Motivational Strategies for Stroke Rehabilitation: A Descriptive Cross-Sectional Study

Abstract

Background: The addition of motivational strategies to a rehabilitation program is thought to enhance patient adherence and improve outcomes. However, little is known about how rehabilitation professionals motivate stroke patients during rehabilitation. The primary objective of this study was to provide a comprehensive and quantitative list of motivational strategies for stroke rehabilitation. In addition, we aimed to examine (1) whether professionals with more clinical experience used a higher number of motivational strategies, (2) the purpose for using each strategy, and (3) the information considered when choosing strategies. Methods: This descriptive, cross-sectional study was conducted using a web survey with a convenience sample of 407 rehabilitation professionals including physicians, nurses, physical therapists, occupational therapists, and speech-language-hearing therapists. Results: We received data for 362 participants. Fifteen strategies were found to be used by more than 75% of the respondents to motivate their patients. Almost all of the respondents reported that they actively listened to and praised their patients to increase patient adherence to rehabilitation programs. Respondents with more clinical experience tended to use a higher number of motivational strategies (rho = 0.208, p < 0.001). For 11 of the 15 strategies selected by more than 75% of the respondents, the highest percentage of respondents reported that they used the strategies to make rehabilitation worthwhile for their patients. The majority of respondents reported that they decided which motivational strategy to use by considering comprehensive information regarding the patient health condition, environmental factors, and personal factors. Conclusions: The comprehensive list of motivational strategies obtained may be useful for increasing patient adherence to rehabilitation, especially for professionals with less clinical experience. Furthermore, our findings regarding the purpose for using each strategy and the information considered when choose strategies might help rehabilitation professionals to optimally utilize the motivational strategy list.

Motivational Strategies for Stroke Rehabilitation: A Delphi Study

“…In addition, we sent email invitations to experts who participated in our previous study. 5 On the first page of the website, participants were asked to report their professional characteristics, such as professional category and years of experience working in rehabilitation.…”

“…Using the resulting list of 22 motivational strategies, we surveyed more than 360 rehabilitation professionals regarding the motivational strategies commonly used in clinical practice for stroke rehabilitation. 5 The survey included an open-ended question in which respondents were invited to propose additional motivational strategies not included on the list. As a result of the survey, we added two motivational strategies ("providing feedback to the patient regarding the results of the practice" and "engage in practice with the patient") to the list.…”

“…Of the seven very effective strategies, all except for 'providing feedback to the patient regarding the results of the practice' were used by more than 75% of the rehabilitation professionals in our previous study. 5 Gradual increases in task difficulty and goal-oriented practice have been recommended to promote functional recovery during stroke rehabilitation. 31 As inappropriate levels of task difficulty can bore or frustrate the patient, 32 the difficulty of a practice task is considered to affect the patient adherence to a rehabilitation program.…”

“…4 Various strategies are used to motivate stroke patients in clinical practice. 2,5 One study using a semi-structured interview format reported that rehabilitation professionals set rehabilitation goals, provided information regarding rehabilitation, and accessed and used the patient's cultural norms to increase patient motivation. 2 In addition, we previously found that 15 motivational strategies, such as active listening and praise, were used by more than 75% of 362 professionals working in stroke rehabilitation.…”

“…2 In addition, we previously found that 15 motivational strategies, such as active listening and praise, were used by more than 75% of 362 professionals working in stroke rehabilitation. 5 Indeed, motivational strategies can positively affect rehabilitation in stroke patients. [6][7][8] For example, an international randomized clinical trial indicated that encouragement effectively improved walking speed in stroke patients.…”