Pathology and Intervention in Musculoskeletal Rehabilitation - E-Book

David J. Magee, James E. Zachazewski, William S. Quillen, Robert C. Manske

• Publisher: Saunders
• Year: 2015
• Print ISBN: 9780323310727
• eBook ISBN: 9780323310734
• Edition: 2
• Topic: Medicine
• Subtopic: Physiotherapy, Physical Medicine & Rehabilitation

- NEW! The Skin and Wound Healing chapter looks at the numerous tools available to assist in objectively monitoring and treating a patient with an acute or chronic wound.- NEW! Rotator Cuff Pathology chapter highlights the anatomy, function, and etiology of the rotary cuff, and addresses rotary cuff injuries, physical examination, and non-operative and operative treatment.- UPDATED! Substantially revised chapter on the Thoracic Ring Approach™ facilitates clinical reasoning for the treatment of the thoracic spine and ribs through the assessment and treatment of thoracic spine disorders and how they relate to the whole kinetic chain.- UPDATED! Revised Lumbar Spine – Treatment of Motor Control Disorders chapter explores some of the research evidence and clinical reasoning pertaining to instability of the lumbar spine so you can better organize your knowledge for immediate use in the clinical setting.- UPDATED! Significantly revised chapter on the treatment of pelvic pain and dysfunction presents an overview of specific pathologies pertaining to the various systems of the pelvis — and highlights how "The Integrated Systems Model for Disability and Pain" facilitates evidence-based management of the often complex patient with pelvic pain and dysfunction.- NEW! Musculoskeletal Bone and Soft Tissue Tumors chapter covers common bones tumors, anatomic considerations and rehabilitation, pediatric patients, and amputation related to cancer.- UPDATED! Thoroughly revised chapters with additional references ensure you get the most recent evidence and information available.- NEW! Full color design and illustration program reflects what you see in the physical world to help you recognize and understand concepts more quickly.

Chapter 1

Patient Education, Motivation, Compliance, and Adherence to Physical Activity, Exercise, and Rehabilitation

Keiba L. Shaw

Introduction

The importance of physical activity and engagement in structured and planned activities through exercise has been considered to be one of the main determinants that influence the aging process as well as health-related quality of life. This concept of health-related quality of life exploded in 1996 with the Surgeon General’s Report on Physical Activity and Health that brought forth the importance of engaging in an active lifestyle to prevent the onset of chronic disease and illness,¹ followed by the National Blueprint in 2001 that stressed the importance of physical activity in adults aged 50 years and older² and the U.S. Department of Health and Human Services (HHS) 2008 Physical Activity Guidelines for Americans document that provided “science-based guidance to help Americans aged 6 and older improve their health through appropriate physical activity” (p. vi).³ The Centers for Disease Control and Prevention (CDC) issued a State Indicator Report on Physical Activity in 2014, presenting state-level information on physical activity behaviors and environmental and policy supports for physical activity. In this report, physical activity among adults and high school students was found to be higher in some states than others (e.g., Colorado > 25% versus Mississippi < 15%) and that overall most states have environmental and policy strategies that encouraged physical activity.⁴ This is good news, but more work needs to be done. It can be safely said that being sedentary is one of the most important health problems of our time and increasing activity levels is often devalued by a large portion of the population as well as health care providers who perhaps believe that there is a “magic pill” that will reduce health care risks. Physicians and other clinicians are more likely to measure cholesterol, blood pressure, and body mass index (BMI) than measure parameters that assess fitness levels, such as a maximal exercise test or at the very least a questionnaire examining physical activity or exercise history.⁵

The professional’s role in motivation adherence

What is Meant by Motivation, Adherence, and Compliance?

