Oyake Kazuaki, Yamauchi Katsuya, Inoue Seigo, Sue Keita, Ota Hironobu, Ikuta Junichi, Ema Toshiki, Ochiai Tomohiko, Hasui Makoto, Hirata Yuya, Hida Ayaka, Yamamoto Kenta, Kawai Yoshihiro, Shiba Kiyoto, Atsumi Akihito, Nagafusa Tetsuyuki, Tanaka Satoshi
Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan.
Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
Commun Med (Lond). 2023 Jun 6;3(1):78. doi: 10.1038/s43856-023-00308-7.
Patient motivation is an important determinant of rehabilitation outcomes. Differences in patients' and clinicians' perceptions of motivational factors can potentially hinder patient-centered care. Therefore, we aimed to compare patients' and clinicians' perceptions of the most important factors in motivating patients for rehabilitation.
This multicenter explanatory survey research was conducted from January to March 2022. In 13 hospitals with an intensive inpatient rehabilitation ward, 479 patients with neurological or orthopedic disorders undergoing inpatient rehabilitation and 401 clinicians, including physicians, physical therapists, occupational therapists, and speech-language-hearing therapists, were purposively selected using inclusion criteria. The participants were asked to choose the most important factor motivating patients for rehabilitation from a list of potential motivational factors.
Here we show that realization of recovery, goal setting, and practice related to the patient's experience and lifestyle are the three factors most frequently selected as most important by patients and clinicians. Only five factors are rated as most important by 5% of clinicians, whereas nine factors are selected by 5% of patients. Of these nine motivational factors, medical information (p < 0.001; phi = -0.14; 95% confidence interval = -0.20 to -0.07) and control of task difficulty (p = 0.011; phi = -0.09; 95% confidence interval = -0.16 to -0.02) are selected by a significantly higher proportion of patients than clinicians.
These results suggest that when determining motivational strategies, rehabilitation clinicians should consider individual patient preferences in addition to using the core motivational factors supported by both parties.
患者的积极性是康复效果的重要决定因素。患者和临床医生对激励因素的认知差异可能会阻碍以患者为中心的护理。因此，我们旨在比较患者和临床医生对激励患者进行康复的最重要因素的认知。
这项多中心解释性调查研究于2022年1月至3月进行。在13家设有强化住院康复病房的医院中，根据纳入标准有目的地选择了479名正在接受住院康复治疗的神经或骨科疾病患者以及401名临床医生，包括医生、物理治疗师、职业治疗师和言语听觉治疗师。参与者被要求从一系列潜在的激励因素中选择激励患者进行康复的最重要因素。
我们发现，康复的实现、目标设定以及与患者经历和生活方式相关的实践是患者和临床医生最常选择的最重要的三个因素。只有五个因素被5%的临床医生评为最重要，而九个因素被5%的患者选择。在这九个激励因素中，患者选择医学信息（p < 0.001；phi = -0.14；95%置信区间 = -0.20至-0.07）和任务难度控制（p = 0.011；phi = -0.09；95%置信区间 = -0.16至-0.02）的比例明显高于临床医生。
这些结果表明，在确定激励策略时，康复临床医生除了使用双方都支持的核心激励因素外，还应考虑患者的个人偏好。
