Abstract:
The research in this thesis used prospective randomised controlled trials to evaluate
two cognitive-behavioural interventions designed to improve adherence to physiotherapy in
patients with ankle sprains. In Study 1, a DVD and written intervention grounded in
Protection Motivation Theory (PMT: Rogers, 1983) and assessment tools were developed
and piloted. In the pilot 31 patients were randomized into one of three treatment conditions
(PMT, attention control and non-contact control). Following the intervention patients
beliefs toward physiotherapy and injury were assessed. Compared to the two controls, the
PMT group had significantly higher scores on severity, vulnerability and response efficacy.
No differences were found for self-efficacy or intentions. Both response efficacy and self
efficacy were significantly related to intentions. Based on these findings, the self-efficacy
component of the PMT DVD was revised.
Study 2 (n = 71), an identical three group design, tested the PMT-based
intervention’s effect on beliefs, intentions, adherence and functional outcomes. Before
physiotherapy, antecedents to adherence (motivation, pain, and subjective norm) and
functional outcomes were measured, then the intervention was given, and beliefs and
intentions evaluated. Adherence to clinic and home physiotherapy was assessed throughout
the treatment programme and functional outcomes again at the end of treatment. Compared
to the two controls, the intervention group was significantly higher on all PMT beliefs
barring self-efficacy. No significant group differences were found for intentions, adherence
and post-physiotherapy functional outcomes. Significant relations occurred between the
antecedents, PMT beliefs, intentions, adherence and functional outcomes. The lack of
group differences on intention, adherence and functional outcome was attributed to most
participants having previously had physiotherapy and antecedent scores that typify highly
adherent patients.
Study 3 (n = 47) compared a home-based programme steeped in adherence
enhancing strategies with its traditional clinic counterpart. Psychological variables
(antecedents, locus of control, and anxiety) and functional outcomes were measured before
and after the course of physiotherapy, and adherence during. No group differences occurred
on either the psychological or functional outcome variables. Compared to the clinic group, the home-based participants required significantly less clinic appointments, had a higher
percentage of attendance and a significantly better completion rate. No group differences
existed for their adherence to the physiotherapy. Significant relations occurred between
psychological variables, adherence, and functional outcomes. Findings suggest home-based
physiotherapy is a viable, safe treatment option.