Motivation is literally the desire to do things. It is the critical element in setting and attaining goals—and research shows that one can influence one’s own levels of motivation and self-control. The word motivation is derived from the Latin term movere, meaning “to move.”⁶ In essence the term motivation attempts to capture the “how” and “what” that moves a person to make certain choices, engage in action, expend effort, and therefore persist in action. Although this definition captures the essence of motivation, there is considerable debate on what this term actually means to individuals and at times to a population as a whole. Motivation has a range of influences on human behavior, and because of this there is no one motivational theory in existence that gives a comprehensive and integrative account of this concept. Nonetheless, a discussion of some of the more prominent and pertinent motivational theories is warranted to help explain or rather hypothesize why individuals think and behave as they do. Motivation to perform an action typically comes about through a gradual awakening of complex mental processes that takes initiative, planning, goal setting, intention formation, task generation, action implementation, action control, and outcome evaluation.

Obtaining a desired reward or experiencing pleasant sensations or escaping undesired, unpleasant consequences is often the impetus for engaging or not engaging in a behavior. Behavioral needs will often inspire individuals to act so as to avoid unwanted consequences or pursue desired responses. Socially, individuals will strive to be valued members of a group, thereby being able to imitate the positive (or negative) behaviors of others within the group. As biological beings, individuals strive to increase or decrease stimulation or arousal while seeking to maximize pleasurable sensations that affect our five senses (i.e., sight, touch, taste, smell, and hearing). In addition, individuals strive to minimize those unpleasant sensations, such as thirst, hunger, and anything that makes one uncomfortable, seeking to maintain homeostasis and balance as a system in the long term. At the cognitive level, individuals are inspired to maintain an attention to things that one deems interesting or threatening, while seeking to develop meaning and understanding to those things with which one is unfamiliar. Again, one strives to increase equilibrium while eliminating anything that one may see as a danger to his or her survival. In the affective domain, motivation plays a large role in order to decrease emotional dissonance. There is a drive to feel good and a need to increase one’s sense of well-being and self-esteem. Security in one’s surroundings and within oneself is sought after, and the individual strives to maintain adequate levels of optimism and enthusiasm to obtain it. Optimism is a cognitive construct (e.g., expectancies regarding future outcomes) that relates to motivation. People who are optimistic exert effort, whereas pessimistic people disengage from effort.⁷ Evidence suggests that individuals who are pessimistic do not fare as well as those who are more optimistic with exercise participation. In a study assessing the relationship between optimism and indices of healthy aging, it was concluded that dispositional optimism was associated with healthy aging.⁷ The relationship between optimism and healthy aging was assessed across three dimensions of health behavior: smoking, alcohol consumption, and physical activity. It was found that higher optimism was positively related to healthy behavior choices.⁸

Motivational Theories

In both the psychology and sport psychology literature, motivation has been classified as either being intrinsic (internal) or extrinsic (external). In addition, individuals will act to satisfy or meet basic needs (Figure 1-1).^9,10 In fact, people will satisfy a need or want by engaging or not engaging in certain behaviors. These needs can be classified as behavioral or external and social, biological, cognitive, affective, conative, or spiritual.¹¹

Figure 1-1 The basis of motivational theories.

Behavioral needs will often inspire individuals to act to avoid unwanted consequences or pursue desired responses. We strive to be valued members of a group and therefore will imitate the positive and/or negative behaviors of others within the group. As biological beings, we strive to maximize sensations that engage our five senses and are pleasurable while striving to minimize sensations that we find to be unpleasant (e.g., thirst, hunger). In this way, we seek to maintain homeostasis and balance in the long term. Cognitively, individuals maintain attention to things that are of interest or that they feel are a threat while seeking to construct meaning and to understand those things with which one is unfamiliar. This again serves to achieve equilibrium while eliminating things that may be seen as threat or danger to one’s survival.

Research has shown that individuals who are pessimistic do not fare as well with exercise participation as those who are more optimistic.

Decreasing emotional dissonance is accomplished in part by how much one is motivated to feel good and to increase one’s self-esteem. Individuals strive to increase feelings of security in their surroundings as well as within themselves. Seeking to maintain adequate levels of optimism and enthusiasm helps to secure this feeling. Research has shown that individuals who are pessimistic do not fare as well as those who are more optimistic with exercise participation.¹²

The framework surrounding the most popular theories on motivation revolves around three major areas: social cognition, humanistic, and multidimensional.

Taking control, developing and maintaining self-efficacy, and meeting individually developed goals are additional aspects of motivation. Individuals have personal dreams and needs related to fulfilling those dreams.

Social Cognitive Theory

Social cognitive theory, as developed and postulated by Albert Bandura, proposed reciprocal determinism as a leading factor in motivation.¹³ Individuals act as contributors to their own motivation, behavior, and development. In addition, the environment interacts with the individual’s behavior and characteristics in order to produce engagement or disengagement in an activity. Simply stated, human development is a back-and-forth interaction between the individual (his or her interpretation and retention of specific information), his or her behaviors, and the environment (Figure 1-2).

Figure 1-2 Social cognitive theory. (Redrawn from Kosling A, Heppner C, Elliott S: Motivation-project, wikispaces.com. Available at: http://motivation-project.wikispaces.com/Socio-cognitive+Theories+of+Motivation. Accessed December 5, 2014.)

In addition, Bandura suggested that self-efficacy, which is the belief that a particular action is possible and can be accompl...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Contributors
• Dedication
• Preface
• Preface
• Chapter 1: Patient Education, Motivation, Compliance, and Adherence to Physical Activity, Exercise, and Rehabilitation
• Chapter 2: The Skin and Wound Healing
• Chapter 3: Cervical Spine
• Chapter 4: Temporomandibular Disorders
• Chapter 5: Shoulder Trauma and Hypomobility
• Chapter 6: Shoulder Instability
• Chapter 7: Rotator Cuff Pathology
• Chapter 8: Shoulder Arthroplasty
• Chapter 9: Elbow
• Chapter 10: Hand, Wrist, and Digit Injuries
• Chapter 11: The Thoracic Ring Approach™: A Whole Person Framework to Assess and Treat the Thoracic Spine and Rib Cage
• Chapter 12: Low Back Pain: Disability and Diagnostic Issues
• Chapter 13: Lumbar Spine: Treatment of Hypomobility and Disc Conditions
• Chapter 14: Lumbar Spine: Treatment of Motor Control Disorders
• Chapter 15: Spinal Pathology: Nonsurgical Intervention
• Chapter 16: Spinal Pathology, Conditions, and Deformities: Surgical Intervention
• Chapter 17: Highlights from an Integrated Approach to the Treatment of Pelvic Pain and Dysfunction
• Chapter 18: Hip Pathologies: Diagnosis and Intervention
• Chapter 19: Physical Rehabilitation after Total Hip Arthroplasty
• Chapter 20: Knee: Ligamentous and Patellar Tendon Injuries
• Chapter 21: Injuries to the Meniscus and Articular Cartilage
• Chapter 22: Patellofemoral Joint
• Chapter 23: Physical Rehabilitation after Total Knee Arthroplasty
• Chapter 24: Rehabilitation of Leg, Ankle, and Foot Injuries
• Chapter 25: Peripheral Nerve Injuries
• Chapter 26: Repetitive Stress Pathology: Bone
• Chapter 27: Repetitive Stress Pathology: Soft Tissue
• Chapter 28: Musculoskeletal Developmental Disorders
• Chapter 29: Pediatric and Adolescent Populations: Musculoskeletal Considerations
• Chapter 30: Management of Osteoarthritis and Rheumatoid Arthritis
• Chapter 31: Systemic Bone Diseases: Medical and Rehabilitation Intervention
• Chapter 32: Muscle Disease and Dysfunction
• Chapter 33: Fibromyalgia, Myofascial Pain Syndrome, and Related Conditions
• Chapter 34: Musculoskeletal Bone and Soft Tissue Tumors
• Index