Motivational Strategies for Stroke Rehabilitation: A Delphi Study

Abstract

Background and Purpose: Although various strategies are used to motivate patients during rehabilitation, consensus regarding the optimal motivational strategies for stroke rehabilitation has not been established. Expert consensus may aid rehabilitation professionals in effectively utilizing motivational strategies to produce the most beneficial outcome for their patients. The primary purpose of this study was to provide a comprehensive list of effective motivational strategies based on consensus among rehabilitation experts, generated using the Delphi technique. In addition, we sought to identify the types of information that are important when selecting motivational strategies. Methods: A total of 198 rehabilitation experts participated in a three-round Delphi survey. The rehabilitation experts included physicians, physical therapists, occupational therapists, and speech-language-hearing therapists who had worked in stroke rehabilitation for at least five years. Panelists were asked to rate the effectiveness of motivational strategies and to rate the importance of different types of information using a 5-point Likert scale. Consensus was defined as having been reached for items with an interquartile range of 1 or less. Results: A total of 116 experts (58.6%) completed the third round of the Delphi survey. Consensus was reached on all of the 26 presented strategies. Seven strategies, such as control of task difficulty and goal setting, were considered to be very effective in increasing patient motivation. In addition, all 11 of the presented types of information were deemed very important or important in determining which motivational strategies to use. Conclusions: We generated a list of effective motivational strategies for stroke rehabilitation based on expert consensus. Our results suggest that experts consider a comprehensive range of patient information when choosing motivational strategies. These findings represent a group of consensus-based recommendations for increasing patient adherence to stroke rehabilitation programs, which may be beneficial to many medical professionals working in stroke rehabilitation.

Applying a Motivational Instructional Design Model to Stroke Rehabilitation: A Feasibility Study in Occupational Therapy and Swallowing Therapy Settings

“…18 When determining the appropriate motivational strategies, therapists were allowed to refer to a list of motivational strategies (Table 1). The list was initially developed by the first author based on data obtained from the educational literature related to the ARCS model, 23,24,26,30,34 semi-structured interviews with physical therapists, 35 and our previous study on motivational strategies for stroke rehabilitation. 19 Finally, the first and last authors who learned about the ARCS model completed the list after reviewing the contents for clarity and relevance.…”

Physiotherapists Use Different Motivational Strategies Tailored to an Individual’s Condition: A Qualitative Study

“…To recruit participants, we first selected 66 potential physiotherapists from those who participated in our previous studies on motivational strategies for stroke rehabilitation 14,15 and had at least 10 years of clinical experience. E-mail invitations were sent to three or four potential participants every week until the required number of participants was reached.…”

“…An interview guide was developed based on our previous studies. 14,15 Prior to data collection, we carried out a pilot test to confirm that the interview guide was clear, understandable and capable of answering the research questions. 16 The pilot test was conducted with three physiotherapists who had less than 10 years of clinical experience, resulting in minor changes to wording.…”

“…22 Motivational strategy was defined as concrete tactics, techniques, or approaches to orient rehabilitation of individuals. 15 These definitions were explained to participants prior to the interview to provide a common understanding of the terms. The…”

“…9,12,13 We previously reported that rehabilitation professionals used a range of motivational strategies to stroke rehabilitation based on comprehensive consideration of the individuals' health-related information, suggesting that they use individual-tailored motivational strategies. 14,15 However, to our knowledge, it remains to be established how physiotherapists select their motivational strategies for each individual.…”