Psychology Textbook Chapter 32 Promoting Adherence to Rehabilitation through Supporting Patient Well-Being A Self

Chapter 32 Promoting Adherence to Rehabilitation through Supporting Patient A Perspective , David , and Guy Open University , UK of South Wales , UK of Chartered Society of Physiotherapy , Primary Care Network , UK Please cite as Kingston , Jenkins , Kingston , 2021 ) Promoting adherence to rehabilitation through supporting patient A perspective . In Jones ( Essentials and sport An open access textbook ( Society for Transparency , Openness , and Replication in Kinesiology . Attribution 40 International This content is open access and part of Essentials of Exercise and Sport Psychology An Open Access Textbook . All other content can be accessed at Chapter Overview The purpose of this chapter is to provide a framework to demonstrate how adherence to rehabilitation programmes and patient wellbeing can be supported through the application of a based social cognitive theory commonly used within sports psychology today . The chapter is divided into four main sections ( a ) a brief overview of theory , describing how it can be applied to promote rehabilitation adherence and patient wellbeing , a description of the personal and situational factors which influence adherence , a review of the most commonly used strategies by to promote adherence , and ( an illustration of how these strategies can support basic psychological need satisfaction and support patient wellbeing . We conclude with a brief discussion on potential avenues for future research . For correspondence

Chapter 32 Promoting Adherence to Rehabilitation Through Supporting Patient Introduction Rehabilitation adherence is defined as the extent to which a patient behaviour corresponds with the health care professionals recommendations ( World Health Organisation WHO , 2003 ) It is a behavioural process , greatly influenced by the environment ( et , 2012 ) and shaped by individual social context , personal knowledge , abilities , motivation and available resources ( et , 2012 ) In practical terms , rehabilitation adherence is the voluntary action of patients in abiding by health professional recommendations ( Brewer , 2013 ) There are several clear , obvious and direct benefits of adhering to rehabilitation advice , such as improved physical functioning , reduced pain , and improved quality of life ( et , 2011 , 2009 Kay et , 2005 ) However , despite the positive impacts on psychological and physical recovery following injury , adherence rates are consistently low ( Brewer , 2013 ) even when the value of adherence is widely reinforced by practitioners ( et , 2020 ) To illustrate , patients have been found to be adherent only 50 of the time when in clinic ( 2003 ) and between of the time in response to home exercise instructions ( et , 2013 Peek et , 2017 ) Poor treatment adherence is not only a concern within physiotherapy ( et , 2010 ) but also within cardiovascular medicine ( et , 2014 ) asthma treatment ( Bender Rand , 2004 ) and affective disorders ( et , 2005 ) Further to the adverse impact has on functional outcomes , it has also been related to excess care visits , increased treatment costs and increased ( et al 2001 ) Indeed , it is estimated that the cost of nonattendance to appointments was approximately ( US ) per week in a Community ( Physiotherapy Service ( Tan et , 2017 ) Treatment may also elicit indirect costs in terms of decreased productivity ( Jin et , 2008 ) further illustrating the importance of supporting adherence to rehabilitation programmes to both improve patient outcomes and decrease the burden on health care services and business . In addition to providing direct functional support for injury rehabilitation , a broader understanding of the reasons why patients comply with rehabilitation guidance may help practitioners increase patient engagement while also facilitating outcomes ( Williams et , 2006 ) Furthermore , Driver et al . 2019 ) reported that recognise the psychological effect of injury occurrence and the impact that effective psychological support following injury may have on treatment outcomes . Healthcare professionals are influential in creating interventions to both reduce the negative responses associated with injury , and promote adherence ( Gordon et , 1998 Pearson Jones , 1992 ) Mechanistically , though it is widely reported that use psychosocial strategies in practice to promote adherence ( Driver et , 2019 ) it is also important that strategies are based and theoretically underpinned ( Driver et , 2019 ) to increase the likelihood that injured athletes recover both physically and psychologically from injury . Given the importance rehabilitation adherence has on outcomes , the focus of this chapter is on utilising motivational research on adherence to identify explicit and more implicit strategies used to support adherence and engagement in rehabilitation programmes . A secondary objective is to link these strategies inductively to a motivational theoretical framework that , based on the satisfaction of fundamental psychological needs , simultaneously predicts individual psychological wellbeing . More specifically , the chapter ( a ) discusses how motivational theory can be used as a framework for promoting adherence and enhancing psychological wellbeing ( provides an overview of the most utilised strategies by to promote adherence ( indicates how current strategies may satisfy basic psychological needs and support patient wellbeing , and ( provides suggestions on future research . 760

