Physiotherapy in acute geriatrics wards: What (de)motivates patients? A qualitative study based on self-determination theory

Abstract

Background: While the benefits of physiotherapy for hospitalized older patients (HOPs) are well established, these patients are often considered demotivated by healthcare team members (HTMs), which is perceived as a hindrance to their rehabilitation. The quantitative data currently available on the lack of involvement of HOPs are mainly measures of mobility. Motivation as such has, to our knowledge, never been measured. Therefore, this study aims to quantify for the first time the motivation levels of HOPs in their participation in activities of daily living (ADLs) and physiotherapy, and to explore the motivating factors behind their participation in physiotherapy.

Methods: The motivation of 60 older patients hospitalized in an acute geriatrics ward was quantified using the Scale of Demotivation Assessment (SDA). Out of these participants, 14 were interrogated through individual semi-structured face-to-face interviews. After transcription, data were analyzed according to Self-Determination Theory, which has been proven effective in the understanding of motivational mechanisms.

Results: The prevalence of demotivation was 47% (95% CI: [0.34;0.6]) for ADLs and 35% (95% CI: [0.23;0.48]) for physiotherapy. The main demotivating factors were the feeling of external control (lack of autonomy) and dependance experienced by HOPs, as well as the limited availability of staff during hospitalization. Conversely, feelings of competence, security, respect for limits, and commitment from the HTMs were important motivating factors.

Conclusion: A large number of relational factors have an impact on the motivation of HOPs regarding their participation in ADLs and in physiotherapy sessions. Appropriate time and space organizing and the provision of suitable equipment, combined with a genuine caring and respectful attitude from the HTMs, could considerably encourage the expression of intrinsic motivation and thus the involvement of HOPs in their own care program.

Keywords: Acute geriatrics ward; Demotivation; Motivation; Older; Physical therapy; Physiotherapy; SDT; Self-determination; Self-determination theory.

Fig. 1

– The Self-Determination continuum according to Ryan and Deci [20]. (adapted from Cook and Artino [21])

Fig. 2

“Échelle d’Appréciation de la Démotivation” (EAD) [26], revised for the purposes of this study and translated into English as the “Scale of Demotivation Assessment” (SDA)

Fig. 3

Description of the cohort and samples for quantitative and qualitative evaluations

Fig. 4

Comparison of the characteristics of the groups “Motivated for ADLs” versus “Demotivated for ADLs”

Fig. 5

Summary of our main qualitative findings (according to the Self-Determination continuum)

Fig. 6

“The ABCs of Self-Determination”: model for care that promotes self-determination in older people