Any professional who helps others change their lifestyle can relate to the struggle of client motivation, and physical therapists are no exception. Whether it’s the patient’s eventual loss of enthusiasm, time constraints, upfront stubbornness, or satisfaction with a half-way fix, motivation is difficult to maintain in physical therapy.
Does this mean physical therapists must cram all their best practices into the first few sessions and hope for the best?
Not after reading the following guide!
You’ll find plenty of ways to keep your patients inspired and motivated, like using our All-in-One Business Platform! With their whole program at their fingertips, patients can sneak in exercises for better adherence and results. Book a demo today!
Before we can address practical ways to motivate patients, we must better understand how humans are motivated.
Intrinsic vs. Extrinsic Motivation
There are actually two types of motivation: intrinsic and extrinsic. Watch the video below to learn more:
Intrinsic motivation occurs when someone does an activity purely for the enjoyment of it. Patients seek out physical therapy when pain or loss of function keeps them from doing what they intrinsically enjoy.
Extrinsic motivation is performing an activity for reasons other than personal enjoyment. Perhaps your patient had to take time off work for an injury and bills are piling up, or they are simply tired of being in pain. While this is a valid type of motivation, it tends to lead to the half-way fix: patients stick with therapy for long enough to experience a decrease in symptoms, only to come back a few months later with a new or worse injury.
The key to a successful therapy outcome is linking goals and progress to their intrinsic motivation.
Self-Determination Theory (SDT) suggests that intrinsic and extrinsic motivation is on a continuum, meaning no one is ever completely “unmotived” or “motivated,” but somewhere in-between. This helps us to remember that we’re all motivated by something, with the best results come from tapping into long-lasting intrinsic motivation.
SDT also notes that motivation occurs when three basic psychological needs are met:
- Autonomy: The need to freely choose actions, thoughts, and behavior. The patient will not succeed if they are coerced into doing therapy by a physician or loved one; success occurs with a personal choice to participate in therapy.
- Competence: The belief that hard work results in success. This comes from understanding the progression of their diagnosis and process of healing from beginning to end.
- Relatedness: The need to feel connected to and supported by those around them.
The more these three needs are met, the more self-motivated your patient will be. This results in better adherence to their home exercise program for lasting results.
However, it’s also important to view each patient as an individual, who is challenged and motivated differently based on their personality.
“Identifying a patient’s personality type and knowing how to optimally motivate a person who has that temperament and learning style can go a long way toward improving adherence,” explains Brenda Boucher, DPT.
Boucher goes on to suggest using a personality test or simply observing and listening to patient preferences to learn what motivates them best. While this is an extra step, it helps you get to know your patient faster so you can work together better and get results.
How It Relates to Physical Therapy
Patients must be largely self-motivated because most of their recovery does not occur in the physical therapy clinic. It takes intentionality to perform prescribed exercises, self-awareness to change their posture and body mechanics, and self-control to adhere to a recovery protocol. See the video above for some motivational tips.
A patient’s self-motivation comes from a deep sense of support from their therapist and loved ones, and a complete understanding of their home exercise program (HEP).
Physical Therapist Margaret Plack says the key to a patient’s adherence to their HEP is to always be asking effective questions to better understand them, even after their evaluation is complete. You must fully understand their goals, environment, community, support system, and barriers to adherence before progress or adherence is achieved. She says,
“You can design the best home exercise program in the world, but if it doesn’t fit that patient, it’s useless.”
Examples of crucial patient questions include:
- How important is it to you to improve or change your behavior?
- How confident are you in completing the exercises?
- Who or what can support you in this new routine?
- What barriers might get in your way? How can we anticipate them?
Not only do such questions give you more information on how to best motivate your patient to adhere to their HEP, but it also expresses empathy that wins over your patient to trust your expertise.
Goals are emphasized because they are one of the objective measures therapists use to get reimbursed by insurance. As a licensed PT, you know how to set appropriate goals for your patient that also gets maximum reimbursement and keeps the sessions warranted.