Kingston , Jenkins , Kingston Understanding Adherence to Rehabilitation The effectiveness of injury rehabilitation is often inhibited by patients failing to adhere to programmes provided by ( et , 2013 ) there are consequences of for treatment effectiveness and the duration of treatment ( Martin et , 2005 ) Furthermore , it also increases the demand placed upon health care professionals , undermines the therapeutic relationship , and increases waiting times , cost of care , and ( Hayden et , 2005 Jin et , 2008 ) In contrast , adhering to recommended medical advice has been associated with improved physical functioning , reduced pain , positive wellbeing , and overall improved quality of life ( et , 2011 et , 2013 , 2009 Kay et , 2005 ) adherence can be manifested in a number of different ways , for example performing exercises incorrectly , forgetting or misunderstanding advice , paying inadequate attention to instructions , or failure to attend set appointments ( Martin et , 2005 ) Theory Specifically , in the context of rehabilitation adherence , researchers have frequently adopted psychosocial motivational theories to help explain the factors underlying behavioural change ( Hagger et , 2009 Hagger , 2010 discussion , see Chapter Rebar et , 2021 , Chapter et , 2021 , Brand , 2021 , and , 2021 ) One such social cognitive theory used extensively across multiple and specifically within healthcare is the determination theory ( Ryan , 2017 Ryan , 2000 also see Chapter et , 2021 ) posits that human beings have innate tendencies for growth , to master challenges and to assimilate motives as they seek a coherent sense of self ( Ryan , 2000 ) In other words , they engage in activities that give them purpose and value . The extent of its use is attributed to its scope in encompassing the social environment and individual psychological factors , and the fact that it is focused , and readily ( and intuitively ) applicable to interventions targeting intrinsic motivation , wellbeing and health . Further , is a theory that , in addition to recognising the role of competence to motivated behaviours , incorporates the concepts of autonomy and the feeling of being connected as fundamental to motivation , enhanced performance , and wellbeing ( Standage Ryan , 2012 ) is a comprising six mini theories , each of which aim to describe motivational based phenomena emerging from research ( Ryan , 2000 ) According to , growth , development , intrinsic motivation , and wellbeing are most readily achieved in social that are supportive of three innate and fundamental psychological needs autonomy , competence , and relatedness ( Ryan , 2000 ) According to basic psychological needs theory ( Ryan , 2000 ) the three needs are essential nutrients for growth and effective functioning . Specifically , the need for autonomy is characterised by the desire for humans to act consistently with their own interests and values . The need for competence pertains to meeting challenge and achieving mastery in a given context , while relatedness represents the need for a supporting , caring connection with others ( Ryan , 2000 ) It is suggested that environments perceived as supportive ( socially ) nurturing of confidence , and volitional , increase a sense of wellness and vitality ( Ryan , Ryan , 2000 ) has been used extensively to examine optimal growth , motivation and wellbeing ( Hodge , 2015 ) The satisfaction of autonomy , relatedness , and competence supports these growth tendencies and specifically , motivation is ( externally prompted motives become increasingly Ryan , 2000 ) and wellbeing is increased ( Nichols , 2013 ) Consequential positive effects have been realised in health ( et , 2004 ) work , and exercise ( et , 2013 ) Ryan and ( 2000 ) proposed that the degree to which the three psychological needs are fulfilled will affect the extent to which an individual will engage in positive 761

Chapter 32 Promoting Adherence to Rehabilitation Through Supporting Patient behaviours ( adherence to rehabilitation programmes ) In contrast , if these needs are frustrated . being and passive engagement are predicted ( et , 2013 ) Researchers have highlighted the beneficial influence of supporting basic psychological needs on individual wellbeing across a variety of domains such as education ( 1996 ) work ( 2005 ) family ( et , 1997 ) and sport ( et , 2003 ) Within the rehabilitation context , previous work has demonstrated that when needs are supported , participation in treatment is more volitional , and adherence more likely ( et , 2013 ) Within an injury context , but specifically focusing on effective return to sport , and colleagues ( 2010 ) explored whether satisfying athletes basic psychological needs would improve aspects of wellbeing and produce positive return to sport outcomes . They concluded that competence perception fulfilment was related to higher levels of vitality and positive affect , which partially predicted an enhanced perspective upon