Bridging the intention-behaviour gap with behaviour change strategies for physiotherapy rehabilitation non-adherence

Abstract

This paper reviews the problem of poor adherence to physiotherapy, the associated barriers and facilitators to adherence and bridging the intention-behaviour gap using behaviour change strategies. Adherence to physiotherapy, especially home-based physiotherapy that includes exercise programmes is problematic, which may be due to patients having to implement new behaviours and then integrate them into their daily lives. Further, patients may be adherent to some components of their physiotherapy and not others. Despite clinical, treatment and psychological factors being identified as reasons for poor adherence, the problem still persists. Effective patient education methods are not the total solution to the problem; patients need to be given skills to integrate the physiotherapy activities  into their daily lives. Behaviour change strategies provide these skills and enable patients to bridge the intention-behaviour gap. These strategies strengthen patients’ self-efficacy and should be selected to meet their needs and assist them to overcome their perceived barriers to undertaking the rehabilitation activities. While treatment goals provide patients with incentives to achieve their desired outcome they do not successfully bridge the gap. Valuable behaviour change strategies are verbal feedback, reinforcement, exercise testing, decision balance sheets, self-regulation, relapse prevention, progressed graded activities and booster sessions and action and coping plans.