, and
speech-language-hearing therapists.
Results: We received data for 362
participants. Fifteen strategies were found to be used by more than 75%
of the respondents to motivate their patients. Almost all of the
respondents reported that they actively listened to and praised their
patients to increase patient adherence to rehabilitation programs.
Respondents with more clinical experience tended to use a higher number
of motivational strategies (rho = 0.208, p < 0.001). For 11 of
the 15 strategies selected by more than 75% of the respondents, the
highest percentage of respondents reported that they used the strategies
to make rehabilitation worthwhile for their patients. The majority of
respondents reported that they decided which motivational strategy to
use by considering comprehensive information regarding the patient
health condition, environmental factors, and personal factors.
Conclusions: The comprehensive list of
motivational strategies obtained may be useful for increasing patient
adherence to rehabilitation, especially for professionals with less
clinical experience. Furthermore, our findings regarding the purpose for
using each strategy and the information considered when choose
strategies might help rehabilitation professionals to optimally utilize
the motivational strategy list.
Introduction
Studies on stroke rehabilitation have recommended the
use of intensive and repetitive task-specific practice, as well as
aerobic exercise (1).
Given that the independent efforts of the patient are necessary to
sustain these practices and exercises, patient motivation is frequently
used as a determinant of rehabilitation outcome (2). High adherence to a rehabilitation program is thought to be indicative of motivation (2, 3), and a lack of motivation is one of the perceived barriers to physical activity and exercise training after stroke (4–7).
Therefore, the addition of motivational strategies to rehabilitation
programs may effectively enhance patient adherence, producing better
outcomes (8).
Motivational strategies such as feedback (9, 10), counseling (11), and information provision (12)
have positive effects on recovery after stroke. An international
randomized clinical trial found that praise and positive feedback were
effective for improving walking speed during inpatient rehabilitation (9).
Feedback using virtual reality has been found to be beneficial in
improving motivation, upper limb function, and activities of daily
living (10, 13). Furthermore, counseling and information provision have been found to have a positive impact on mood (11, 12).
However, few reports have comprehensively investigated strategies used
by medical professionals to motivate patients undergoing stroke
rehabilitation.
Maclean et al. (3)
conducted a semi-structured interview of medical professionals to
determine how they increase patient motivation with respect to stroke
rehabilitation. The researchers reported that setting rehabilitation
goals, providing information about rehabilitation, and accessing and
using the patient's cultural norms appeared to have a positive effect on
motivation (3).
However, it is difficult to generalize these findings to the general
population due to the small sample size and in-depth interview method
used (14).
As opposed to semi-structured interviews, the findings from quantitative surveys are generalizable to a larger population (14).
Therefore, the primary objective of this study was to provide a
comprehensive list of motivational strategies that medical professionals
use for stroke rehabilitation in Japan based on quantitative survey
data. A list of motivational strategies is likely to be useful in
increasing patient adherence to rehabilitation programs. Based on our
clinical experience, we hypothesized that motivational skills could be
acquired through clinical experience. In addition, understanding the
purpose of each motivational strategy and the information that is
evaluated when choosing strategies may contribute to effective
utilization of the list. Thus, our secondary objectives were to examine (1) whether rehabilitation professionals with greater clinical experience used more motivational strategies, (2) the purpose for using each strategy, and (3) the information considered when choosing motivational strategies.
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