return to sport . Additionally , satisfying the need of relatedness was positively related to increased levels of esteem and vitality , which reduced concerns over returning to sport following injury . Environments that promote the satisfaction of the three basic needs can thus be instrumental in reducing concerns regarding returning to sport following injury ( Although there is an increasing amount of research exploring need satisfaction in an injury context , research examining the frustration of these needs has been limited ( et , 2013 ) While research has tended to focus on individuals perceptions of their medical professionals support of their basic psychological needs ( et , 2013 ) additional research on the influence satisfying and frustrating basic psychological needs has on sport injury and rehabilitation may prove illuminating ( Li et , 2019 ) At an organisational level , Hall et al . 2010 ) and et al . 2014 ) suggest that , to improve treatment adherence , health professionals should function within environments that enable them to make specific rehabilitation regimen decisions based on patient preference , clinical circumstances , personal experience , and scientific evidence . The desirability of a more approach to rehabilitation is further supported through studies which have indicated that , at an individual level , understand the importance and potential to effect successful outcomes following treatment , and of using psychosocial interventions to increase rehabilitation adherence ( Driver et , 2019 , 2002 Francis et , 2000 et , 2007 Holden et , 2015 et , 2010 et , 2008 , 2007 ) Moreover , they also acknowledge the value of utilising psychological strategies in their practice to help alleviate the potential negative psychological effects associated with injury ( 2003 Clement , 2013 et , 2010 ) Although the importance of adherence and psychosocial strategies to enhance rehabilitation are clearly expressed by , research suggests that many practicing lack confidence in using such strategies ( Driver et , 2019 , 2003 ) Nevertheless , it is encouraging to know that have explicitly expressed interest in gaining knowledge of psychosocial strategies which may increase rehabilitation adherence ( Barrow et , 2007 et , 2010 , 2002 ) One of the key of effectively implementing behavioural change is understanding other factors that might impact on one ability to do so adherence is no different . Moderating Factors in Predicting Adherence to Rehabilitation It is clear from the evidence reviewed that using models such as and specifically its of basic psychological needs as a framework for promoting adherence to rehabilitation protocols may be fruitful ( et , Unfortunately , however , simply creating environments that support basic needs and thus according to , wellbeing may oversimplify the situation . Within the personal and social milieu there are a variety of other factors that can impact the relationship between received instructions and adherence in the context of injury ( Jack et , 2010 ) 762

Kingston , Jenkins , Kingston behaviour , such as adherence , is influenced by patients cognitive appraisals of a variety of personal and situational factors these in turn influence perceptions of the injury state and in turn behavioural and emotional responses ( Brewer , 2001 Brewer at , 2003 et , 1995 et , 1998 ) Personal factors include type of injury ( type , severity ) and psychological ( motivation , personality , physical ( physical state , activity levels ) and demographic ( gender , age ) individual differences ( Walker et , 2007 ) Whereas situational factors relate to environmental ( physiotherapy environment , rehabilitation sessions ) and social influences ( social support Marshall et , 2012 ) Consideration of potentially moderating factors will allow practitioners to both predict lower levels of adherence ( Wheeler et , 2012 ) and further consider their approach to patient support . Psychosocial motivational theories have been instrumental in describing behaviour regulation in the rehabilitation environment ( Hagger et , 2009 Hagger , 2010 ) gaining a nuanced understanding of why patients engage or disengage in rehabilitation will likely enhance promotion of adherence ( Goddard et , 2020 ) Moreover , when developing interventions to successfully facilitate behaviour change , these should be theoretically grounded and around the factors that influence successful rehabilitation ( Clement , 2017 , 2008 ) Within this section , we will reflect on a number of personal and situational factors that have been demonstrated to moderate the relationship between prescribed rehabilitation protocols and adherence within athletic populations these may need to be considered in targeting basic need satisfaction and wellbeing . Personality Characteristics In their extensive review ( 45 studies ) and ( 2013 ) identified over twenty personality characteristics associated with rehabilitation and injury outcome ( anger , depression , anxiety , optimism , competitiveness , hardiness ) Consequently , the role of personality in predicting rehabilitation adherence may be a significant area to examine ( Wheeler et , 2012 ) For a more comprehensive discussion on personality and physical activity , see Chapter ( Wilson Rhodes , 