But there’s so much more to goals than what ensures more visits or has the highest monetary returns!
The Importance of Goals
While there’s nothing wrong with writing goals that reimburse well (we all need a paycheck!), your patients are more likely to work hard towards goals they see as purposeful. If you set goals that your patient is motivated to achieve, everyone wins!
Goals that are patient-oriented keeps the patient engaged in their recovery instead of simply doing what the therapist told them to. Choosing or contributing to their goals caters to their need for autonomy, and results in better adherence to the exercise plan.
How to Create Motivating Goals
It’s easy to get stuck in a goal rut.
The patient had a hip replacement? Low back pain? Shoulder surgery? Don’t start writing out goals from memory just yet! While it’s important to have standard reimbursable goals, put a unique spin on them by incorporating these tips (and more!).
Collaborate with Your Patient
Ask good questions and listen carefully to what your patient finds important. If you set goals that are only your idea, the patient will be less likely to comply.
Allow your patients to contribute (as appropriate) to their goals. Connect the dots for them if you must have a “therapy-minded” goal, like a specific range of motion or absence of a special test. For example, explain how having greater than 110 degrees of knee range of motion will enable them to safely return to hiking.
Set Goals that are Realistic
While it’s important to set goals that inspire your patient to work hard, it’s equally as important to set realistic and relevant goals.
As best you can, write goals that are achievable and set your patient up to succeed. A patient who tore their ACL might be chomping at the bit to return to their sport, but it’s crucial for them to be equally as enthusiastic about achieving the smaller goals first. Emphasize complete recovery over the speed of recovery.
Set Easy Short-Term Goals
Specifically, set short-term goals that your patient can accomplish on a weekly basis. This keeps the patient highly engaged in their therapy and gives clear direction on what they should be working on.
It Starts With You
Many new physical therapy graduates are enthusiastic and engaged with their patient care. But after years of practice and seeing the same diagnosis one-too-many times, it’s common for a therapist’s demeanor and mannerisms to contribute to poor patient motivation.
It’s easy to point the finger at the patient when motivation fades, appointments are frequently canceled, adherence to HEP is poor, and goals are slow to be met. But take time to reflect on your patient interactions and how you might positively–or negatively–affect their motivation. Learn more about appropriate communication with your patients in this video:
Evaluate Your Mindset Towards Your Patient
It’s been clinically proven that patient motivation is strongly linked to how they feel they are perceived by their therapist.
Patients are often able to identify if you have low expectations for their recovery or if you’ve labeled them as unmotivated or unsuccessful. This understandably takes the wind out of their sails; why work hard if there’s little hope for recovery?
It’s crucial to assess your demeanor and mindset towards each patient. What you think about their personality, quirks, anticipated recovery, and more spills over into how you interact with your patient, and thereby, their healing.
Evaluate Your Interactions With Your Patient
Therapy involves a lot of one-on-one time with your patient. Inevitably, you will treat a patient you’re not fond of. But if a therapist is cold towards the patient, speaks sharply, gives negative comments, or gives mixed messages on the patients’ role in their recovery, patients are less likely to be successful.
It’s your job as the professional to always be good company and not show a preference between patients. Showing empathy goes a long way in rehabilitation. Patients who feel valued and treated with dignity and respect are more likely to be motivated to please their therapist.
Avoid Using Technical Jargon
There’s a fine line between establishing your expertise and ostracizing your patient. Using overly-technical language creates a barrier, as a patient might feel foolish asking clarifying questions, or not even know what to ask.
A lack of clarity and comprehension means patients will be less involved with their own care. This leads to poor motivation, and in turn, less successful outcomes.
Save the technical language for your co-workers and use everyday language or analogies to help the patient visualize and understand their diagnosis. Provide time and plenty of opportunities for the patient to ask questions, and don’t hurry through the answer. Affirm their participation with comments like “That’s a great question!” or “Thanks for asking that.”
