Common Experiences and Beliefs among Highly Active Individuals

The purpose of this study was to identify and analyze how motivational characteristics, fulfillment of psychological needs, and individual experiences and beliefs play a role in influencing individuals’ motivation for physical activity. Validated questionnaires, including the International Physical Activity Questionnaires (IPAQ), Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS), and Motives for Physical Activities Measure Revised (MPAM-R) were used along with a narrative approach via recorded interviews to elucidate the experiences of highly active middle-aged adults. Videos were created to capture “movement stories” that combined footage of participants doing the physical activities they enjoyed along with pieces of their interviews. The MPAM-R showed that ranking for interest/enjoyment and competence tended to be higher (45 and 44.4 respectively), while motives for social/relatedness and appearance tended to be ranked lower (22.2 and 28.8 respectively). The BPNSFS showed that the participants of this study tended to rank their satisfaction higher than frustration in the three realms of basic needs: autonomy, relatedness, and competence. Statements prioritizing competence were the most frequently mentioned during interviews (6.6 times) followed by statements of social/relatedness (5.8 times) and then interest/enjoyment (5.6 times). Statements about fitness (2.2 times) and appearance (2.8 times) were the least frequently mentioned categories. The MPAM-R in contrast showed that social/relatedness was the least common motivational factor, despite being heavily mentioned during interviews. This study suggests that psychological satisfaction is a common characteristic among highly active individuals, and that competence may be the most important motivating factor, followed by personal enjoyment, and relatedness to others

Does Patient Self-Efficacy at Intake Predict the Therapeutic Outcome?

Title: Does Patient Self-Efficacy at Intake Predict the Therapeutic Outcome? Authors: Molly Geiger SPT1, Stephanie Juhnke SPT1, Ellen Maloney SPT1, Danny McMillian DSc.1 Affiliation: 1. School of Physical Therapy, University of Puget Sound Purpose: Several studies have linked psychosocial factors, such as depression, self-efficacy, and fear-avoidance to poor outcomes, increased disability, and the development of chronic pain. In a primary care setting, Foster has shown self-efficacy to be the most important for determining outcomes. The aim of this study is to examine the relationship between self-efficacy (SE) levels and physical therapy (PT) outcomes. We believe a patient’s SE levels will be positively correlated with PT outcomes. Specifically, higher SE levels will be associated with successful outcomes. Subjects: 11 Subjects (5 females and 6 males, ages 21-76 years old) from the University of Puget Sound’s outpatient musculoskeletal clinic participated in this study. Patients presented with a wide range of musculoskeletal impairments. Materials & Methods: Subjects from the University of Puget Sound’s musculoskeletal clinic were recruited for the study. Subjects completed the General Self-Efficacy Questionnaire prior to their initial evaluation and a specified relevant outcome measure and the Numeric Pain Rating Scale on both the initial and final treatments. Changes in outcomes were compared to the minimal clinically important difference (MCID) and then correlated with the GSE score. Results: The results of this study reveal no statistically significant relationship between SE levels and physical therapy outcome. A Point Biserial Correlation showed that the initial GSE score was only moderately correlated with the pain scale, r=0.589 p-value=0.296, and with the results on the outcome measures, r=0.503 p=0.114. Notably, for all subjects the average GSE score was high at 79.8%. The average GSE scores for those who saw improvement (met MCID or not) versus those who saw no change or worse outcomes was 85.0% and 65.8% respectively. Conclusion: While this study only shows a moderate correlation between SE levels and PT outcomes, it does shine a light on the uniqueness of PT performed in an educational setting. Because student physical therapists were treating patients under supervision of the clinical instructors, it is conceivable patients pursuing treatment in this setting have high SE levels. This could explain the lack of variability in the data collected as well as indicate a need to expand the psychosocial parameters measured. Although significant results were not achieved, a comparison of SE averages between groups (improved or not) does suggest the potential for a relationship between psychosocial factors and therapeutic outcomes to exist. Clinical Relevance: The lack of variability obtained in this study indicates the need for larger sampling and an expansion of the psychosocial factors measured. Additionally, when collecting data in an educational setting, clinical researchers should acknowledge that generalizability might be limited by the unique characteristic of patients receiving care in that setting. References: Tijou I, Yardley L, Sedikides C, Bizo L. Understanding adherence to physiotherapy: Findings from an experimental simulation and an observational clinical study. Psych Health. 2010;25(2). Foster NE, Thomas E, Bishop A, Dunn KM, Main CJ. Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain. 2010;148(3):398-406. Bergbom S, Boersma K, Overmeer T, Linton SJ. Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments. PHYS THER. 2011;91:754-764. Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. PHYS THER. May 2011;91:700-711. Overmeer T, Boersma K, Denison E, Linton SJ. Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes? A randomized controlled trial. PHYS THER. 2011;91(5):804-819. Foster NE, Delitto A. Embedding psychosocial perspectives within clinical management of low back pain: Integration of psychosocially informed management principles into physical therapist practice--challenges and opportunities. PHYS THER. 2011;91:790-803

Salutogenesis: Implications for Maintaining a Psychologically Informed Physical Therapy Practice

Pathogenesis, the study of disease origins and causes, looks retrospectively at how to eliminate illnesses once they occur and has been the prevalent approach in Western medicine. Salutogenesis, by comparison, is the study of health origins and causes and looks prospectively at how to create health. There are many psychosocial instruments used to measure the personal factors that influence salutogenesis. However, the salutogenic model has rarely been studied in physical therapy settings, even though physical therapy educators and researchers are currently describing the importance of a psychologically informed practice. Twenty-five psychological constructs within the salutogenic model were evaluated for this review. The evaluative process examined the constructs based on: 1) Measurability, determined by the reliability and validity of the outcome measures; 2) Relevance to physical therapy, determined by the construct’s ability to address learnable skills that can be influenced by physical therapists; and 3) Practicality, determined by the ability to measure the construct in a clinical setting using common practice patterns. Of the twenty-five constructs evaluated for this review, three met the above criteria and were chosen for further examination: self-efficacy, resilience, and sense of coherence. The results suggest that these three constructs have potential use in physical therapy. Using one or more of these constructs to attain relevant psychosocial information about patients may assist physical therapists in determining appropriate interventions. Therefore, although this literature review proposes the clinical use of self-efficacy, resilience, and sense of coherence in physical therapy, further research is recommended to develop their optimal use

Defending the Art of Physical Therapy: Expanding Inquiry and Crafting Culture in Support of Therapeutic Alliance

Title: Defending the Art of Physical Therapy: Expanding Inquiry and Crafting Culture in Support of Therapeutic Alliance Authors: Nicole Brun-Cottan1, SPT, Danny McMillian PT DSc.1, Jennifer Hastings, PT PhD. ,NCS.1 Affiliations 1. School of Physical Therapy, University of Puget Sound, Tacoma WA, USA. Theory/Body: The successful practice of physical therapy within the biopsychosocial construct requires a professional culture that places value on the interpersonal relationships that foster healing and the face time required to build those relationships. The unfortunate truth is that pressures on current practice are not facilitating this dynamic approach. The drive for increased productivity, cost effectiveness and ultimately, profit, are changing the landscape in which we practice. For-profit entities are placing an emphasis on data-driven practice patterns and tying reimbursement to performance on standardized outcomes measures. The data that drives these models is often not informed by physical therapists, and changes are being imposed by payers without adequate regard for the impact on quality of life for both patients and practitioners. This phenomenon is fueled by an overemphasis on quantitative research in evidence based medicine and an under-appreciation of clinical expertise and patient values. This imbalance undermines the holistic, patient-centered approach that has been the basis for physical therapy since its inception. In this paper an argument is presented that we are losing the art of practicing physical therapy. Authors suggests that in order to preserve defining characteristics of the profession, there is an urgent need to redirect our research agenda and PT education with a focus on the study of contextual and psycho-social factors that influence treatment outcomes. Recent research findings indicate that the effect of therapeutic alliance may be as important to outcomes as the chosen intervention. The authors suggest that excellence in DPT education must incorporate education addressing the vital importance of therapeutic alliance and also include training in the skills for developing such unique intentional relationships. References 1.Hall AM, Ferreira PH, Maher CG, Latimer J, Ferreira ML. The Influence of the Therapist Patient Relationship on Treatment Outcome in Physical Rehabilitation: A Systematic Review. Physical Therapy. 2010;90(8):1099-1110. doi:10.2522/ptj.20090245. 2.Kayes NM, McPherson KM. Human technologies in rehabilitation: “Who” and “How” we are with our clients. Disability & Rehabilitation. 2012;34(22):1907-1911 5p. doi:10.3109/09638288.2012.670044. 3. Rosin T. Fee-for-service vs. value-based care: 6 points of debate raised by health policy experts. http://www.beckershospitalreview.com/finance/fee-for-service-vs-value-based-care-6-points-of-debate-raised-by-health-policy-experts.html

Common Experiences and Beliefs Among Highly-Active, Previously-Sedentary, Middle-Aged Adults

BACKGROUND: Physical Activity (PA) Guidelines recommend reducing sedentarism and describes correlations between adequate PA and improving health outcomes. The self-determination theory (SDT) was used to identify motivational factors crucial to a physically active lifestyle. PURPOSE: Identify and analyze how motivational characteristics, fulfillment of psychological needs, and individual experiences/beliefs influence an individual’s motivation for PA. METHODS: Participants (3 females, 2 males; age 36-55) were recruited using nominated sampling and public advertising. Current levels of moderate-to-high PA were determined by the International Physical Activity Questionnaire and previous-sedentarism was self-reported as a minimum of 18 months. The SDT was the theoretical basis for determining fulfillment of psychological needs. The Basic Psychological Needs Satisfaction and Frustration Scale-General and Motives for Physical Activities Measure Revised (MPAM-R) measured general psychological satisfaction-frustration and motivational factors, respectively. Semi-structured interviews were conducted, and statements were coded to identify experiences and beliefs of the participants serving as a comparison to survey data. RESULTS: Psychological satisfaction (autonomy p=0.043; competence p=0.042; relatedness p=0.041) was significant compared to psychological frustration. Averaged MPAM-R scores revealed fitness (6.88) as the highest motivational factor while social (4.52) the lowest. Interview coding frequency was ranked as competence (58) followed by social/relatedness (49), autonomy (47), interest (30), fitness (29), appearance (15), and expressions of psychological satisfaction (38) dominated statements of frustration (11). CONCLUSION: Moderate-to-high PA was associated with greater life satisfaction than frustration across all three domains. Survey instruments and interviews supported this conclusion; additionally, overcoming sedentarism is highly driven by autonomous decisions to improve health and well-being

Common Experiences and Beliefs Among Highly Active, Older Adults

Background: Research on correlates and determinants of physical activity has shown that age and motivation are associated with physical activity. Self-Determination Theory (SDT) provides a well-researched framework for understanding motivation, and proposes that the satisfaction of three primary psychological needs: autonomy, competence, and relatedness, fuels motivation for physical activity and promotes wellness. Purpose: Use SDT to identify experiences and beliefs that affect motivation for physical activity in older adults and provide a narrative approach to share their “movement stories.” Methods: Participants were recruited using nominated sampling and a public advertising campaign. Participants were at least 55-years old with International Physical Activity Questionnaire scores categorizing them as moderately-vigorously active. Data was collected using the Motives for Physical Activities Measure – Revised, Basic Psychological Need Satisfaction and Frustration Scale – General Measure, and via in-person interviews. Interviews were filmed and narratives created using Adobe. Interview scripts were analyzed by researchers and common themes coded. Results: Qualitative analysis showed participants expressed higher life satisfaction than frustration. Collectively, statements that expressed motivation were most common for competence (55), relatedness (33), autonomy (28), and interest/enjoyment (27). The least commonly mentioned motivation types were appearance (3) and fitness (13). Conclusion: Overall, active older adults showed greater satisfaction over frustration with basic psychological needs. Motivational factors influencing PA varied greatly among participants, but they shared many common beliefs and experiences. It was shown that motivation stemmed most strongly from competence, interest, and relatedness and those promoting PA within this age group should focus on these domains