2021 ) Of the research that has been conducted , much has focused around the Big Five personality domains of Neuroticism , Openness , Extraversion , Agreeableness and Conscientiousness ( Costa , 1992 ) with evidence provided of associations with rehabilitation adherence . For example , positive correlations have been found between adherence and extraversion ( Vickers 1994 , 1998 Lin et , 2007 Wheeler et , 2012 ) agreeableness ( Vickers , 1994 ) and conscientiousness ( Vickers , 1994 , 1998 et , 2007 ) Conversely , negative correlations have been reported between adherence and neuroticism ( 1998 Vickers , 1994 et , 2007 ) More recently , exploring adherence within diabetes patients , Wheeler et , 2012 ) found that conscientiousness and extraversion were related to adolescents of adherence , while neuroticism was related to . In contrast , et al . 2014 ) utilising the Big Five , found that there were no significant correlations between neuroticism , extraversion , and adherence to exercise participation , however , they found that conscientiousness , agreeableness , and openness were correlated with adherence . According to and colleagues ( 2014 ) the Big Five personality factors explained of the variance in attendance to all rehabilitation sessions , and 16 of the variance in adherence ratings across sport settings . Whilst the extent of the research is substantial , it is difficult to draw conclusions on specific personality characteristics as replication of research is scarce ( 2013 ) Nevertheless , whether directly related to adherence , or through other identified , understanding their patients , and the personality attributes that may predict adherence will assist practitioners in tailoring programmes to more effectively meet individual needs ( Wheeler et , 2012 ) 763

Chapter 32 Promoting Adherence to Rehabilitation Through Supporting Patient is a widely researched individual difference factor which has been found to impact rehabilitation adherence ( et , 2015 ) Defined as the belief in ones ability to execute certain tasks and to achieve a specific outcome ( 1977 ) research examining the role of on adherence has demonstrated significant positive correlations between and physical and mental health ( Robb et , 2013 ) and resultant elevated levels of physical functioning ( et , 2004 ) Specifically , in a rehabilitation adherence setting , has shown to be a strong predictor of adherence to physiotherapy treatments ( et , 2015 ) outpatient physical therapy ( Jack et , 2010 ) and cardiac rehabilitation and exercise treatment ( Martin , 2001 Angelo et , 2014 ) According to Mayer ( 2014 ) plays a significant role in adherence to rehabilitation programmes due to its association with motivation . This function may be realised through its influence on the initiation of behaviours and persistence to overcome barriers to achieve results ( 1997 , 2007 ) is also associated with problem solving which increases positive emotions and relates to one sense of control over their environment and behaviour ( 2001 ) these may in turn facilitate rehabilitation adherence . Research on the closely related concept of ( Judge , 2002 ) suggests that if a patient perceives that they are unable to accomplish tasks set and do not receive support from their medical professional , esteem is undermined ( Pettigrew , 2001 ) Promoting or the belief in the patient ability to meet the demands of rehabilitation tasks and recover effectively is therefore likely to promote both adherence and positive affective behaviours . For further discussion on , see Chapter 27 ( et , 2021 ) Emotional Responses Injury can be a stressful time for most individuals , and how they respond to injury is dependent on the cognitive appraisals , which subsequently influence emotional responses ( anger , fear , tension see Chapter 12 for more discussion on affect , emotion , and mood , 2021 ) and as previously mentioned , behavioural responses ( rehabilitation adherence et , 1998 ) In short , and colleagues suggest that influence emotions which in turn affect behaviours , and these are likely to impact on wellbeing and outcomes following injury ( Walker et , 2007 ) Injured individuals may experience depression , anxiety , and posttraumatic stress disorder ( et , 2018 ) Indeed , research suggests that a fifth of individuals who sustain traumatic injury display psychological distress , and one in three meet the threshold for depression and ( Shih et , 2010 Sterling et , 2011 ) While it is normal for athletes to encounter emotional responses such as tension , depression , anger , frustration and boredom ( Evans Hardy , 2002 Pearson Jones , 1992 Hardy , 1990 ) up to 13 report high levels of psychological distress post injury ( Brewer et , 1993 ) and severity of the injury exacerbates the risk of significant psychological issues ( Heil , 1993 ) Given that psychological distress may remain high up to three years following injury ( Craig et , 2016 ) helping patients constructively manage their appraisals of injury and rehabilitation may be an important support function of . Social Support As alluded to at the start of this section , et ( 1998 ) integrated model of responses to sports injury suggests that situational factors ( rehabilitation environment , rehabilitation sessions , social support , treatment efficacy ) influence cognitive appraisals of the injury , and these in turn have a significant impact on behaviour , emotional responses , and rehabilitation outcomes ( 2010 ) The model also specifically describes the influence social support has on rehabilitation adherence it is viewed as an important factor in assisting individual abilities to cope with the stressors associated with injury ( Mitchell et , 2014 et , 1998 ) Regarding 764

Kingston , Jenkins , Kingston rehabilitation adherence , early research suggested that social support is a key predictive factor ( et , 1993 ) More specifically , and in support of the model , research has confirmed that social support can facilitate rehabilitation adherence by boosting , buffering stress , increasing perceived tangible assistance , decreasing depression symptoms ( Mitchell et , 2014 et , 1983 Hill , 1991 ) and enhancing subjective wellbeing ( Thomas , 2010 ) Receiving and perceiving support from friends , family , significant others ( coaches ) and healthcare professionals is pivotal to adherence ( et , 2010 ) and in the context of rehabilitation , the physiotherapist is pivotal to providing social support for the patient ( Gordon et , 1998 ) I Photo by from Therapeutic Alliance A strong working alliance based on consensus in relation to goals , tasks set and a positive connection between patient and provider ( et , 2017 ) is important in health care ( et , 2012 ) A strong alliance also encapsulates emotional and cognitive components of communication , with goal setting and trust seen as vital to achieving successful outcomes ( et , 2017 ) and associates found medium to large effects when examining working alliance and patients to treatment , perception of benefit from treatment , and rehabilitation adherence ( et al . 2007 et , 2008 2013 et al . 2013 et al . 2015 ) A key component of the therapeutic relationship is the concept of trust , and while trust between patient and practitioner has been widely researched , the concept of trust has been difficult ( Pearson , 2000 ) Nevertheless , Rowe and ( 2006 ) found trust to facilitate strong working relationships between health care professionals and patients , and consequently , it has been the focus of several studies in recent years ( et , 2017 ) Thom et al . 2002 ) for example , found that patients who had low levels of trust in their health care provider were less likely to maintain their treatment recommendations , report fewer symptom improvements and lower satisfaction with the care provided . Furthermore , Baker et al . 2003 ) identified trust between patient and health care professional as the main predictor of treatment satisfaction . 765

Chapter 32 Promoting Adherence to Rehabilitation Through Supporting Patient Independent of trust , the working alliance has been associated with patient belief in efficacy of treatment , treatment adherence and patient satisfaction ( et , 2007 ) Brewer and colleagues ( 2003 ) reported that patients belief in treatment predicted rehabilitation attendance and adherence . Therefore , it is important that practitioners have a close working relationship with patients to ensure that they can improve patients perceptions of treatment efficacy ( Levy et , 2008 ) Exploration into the working alliance is in its infancy ( et , 2017 ) nevertheless , preliminary research in this area suggests it is a promising area for interventions in adherence ( et , 2009 ) as stronger relationships between medical professionals and patients can lead to better , increased patient satisfaction , and improved treatment outcomes ( et , 2007 et , 1993 ) Treatment Efficacy While pertains to an individual belief in their ability to be successful ( 1977 ) treatment efficacy is described as an individual belief that the prescribed treatment will lead to desired health outcomes ( Taylor May , 1996 ) Strong treatment efficacy and perceptions of effectiveness of rehabilitation has been positively associated with better adherence to rehabilitation programmes ( Brewer at al Evans Hardy , 2002 et , 2005 ) Levy et al . 2008 ) found that treatment efficacy predicted adherence in both and clinical based rehabilitation . Exploring the role of psychological processes on outcomes following shoulder physiotherapy , Chester and colleagues ( 2018 ) more recently concluded that patients who expected or believed that their treatment would lead to a complete recovery had more successful outcomes . The aforementioned research aligns with ( 1977 , 1982 ) theory which indicates that impacts , behaviours , actions , and emotions . Further , and of particular pertinence to the rehabilitation context , 1982 ) argued that increased efficacy would determine coping behaviours and dejection following past failures . Consequently , an athletes appraisal of their efficacy following injury is highly likely to impact their future behaviour , such as adherence ( Hargreaves , 2013 ) One method that may use to facilitate treatment efficacy and increase an individual sense of autonomy is through the process of setting mutual goals with patients ( Kingston Wilson , 2009 ) Crucially , facilitating treatment efficacy through this mechanism may also increase meaningful communication , and improve