Don’t Ignore Patient Feedback
While it’s not realistic to expect every patient to give you a five-star review, don’t let your expertise get in the way of humbly taking feedback. Learn more in this video:
Whether it’s about your evaluation, goals, prescribed exercises, or interactions, be ready and willing to accept feedback, even if you disagree. Patient motivation and loyalty are restored when they feel valued and heard by their therapist. Use good listening skills to encourage positive communication with your patient.
Specific Ways to Motivate Patients
When patients are overwhelmed, discouraged, or demotivated, they will expect you to give words of wisdom and formulate a new action plan. Seize the opportunity to encourage your patient to keep going!
Advocate for Your Patient’s Motivation
A common phrase among physical therapists frequently is “advocate for your patient.” Usually, this is in regard to getting the services your patient needs, whether its more visits, equipment, or another specialist’s opinion. But what about advocating for your patient’s motivation?
Poor motivation can have many causes. Sometimes the patient doesn’t believe they will ever get better. Sometimes they had a bad day, week, or month. Sometimes they feel too overwhelmed with life and finances, and performing an HEP adds too much stress.
When you see your patient begin to sink in the rut of discouragement, it’s your job and privilege to lift their spirits and help them gain a positive perspective. Whatever the reason for poor motivation, you can advocate for your patient’s motivation through calm reassurance.
Engage the Patient from the Beginning
As they say, you never get a second chance to make a first impression. From the very beginning of your evaluation, be intentional with explaining the whole therapy process, from clinician expectations, patient participation, prognosis, and more.
Giving the patient the big picture will help them understand the healing process and anticipate the next step in their recovery. This will reduce discouragement when a regression or plateau hits and helps to keep motivation high.
Develop a Trusting Relationship
Patients are more likely to follow your professional advice and adhere to their program if they like and trust you. But this doesn’t mean you need to turn on the charm to win them over.
Often, trust is won through careful listening, thoughtful responses, and showing genuine interest in the patient. Keep in mind that your behavior is always on display; how you interact with co-workers and other patients confirms or denies your trustworthiness. Learn more in this video:
Keep a Positive Attitude
It’s inevitable that patients will get discouraged in therapy. Progress might be slower than they expected. Or if a patient is making a good recovery, it’s common to see them do too much and have a regression. It’s easy for the patient to wonder if things will ever get better.
Encourage your patient by explaining the healing process, how setbacks are beneficial to learning their body and limitations, and how everyone heals in their own time. It can be especially helpful to remind them of the goals they’ve already achieved.
Be a Believer in Your Patient
Sometimes the best way to motivate your patient is by maintaining an unwavering commitment to their recovery, never doubting their ability. Many of us have faced deep discouragement and depended on someone who never stopped believing in us.
Physical therapy is a long journey that requires perseverance. We all need a cheerleader, and as a therapist, you have the unique privilege to see your patient succeed by combining expertise, empathy, and encouragement.
Use Positive Communication Strategies
A discouraged or frustrated patient will look to you to fix the problem. Be prepared to take some (perhaps unnecessary) blame for why your patient isn’t making progress and help them problem-solve.
Again, empathy and displaying a genuine desire to help the patient diffuses the situation, builds trust and loyalty, and encourages the patient to continue with their program. Watch this video for more communication tips:
Use Electronic Software
Our society is increasingly using technology to track and enhance every aspect of life. More and more people use mobile phones, tablets, or computers for simple tasks and reminders. Paper handouts are easily lost, damaged, or forgotten, which can cause poor HEP adherence.
Almost all physical therapy practices have switched from paper to electronic charts, so why are we still handing out paper HEPs?
One of the best ways to maintain HEP momentum is by having it readily available to your patient using Exercise.com’s All-in-One Business Platform!
Craft an engaging HEP using written instructions and videos so it’s always at their fingertips. This encourages adherence by creating less of an excuse to forget or postpone doing their HEP. They can perform their HEP anytime, anywhere!
