School of Public Health, The University of Hong Kong, Hong Kong, China.
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.
Soc Sci Med. 2020 Jan;244:112646. doi: 10.1016/j.socscimed.2019.112646. Epub 2019 Oct 31.
The aim of this prospective study was to examine the utility of an integrated model comprising constructs from self-determination theory (SDT) and the theory of planned behavior (TPB) in predicting adherence to a post-surgery rehabilitation program in patients receiving anterior cruciate ligament (ACL) reconstruction. Constructs of the integrated model measured at baseline were expected to predict patients' rehabilitation adherence two months later.
Patients (N = 121, M age = 27.62, range = 18-53; 36.66% female) scheduled to have ACL reconstruction surgery within two months were recruited from a Hong Kong public hospital. At baseline and two-month follow-up, patients completed measures of perceived autonomy support from doctors and physiotherapists and treatment motivation from SDT, social cognition constructs from the TPB factors, and adherence to the postsurgery rehabilitation program recommended by their surgeon.
Path analysis displayed good goodness-of-fit of the proposed model with the data (χ2 = 11.47 (df = 9), CFI = 0.98, TLI = 0.93, RMSEA = 0.06 [90% CI = 0.00; 0.10]) after controlling for age, gender, time of surgery, post-surgery rehabilitation, and injury severity. Consistent with hypotheses, perceived autonomy support from physiotherapist and autonomous treatment motivation directly and indirectly predicted the TPB constructs and treatment adherence. However, there was no association between perceived autonomy support from doctors and autonomous motivation.
The integrated model was effective in explaining the psychological processes that relate to medical adherence. Findings also highlight the importance of the autonomy support from physiotherapists and provide evidence for potential intervention targets.
本前瞻性研究旨在检验一个综合模型的有效性，该模型综合了自决理论（SDT）和计划行为理论（TPB）的概念，用于预测接受前交叉韧带（ACL）重建术的患者对术后康复计划的依从性。基线测量的综合模型的结构预计将预测患者两个月后的康复依从性。
从香港一家公立医院招募了 121 名预计在两个月内接受 ACL 重建手术的患者（M 年龄=27.62 岁，范围 18-53 岁；女性占 36.66%）。在基线和两个月随访时，患者完成了医生和物理治疗师感知自主性支持以及 SDT 治疗动机、TPB 因素的社会认知结构以及他们的外科医生推荐的术后康复计划的依从性的测量。
路径分析显示，在控制年龄、性别、手术时间、术后康复和受伤严重程度后，所提出的模型与数据的拟合度良好（χ2=11.47（df=9），CFI=0.98，TLI=0.93，RMSEA=0.06[90%CI=0.00；0.10]）。与假设一致，物理治疗师感知的自主性支持和自主治疗动机直接和间接地预测了 TPB 结构和治疗依从性。然而，医生感知的自主性支持与自主动机之间没有关联。
综合模型有效地解释了与医疗依从性相关的心理过程。研究结果还强调了物理治疗师自主性支持的重要性，并为潜在的干预目标提供了证据。