relationships between the patients and the supporting medical professionals ( et , 2011 ) Although there are any number of factors that can impact on rehabilitation adherence which are beyond the scope of , this section highlights the importance of supporting personality factors such as conscientiousness , facilitating belief in meeting the demands of the rehabilitation process , and ensuring that patient emotional states are considered . At a situational level , it is clear that the physiotherapist can play a pivotal role in supporting the injured athlete and facilitating patient belief through effective communication and connecting with patients in a respectful and trustful manner . The research reviewed paints a compelling picture of personal and situational factors affecting rehabilitation adherence and wellbeing . It is important therefore , that practitioners at all levels are provided with opportunities to better support engagement with rehabilitation protocols . clearly already utilise many appropriate strategies to promote adherence in practice , and it is likely that these strategies also satisfy the three basic psychological needs of autonomy , competence , and relatedness . The following section of this chapter will consider research on reported use of strategies by to promote rehabilitation adherence . Further , there will be an attempt to explicitly link the reported strategies to the satisfaction of basic psychological needs to illustrate their potential wider benefits for motivation , growth and wellbeing . 766

Kingston , Jenkins , Kingston Common Strategies Utilised by in Practice Goal Setting , Monitoring Progress , and Positive Reinforcement Goals are direct regulators of human action they can be used to provide impetus for behaviours ( Kingston Hardy , 1997 Locke , 1985 Ryan , 2000 ) Goal setting , the act of identifying and strategizing around objectives ) contributes to action through two main functions , a motivational function and a cognitive function . goal setting influences the degree of effort an individual commits towards a goal ( Locke , 1990 ) while the cognitive effects of setting goals influence the individual through , for example , increased focus and action , increase persistence , and the adoption of alternative strategies when they are in doubt ( problem solving Locke , 1990 Locke , 2013 ) It is apparent , therefore , that it is not so much the goals themselves that provide volition , but the process of reflecting , setting , strategizing and pursuing goals that create the impetus for action ( Kingston Wilson , 2009 ) Research examining strategies to enhance adherence to rehabilitation programmes has demonstrated that goal setting is a key strategy ( et , 2010 et , 2007 et , 2017 Driver et , 2019 , 2002 Holden et , 2015 , 2003 , 2007 ) More specifically , 2007 ) reports that setting goals , progress monitoring , and provision of positive feedback ( from ) are frequently used to support adherence . Furthermore , goal setting is reported to encourage accountability , especially when patients have had an input into the goal setting process ( 2007 ) and colleagues ( 2017 ) found that a third of in their study used goal setting to enhance rehabilitation adherence , while Driver and colleagues ( 2019 ) found that 95 ofthe surveyed used goal setting in the last 12 months . This frequent use of goals and goal setting is also supported in research highlighting the benefits of using goal setting to increase rehabilitation adherence ( et , 2001 Evans Hardy , Reinforcing the findings of ( 2007 ) as well as the notion that goal setting itself positively impacts engagement and adherence , a number of researchers have demonstrated the beneficial effects of positive reinforcement and feedback to patients ( et , 2007 Driver et , 2019 Francis et , 2000 Holden et , 2015 ) This starts to illustrate some of the mechanisms underpinning the positive effects of goals . Francis and colleagues ( 2000 ) for example , found that in a sport setting used goals to increase athlete motivation and provide positive reinforcement . Extending this suggestion , Driver et al . 2019 ) argued that positive reinforcement may be a natural response to encourage desired behaviours , rather than a specific strategy to enhance rehabilitation adherence . The importance of monitoring goals as a route to providing feedback and encouragement to patients during rehabilitation has been demonstrated widely ( et , 2017 , 2007 Peek et , 2017 ) and further is considered to be one of the key components to support physical activity behavioural change ( National Institute of Clinical Excellence NICE , 2014 ) Whilst the evidence presented suggests that goal setting , monitoring progress , and providing positive reinforcement are beneficial for increasing rehabilitation adherence , it is also reasonable to suggest that the basic psychological needs of competence and autonomy are simultaneously being satisfied . Making the link between these two concepts , and Ryan ( 2000 ) contended that to understand behaviour ( as well as the psychological development and wellbeing ) one must consider the three basic psychological needs that give goals their psychological potency , and which influence the regulatory processes which direct goal pursuits . Extending this link , and in alignment with the predictions and need satisfaction , and Locke , 2007 ) proposed that goal setting not only positively affects performance , but also increases subjective wellbeing . 767

