Patient motivation in therapy and its impact on rehabilitation outcomes post-stroke: the therapists' perspective

Ntsinde, Xoliswa C
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Background: Patient motivation has been associated with positive rehabilitation outcomes in stroke survivors. Patient motivation has also been attributed to stroke survivors who present with a positive manner towards rehabilitation, whilst low motivation is attributed to a negative manner towards rehabilitation. Currently there are no clear or universal guidelines of ascertaining motivation status in patients with stroke, understanding of factors that may impact it and its effect on rehabilitation outcomes. Aim of the study: It was to establish if the rehabilitation therapists have a shared understanding of determining stroke patient motivation in rehabilitation, the appropriateness of the use of motivation and to determine the rehabilitation therapist’s perception of a relation between patient motivation and rehabilitation outcomes. Methods: A qualitative research design using semi-structured interviews for data collection was undertaken. Interviews were conducted in three rehabilitation hospitals in the Gauteng province, South Africa. Study participants were stroke rehabilitation therapists. Their responses were manually documented and also recorded using a voice recorder to capture the data. The collected data was transcribed verbatim. Content analysis was done. Emergent themes were established. Coding of the key concepts was done by the researcher and the research assistant. An inductive approach was used to develop the code structure. The existing codes were refined using a constant comparison method. The code structure was finalized at the point of saturation. Two members of the research team reviewed the data independently checking for discrepancies in the finalized code structure. Final codes to all data were discussed and settled. Results: Patient motivation was determined by the patient’s manner towards the rehabilitation and professionals. The elements of the manner were identified as willingness, compliance and active participation. Family support, social circumstances and therapists’ attitudes were deemed to have an effect on the patient’s motivation. Therapists believed that the term motivation as used in stroke rehabilitation was used appropriately as it was based on the patient’s ability and experiences. There was general consensus among the therapists of the direct relationship between motivation and rehabilitation outcomes. Conclusion: A number of factors are attributed to the patient’s motivation and thus there is a need for rehabilitation therapists to pay attention to these factors, to enable them to support the stroke survivors in staying motivated thereby optimising the rehabilitation outcomes
A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree Master of Science in Physiotherapy, 2020