Clinically Appicable Paper. Adherence to sport injury rehabilitation programs: an integrated psycho-social approach
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Introduction: The Adapted Planned Behaviour Model (APBM) is a two stage psycho-social theoretical model consisting of initiation or decision-making, and maintenance or rehabilitation behaviours. The initiation phase includes the primary factors of threat appraisals (perceived severity and susceptibility), goal orientation (learning goal and performance goal orientation) and attitude to the rehabilitation. These five factors directly influence the rehabilitation intentions which in turn influence rehabilitation adherence. Self-efficacy and self-motivation have roles in both the initiation and maintenance phases by influencing intentions and adherence. Rehabilitation adherence is further influenced by behavioural habits and secondary factors of coping ability (distraction, palliative, instrumental and emotional), treatment efficacy and social support (emotion and listening support and task appreciation and personal assistance from other people). Purpose: To test the ability of the APBM to predict rehabilitation intentions and adherence in individuals undertaking sport injury rehabilitation for tendonitis-related overuse injuries. Methods: This was a prospective one-group design in which 70 participants were followed through their rehabilitation. The sample consisted of 44 male and 26 female participants with a mean age of 32.5 years (±10.2), with most of the tendonitis-related overuse injuries being located at the ankle (41%), and lesser numbers at the knee (28%), shoulder (20%) and elbow (11%). Typically, the participants attended two 40 to 60 minute clinic rehabilitation sessions per week for eight to 10 weeks. The rehabilitation protocol consisted of structured progressive exercises and stretching activities, and in the early stages ice, heat and ultrasound were also included. At the beginning of the rehabilitation, participants were measured on self-efficacy, self-motivation, and the primary factors of the APBM (threat appraisals, goal orientation, and attitude to the rehabilitation programme) and rehabilitation intentions. During the rehabilitation attendance at the clinic appointments was recorded, and adherence to the clinic- and home-based rehabilitation were measured. At the end of the rehabilitation the behavioural habits and the secondary factors of the APBM (coping ability, social support and treatment efficacy) were measured. Results: Regression analyses tested the ability of the psychosocial variables of the APBM to predict intentions, and the ability of the psycho-social variables and intentions to predict adherence. Intentions were significantly predicted by perceived severity, perceived susceptibility, learning orientation and attitude, but not self-efficacy, self-motivation and performance goal orientations. Clinic attendance was predicted by self-efficacy, self-motivation, intention, palliative coping, treatment efficacy, and personal assistance from the family. Clinic adherence was predicted by selfefficacy, self-motivation, intention, distraction and palliative coping, treatment efficacy and task appreciation by the physiotherapist and emotional support from friends. Homebased adherence was predicted by distraction and palliative coping, habit and task appreciation by the physiotherapist. Conclusion: The findings point to psycho-social variables influencing rehabilitation intentions, clinic attendance and adherence to clinic- and home-based rehabilitation in an interactive manner during sport injury rehabilitation.