The Nature of Movement Symmetry: Implications for Function and Injury Risk

Human movement requires an equipoise of mobility, strength, and neuromuscular control for optimal performance and injury protection. When certain movement asymmetries are present they create functional impairments that can negatively impact an individual’s performance and increase the likelihood for injury. This results in decreased quality of life due to missed time from work, sport, or social interaction and increased financial burden. There is limited evidence addressing what degree of asymmetry impacts functional performance or increases injury risk. Some activities such as throwing are naturally asymmetrical, thus asymmetry of the upper extremity may be beneficial in specific occupations or sporting professions. However, literature regarding asymmetries impact on injury risk in these populations is currently lacking. In sports such as basketball or soccer literature suggests that asymmetry may decrease performance and increase risk for injury. Current literature frequently cites an asymmetry of 10% or more as the predictor of increased injury risk. The purpose of this literature review is to identify movement asymmetries that warrant physical therapy intervention in an effort to improve functional performance and minimize injury risk. Movement asymmetries during functional activities can present in various ways, including range of motion, neuromuscular control or force production differences between limbs or within muscle groups. A review of the literature was completed to identify the implications for various movement asymmetries. Excluded were studies of leg length discrepancies, structural spinal conditions, or neurological conditions, as well as studies that included prepubescent children. Emerging literature trends suggest lower extremity symmetry is important for function and reducing injury risk. Movement asymmetries are most significant for tasks that demand bilateral weightbearing or for identifying readiness for return to sport. Asymmetry in the upper extremity has less of an impact on function or injury risk and appears to be acceptable when a task requires asymmetrical patterns or the demand remains within tissue tolerance

What Motivates Highly Active Mothers? A Self-Determination Theory Perspective

What Motivates Highly Active Mothers? A Self-Determination Theory Perspective Natalie McDaniel, SPT; Stephane Robert, SPT Mentor: Danny McMillian, PT, DSc, OCS Background: Physical inactivity is a major global health concern linked to high mortality rates. Extensive research demonstrates the role of physical activity (PA) in enhancing overall well-being, longevity, and disease prevention. Mothers living with children face significant challenges in pursuing PA. Purpose: This qualitative research uses Self-Determination Theory (SDT) to investigate experiences and beliefs influencing PA motivation and satisfaction in highly active mothers. Methods: (N=5). Participants completed the Motives for Physical Activities Measure - Revised (MPAM-R) and the Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS) and participated in semi-structured interviews which were subsequently coded. Results: Based on coding frequency from the interviews, participants collectively expressed greater psychological satisfaction (32) than frustration (19). Coding further reveals the following motivational themes in order of magnitude: Competence (80), Fitness (49), Autonomy (46), Social/Relatedness (45), Interest (40), and Appearance (18). MPAM-R scores indicated high satisfaction across Fitness (6.36), Interest (6.17), Competence (5.97), Appearance (3.7), and Social (3.52). BPNSFS outcomes consistently favored psychological satisfaction over frustration in Autonomy (r=0.57), Relatedness (r=0.634), and Competence (r=0.63). Conclusion: Motivational factors influencing PA were most associated with competence, suggesting the importance in mastery of PA. The frequent expressions of psychological frustrations demonstrate this demographic’s ability and motivation to overcome these obstacles and maintain high levels of PA. Clinicians working with this population should be equipped to assist with inevitable challenges and provide mothers with the resources to overcome them

Motivational Characteristics and Fulfillment of Psychological Needs Among Physically Active Undergraduate Students

Background: Physical activity (PA) guidelines describe positive correlations between PA and health outcomes. Self-determination theory (SDT) was used to identify motivational factors crucial to a physically active lifestyle.Purpose: Identify and analyze how motivational characteristics, fulfillment of psychological needs, and individual experiences/beliefs influence PA.Methods: Participants defined as moderately to vigorously physically active by the International Physical Activity Questionnaire were recruited using nominated sampling and public advertising. Motivational characteristics and psychological needs were assessed using SDT, Motives for Physical Activities Measure – Revised (MPAM-R), and The Basic Psychological Need Satisfaction and Frustration Scale – General (BPNSF). Semi-structured interviews were recorded and transcribed for investigators to independently code operationally defined thematic statements and then jointly discuss consensus for final codes.Results: Qualitative analysis showed participants expressed higher life satisfaction (41) than frustration (19). Frequency of statements that expressed motivation included: competence (60), relatedness (35), autonomy (34), interest/enjoyment (34), fitness (12), and appearance (8). The MPAM-R survey revealed interest/enjoyment = 6.2, competence = 6.0, fitness = 6.0, appearance = 5.1, social = 3.9. The BPNSF survey revealed satisfaction was significantly greater than frustration with a large effect size for each psychological need (Autonomy n = 20, p = .05, z = -3.89, r = .87; Competence n = 20, p = .05, z = -4.0, r = .89; Relatedness n = 20, p = .05, z = -3.90, r = .87).Conclusion: Physically active undergraduate students showed greater satisfaction than frustration. Students also shared common beliefs such as a desire for lifelong PA. Motivation stemmed highest from competence, followed by relatedness, interest, and autonomy