Using Exercise.com’s software is an excellent way to combat discouragement by giving your patients easy access to their goals and plan through the web and app. Seeing how much progress they’ve made and anticipating their next goal boosts motivation, too!
If your state’s physical therapy legislation allows, Exercise.com’s software also offers exceptional communication services so patients can ask questions about their HEP between visits.
It’s an easy and fun way to motivate adherence to their HEP!
See for yourself - Meet with the Exercise.com Team today
Grow and manage your physical therapy practice better with Exercise.com
Motivational Interviewing (MI)
One underused motivational technique in physical therapy practices is Motivational Interviewing (MI). In this evidence-based approach, the therapist asks open-ended questions to learn why the patient is seeking professional intervention.
Additionally, the therapist repeats statements made by patients and families so they can hear what was said in their own words. This demonstrates the therapist’s comprehension of the patient’s concerns, which builds trust and allows the patient or family to clarify details. Watch this explanation and demonstration below:
This is a dramatic shift from conventional models of care that dish out textbook advice and assume the patient will adhere to recommendations.
Similar to using the SOAP acronym for writing thorough documentation, many professionals use the acronym OARS to help guide their way through an MI consultation and cover all subjects:
- O: Ask open-ended questions.
- A: Use affirmations and positive statements to express genuine interest in the patient’s perspective.
- R: Use reflective listening skills and offer opportunities to clarify information. Invite the patient to elaborate on their thoughts and opinions.
- S: The therapist summarizes information in such a way that inspires action.
Specifically with HEPs, asking open-ended questions gives insight on potential barriers that might prevent the patient from being adherent to the program. Common barriers might be time restrictions, pain, and lack of confidence in their ability to perform the exercises.
Affirmations and reflective listening encourage patients to set smaller, more manageable goals that build the patient’s confidence as they work towards their bigger goal. As the patient experiences positive outcomes, their willingness to comply with their HEP increases.
Summarizing the information in a positive way builds patient confidence and trust in the therapist’s comprehension of their specific case and plan for change.
Provide an Engaging HEP
We all have countless duties to accomplish every day, so it’s understandable when the HEP occasionally slips through the cracks. But shocking research shows that only 35% of physical therapy patients adhere to their HEP!
Since the most momentum and progress are gained when a patient adheres to the HEP, the real battle for patient motivation lies in creating an engaging HEP that the patient is inspired to incorporate into their daily routine. Once they see that their HEP is critical to their recovery, they will be much more motivated to continue in therapy.
Explain the Importance
Therapists know how crucial HEPs are to recovery, but patients tend to see them as optional or “the cherry on top” to therapy visits. Plan extra time to explain in a winsome way how and why HEPs are used. It can also be beneficial to detail what happens if the HEP isn’t followed, such as a prolonged recovery and extra time and money spent on visits.
Encourage your patient to focus on progress, not perfection. Be persuasive, but be careful not to guilt or coerce your patient into adherence. Remember that patients are most compliant when they choose to do the HEP for themselves. Using MI can be especially valuable when helping your patients see the importance of performing their HEP.
Watch this video to get some inspiration for how to explain the importance of HEPs.
Strategize with Your Patient
It’s important to remember that HEP exercises may seem attainable within the four walls of a therapy clinic, but there are constant distractions and demands in the patient’s everyday environment. Many patients report the biggest reason for not complying with their HEP is time.
Sit down with your patient and get creative with finding time to do exercises. While it’s ideal to set aside 15 or 20 minutes to perform their HEP–and this should still be the first choice–that’s often not feasible. Very few patients have enough time in their day to complete their entire HEP in one sitting.
So encourage your patients to break up their program into manageable chunks. Have them perform seated exercises while eating lunch, standing exercises while brushing their teeth or washing the dishes, stretching before climbing in bed (which promotes better sleep anyway!), or seizing other times of the day.
Make sure your patient is on board with your recommendations, otherwise non-adherence is almost guaranteed. Remember that you’re fitting the HEP into their day, not their day around their HEP.
Encourage your patient to not see their HEP as a temporary fix but a lifestyle change. Patients often aren’t rid of HEPs when discharged, as many therapists give the patient a maintenance HEP to sustain their results. The patients who benefit the most from therapy are the ones who incorporate their HEP permanently into their daily routine.
Think Outside the Box
Sometimes the cause of demotivation is that HEPs are often independent work and can be isolating. If this is the case, gather your patient’s opinions and hobby preferences to incorporate socialization into their HEP.
Maybe a co-worker is willing to do the HEP with your patient at lunchtime; enlist their kids to count repetitions at home, or make health changes for the whole family. Your patient could also enroll in a general conditioning or balance class at a fitness center. This can fulfill their need for relatedness by connecting them to others and encouraging accountability, as demonstrated in the video below:
For a patient who isn’t used to exercising, getting them on a simple cardiovascular program releases feel-good endorphins that get them hooked on exercise, which results in better adherence to their therapy HEP.
The bottom line is to make HEPs as interesting and engaging as possible or connect it with an activity that is enjoyable, like doing exercises between TV commercials.
Give Clear Instructions
Some patients never attempt their HEP because they didn’t understand the exercises or the purpose of a specific exercise or stretch. Thoroughly explain all the details and purpose of their HEP to avoid any confusion.
Increase adherence by meeting their need to feel competent in their HEP: allow time for questions (and encourage them to ask questions at any time!), go through each exercise with detailed explanations, and give a reference for home (like a handout or app).
Make a Playlist
HEPs can sometimes feel like drudgery because counting exercise repetitions and length of stretches can seem endless and boring. Many patients find that creating a playlist of upbeat music can make the time fly by, help push through pain or discomfort, and be an overall motivator when completing their HEP.
Don’t Let a Bad Day Turn into a Bad Week
Life happens. Stressful, bad days happen to us all. There will be days that despite their best intentions, your patient will not be able to find the time or motivation to complete their HEP.
And that’s ok!
Encourage your patient to not let a bad day (or even a few bad days) derail their motivation. Be empathetic to hard seasons, but also support their commitment to change and improvement. Help your patient see the journey and not get bogged down in stumbling for a few days.
Celebrate the Small Wins
Therapy is a marathon filled with many mini accomplishments. Celebrate the victories with your patients, even if they’re small. Your enthusiasm and approval can be the greatest motivator for some patients.
Encourage your patients to see the real-world benefits of their HEP. Remind or reinforce the concepts you introduced during the evaluation: how certain exercises and stretches enable proper postural alignment, body mechanics, mobility, and strength that help them do the things they want to do. Linking the HEP to intrinsic motivation will keep your patient motivated and engaged.
Frequently Asked Questions (FAQ)
Why do patients lose motivation in physical therapy?
Patients might feel overwhelmed or confused by the home program they’ve been given, or they simply may not find it interesting or meaningful. Progress might not happen as quickly as they had hoped, or they might not have a good relationship with their therapist.
How can you motivate your physical therapy patient?
Start off on the right foot by building a positive relationship and purposeful communication. Allow plenty of time and opportunities throughout the session for questions. Giving the patient an effective, engaging, and purposeful HEP that yields results increases motivation.
What is Motivational Interviewing?
Motivational Interviewing (MI) is the process of asking open-ended questions, repeating or rephrasing the patient’s answers, and summarizing all the information in a way that inspires the patient to adhere to the HEP.
Is there a way to do HEPs on a mobile device?
Yes! Exercise.com’ s All-in-One Business Platform allows you to set up HEPs with video and/or text instruction so your patient always has access to their HEP.
And there you have it! The above ideas are just a few to get the creative juices flowing on how to inspire and motivate each individual patient.
Don’t forget to check out Exercise.com’s All-in-One Business Platform to create an engaging HEP for your patients! Book a demo today!