Chapter 32 Promoting Adherence to Rehabilitation Through Supporting Patient Achievement has a cyclical relationship with . In the rehabilitation context , when patients are completing their goals in their rehabilitation , they are more likely to feel confident in their injury , which in turn allows them to master the rehabilitation exercise they have been tasked with ( 2007 Brewer et , 2003 , 2010 ) By providing patients with positive feedback , positive encouragement , and reinforcement , provide patients with the opportunity to develop confidence in their capability to complete their rehabilitation exercises correctly . In both cases the basic need of competence is likely being fulfilled , and behaviours become increasingly and integrated to the self ( Ryan , 2000 ) One of the secondary benefits to sharing information and helping patients understand the importance of completing exercises correctly is that they perceive a greater level of autonomy around their treatment . According to et . al . 2011 ) if increase an individual control over rehabilitation , they can reduce any external pressures following injury . This can be done , for example , by allowing patients or athletes to select when or how they carry out their rehabilitation exercises . Furthermore , allowing patients to have input in the goal setting process may also increase their sense of control . With mutually agreed upon goals , patients are more likely to adhere because there is a sense of ownership , thus satisfying the need of autonomy ( 2010 ) and helping them to their rehabilitation behaviours . The process of setting goals , monitoring progress , and receiving positive reinforcement from is a key strategy utilised by to facilitate rehabilitation adherence . In addition to the direct motivational benefits around effort and persistence , by utilising these strategies , are also likely to be increasing patients perceptions of competence around the injury . Moreover , encouraging patients to have an input into the goals set in rehabilitation , sharing information , and giving ownership in completing exercises correctly may support autonomy perceptions . Providing Information and Rationale for Treatment et al . 2017 ) noted that providing patients with information and a rationale of treatment was a commonly cited strategy used by . have suggested that increasing patient knowledge of injury can help create a strong working relationship between them and the patient ( Peek et , 2017 ) It can increase confidence , positive perceptions regarding the cessation of treatment , and speed the rehabilitation process ( by providing clear steps of rehabilitation , 2009 2010 ) as well as patient adherence ( Peek et , 2017 ) The manner in which this information is provided can range from strategy and potential benchmarks to providing supportive written or online resources . Receiving education on management of treatment has been found to have a positive effect in patients with chronic pain ( Cooper et , 2009 ) Similarly , and Kelt ( 2000 ) reported that increasing patient knowledge and understanding of their injury increases the likelihood of effectively coping with the associated psychological stress . Educating patients and providing knowledge regarding their injury is also likely to enhance the quality of the relationship this has been highlighted as a key predictor of patient engagement in rehabilitation ( 2007 ) Similarly , providing patients with information is likely to facilitate trust , which in turn would increase the connection between them and support the working alliance . This collaboration with and provision of resources to patients , and the closeness and enhanced connectivity that results , is likely to support the basic psychological need of relatedness . Further , providing patients with advice , guidance , and knowledge regarding their injury and prevention helps satisfy the basic need of competence through instilling belief regarding recovery , notably around returning to sport ( et , 2011 ) 768

Kingston , Jenkins , Kingston Tailoring Exercises to Individual Patient Needs Central to the notion of support , is the value attached to an approach . This facilitates the perception that patients needs are the primary rationale for specific prescribed exercises . Fundamentally , by designing exercises which are , individuals are more likely to engage in the rehabilitation process ( Hall et , 2010 et , 2007 ) There is an abundance of evidence to support this contention provide a wide variety of exercises which are injury site and severity dependent and are often tailored to meet individual patient needs ( et , 2017 Peek et , 2017 , 2007 ) In fact , 60 of noted that they manipulate aspects of the rehabilitation programme on an individual primarily to facilitate adherence ( et , 2017 ) For example , would reflect how exercises could be incorporated into a patient daily routine , reduce the frequency or complexity of exercises , and be based on patient preferences ( et , 2017 Peek et , 2017 ) The tailoring of rehabilitation