The Autonomy-supportive Approach: The Key to Promoting Rehabilitation Adherence?

Poor adherence (i.e., “the extent to which a person’s behaviour . . . corresponds with agreed recommendations from a healthcare provider” [1]) is a common problem in a range of healthcare settings, including those offering physiotherapy [2]. In fact, research has suggested that adherence to rehabilitation is as low as 30% [3]. A systematic review by Jack et al. [4] proposed that common barriers to treatment adherence in physiotherapy include previously low levels of physical activity, low self-efficacy, depression, anxiety, numerous perceived barriers to exercise, and increased pain during exercise. At the same time, motivation is another critical factor that affects adherence to prescribed treatment in healthcare settings [5,6]. It has been suggested that theory should guide interventions in the health domain [7,8], as theory can provide a deeper understanding of the process of change and contribute to more effective interventions [9,10]. One such theory, self-determination theory, has gained increasing attention in the health domain recently [11]. From the perspective of self-determination theory, autonomy support has been advocated as an approach to facilitate patients’ motivation for rehabilitation and ultimately their rehabilitation adherence [11]. In healthcare settings, autonomy support refers to acknowledging the patients’ perspectives, allowing them free choice, responding to their initiations, providing them with relevant information, and minimizing control [12]. In following the autonomy-supportive approach, healthcare providers should (I) nurture patients’ inner motivational resources, (II) use noncontrolling language, (III) offer rationales meaningful to patients, (IV) provide patients with choice, and (V) acknowledge and accept patients’ negative feelings [13]. More specifically: