How do patients perceive their physiotherapists' interaction style and what is the relation with patients' motivation for therapy?

Background: Theory suggests that how patients perceive the communication of their therapist is an important factor in shaping patient motivation for therapy however, empirical evidence is limited.

Approach: Grounded in Self-Determination Theory, this cross-sectional study examined how patients perceive their therapist’s motivating (autonomy-support and structure) and demotivating (control and chaos) interaction styles and how these perceptions relate to their motivation for therapy, as measured along the motivation continuum. A sample of 112 physiotherapy patients aged between 19 and 93 years (M=52.61, SD=18.08) completed questionnaires assessing their perceptions of therapist’s interaction styles (Situations In Self-management Support – HealthCare Professionals) and their personal motivation to engage in therapy (Behavioral Regulation Exercise Questionnaire). Variable-centered analyses, including repeated measures ANCOVA and Pearson correlation, were conducted to compare therapist interaction styles and to get insight into the relationship between perceived therapist interaction styles and patient motivation.

Preliminary results of ongoing data collection: A repeated measures ANCOVA was conducted to compare the scores of the four interaction styles, while controlling for gender. Post-hoc Bonferroni correction indicated that patients reported the highest levels on autonomy-support (M=3.92, SD=.78) and structure (M=3.91, SD=.81), followed by control (M=1.98, SD=1.10), and with chaos scoring lowest (M=1.41, SD=.98), on a scale ranging from 0 to 5. Regarding motivation, mean scores across the motivation continuum - going from intrinsic motivation to amotivation - were as follows (range: 0 – 4): intrinsic regulation (M=2.51, SD=1.09), integrated regulation (M=2.70, SD=1.05), identified regulation (M=3.05, SD=.77), introjected regulation (M=2.01, SD=1.09), external regulation (M=.42, SD=.78), and amotivation (M=.24,SD=.48).

Pearson correlations indicated that perceived autonomy-support and structure correlated positively with intrinsic, integrated and identified regulation (.40≤ r ≤.50; all p<.001). Additionally, they also correlated positively with introjected regulation (autonomy-support: r=.27, p=.005; structure: r=.21, p=.026), and negatively with external regulation (autonomy-support: r=-.21, p=.026; structure: r=-.25, p=.009). In contrast, perceived control correlated positively with intrinsic regulation (r=.31, p=.001), while perceived chaos correlated positively with external regulation (r=.27, p=.005) and amotivation (r=.24, p=.011).

Implications: These findings implicate that patients’ perception of their therapist’s interaction styles are related to their motivation to engage in therapy. Specifically, patients who perceive higher values on motivating interaction styles are related to higher levels of autonomous forms of motivation and less external regulation, while higher values on chaotic interaction style are related to higher values on controlled motivation and amotivation. Unexpectedly, more perceived control by their physiotherapist was related to higher intrinsic motivation in patients.

This study emphasizes the importance of therapists' contributions to a motivational therapeutic environment. Further research will explore these relationships in greater depth, with the aim of determining educational implications to optimize interaction styles of therapists and improve therapeutic outcomes.