Self-efficacy when physical therapy consults are discharged? How do patients with chronic pain deal with it?
Self‐efficacy (SE) is defined as an individual's confidence or belief in their ability to achieve behavioral goals in a specific field (Bandura, 1977). In the context of chronic pain SE refers to beliefs held by people with chronic pain that are able to carry out certain activities, even when experiencing pain. SE is a widely examined psychological influence on chronic pain and related functional outcomes. It mediates therapy effects, by influencing e.g. adherence to home exercises etc.
Therefore, an important target of physical therapy interventions is to increase SE by providing knowledge, changing beliefs, and offering self-management techniques. This is especially important when patients are about to finish rehabilitation or in times where physical therapy consultations are on hold.
In a cross-sectional study, more than 200 patients with chronic pain were interviewed by a physical therapist at discharge from a functional restoration program using the Chronic Pain Self‐Efficacy Scale (CPSS) (Souza, 2020). No associations were observed with age, symptoms duration, patient–therapist interaction. Specifically, better perceived clinical improvement, lower pain intensity, and a lower number of physiotherapy (PT) sessions were significantly related to greater levels of SE. It has indeed been shown that SE plays a role in the number of visits to health‐care settings regardless of pain severity and is a strong predictor of adherence to home‐based PT involving exercise.
In this study, most participants were discharged after completing rehabilitation program. Of course this is a different situation compared to situations were rehabilitation was not yet finished and consultations are interrupted/reduced due to other factors (e.g. holidays, lockdown, etc.). In these situations it is especially important to target patient’s SE in physical activity, with the objective of facilitating them in doing exercises independent from the therapist. Therapists can help their patients with removing some barriers by providing home exercises, referring to apps and websites, the use of tele-rehabilitation, etc. Nevertheless, the chance for success of a such approach is predicted by self-motivation, SE, previous compliance with exercise-related behavior, and social support.
How do you (motivate your patient to) stay active independent from sports club/physical therapy consultations?
See results: https://linkto.run/r/WVGVX8FK
2020Pain in Motion
References and further reading:
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological review, 84(2), 191-215. doi:10.1037//0033-295x.84.2.191
Souza, C. M., Martins, J., Libardoni, T. d. C., & de Oliveira, A. S. Self-efficacy in patients with chronic musculoskeletal conditions discharged from physical therapy service: A cross-sectional study. Musculoskeletal Care, n/a(n/a). doi:10.1002/msc.1469