programmes to individuals provides the opportunity to support all three of the fundamental basic needs described within . Rehabilitation programmes with significant patient input and mutually agreed upon exercises and goals are likely to promote a strong working alliance between the patient and physiotherapist ( and hence support the need relatedness ) and increase the patient perception of autonomy . Further , by tailoring sessions based on patient ability , preferences , and lifestyle , patients are more likely to ( a ) complete their prescribed rehabilitation programmes , and ( master the specific exercise , and thus satisfy the basic need of competence . Adopting a highly approach can help patient perception that their needs are front and centre of decisions regarding specific support . Tailoring exercises and designing bespoke programmes has been associated with improved rehabilitation adherence ( et , 2017 Peek et , 2017 , 2007 ) Furthermore , the wider benefit in terms of performance and wellbeing can be realised as tailoring exercises to suit patients requirements can simultaneously satisfy all three basic psychological needs . Providing Practical and Emotional Support In the context of rehabilitation , the physiotherapist is ideally placed to provide support to the patient ( et , 2014 ) Following injury , an athlete may experience a range of feelings such as anxiety , frustration , anger isolation ( Carroll , 1998 ) which may be alleviated or suppressed through direct support or by increasing a patient sense of support ( et , 2010 , 2003 , 2007 ) can support and influence rehabilitation adherence positively in a number of ways by building a positive rapport and communicating effectively with patients ( Brewer , 2013 ) Moreover , providing patients with a rationale for exercises without jargon or overly technical language , and recognising individuals needs for informational and emotional support , are examples of how a can promote an environment which encourages rehabilitation adherence ( Brewer , 2013 ) Interviews with indicate that they see it as their role to provide support to patients , as they are more likely to adhere if they are comfortable in the environment ( Anderson , 2007 ) It is also important to note that understand that , if patients are insufficiently supported by significant others , it can have a negative impact on adherence ( 2007 , 2000 ) Consequently , any methods to help patients sense of direct and indirect support can help support adherence through fulfilling the basic psychological need of relatedness . This support can take many forms , such as listening to concerns , helping individuals control emotions , providing positive feedback , providing education about the injury , and providing steps to overcome the injury ( 2010 ) It is also important to recognise that support should be consistent , and active . Being too hands off in an attempt to give autonomy , or perceiving that the patient requires less support as they progress through 769

Chapter 32 Promoting Adherence to Rehabilitation Through Supporting Patient the rehabilitation , may inadvertently undermine basic need satisfaction , which can have a consequential impact on rehabilitation outcomes and patient wellbeing ( et , 2011 ) Implications This chapter has provided an overview of the research surrounding rehabilitation adherence with specific reference to some of the factors that underpin engagement with rehabilitation . The has been used extensively to examine optimal growth , motivation , and wellbeing ( Hodge , 2015 ) and research suggests that environments supportive of the three basic psychological needs of autonomy , competence , and relatedness promote positive health behaviours and wellbeing ( et , 2004 et , 2013 Nichols , 2013 ) One such adaptive behaviour that results from need satisfaction , and in the context of injury rehabilitation , is adherence ( et , 2013 ) In practice , are integral in providing both physical and psychological support to patients ( Johnson , 2003 ) and therefore it is important for to develop a clear understanding of strategies to increase adherence and their potential wider implications ( working alliance , emotional support , and wellbeing ) Broadly speaking , to support the needs of autonomy , relatedness , and competence , should aim to create environments which satisfy these needs ( et , 2010 ) Whilst it is recognised that currently use several strategies that effectively support adherence , a more , direct approach may help to adherence and satisfy basic psychological needs . Although much of the empirical support for the value of basic need satisfaction has focused on need satisfaction , frustration of these needs even inadvertently may undermine adherence and wellbeing . This type of strategic approach has the potential to help patients assimilate motives and facilitate wellbeing throughout the rehabilitation process . It is important to acknowledge that whilst it seems that innate psychological need satisfaction in the rehabilitation environment would produce positive outcomes , there are a number of factors which have the potential to moderate its relationship with adherence and subsequently the effectiveness of treatment ( Brewer , 2001 ) Whilst those that have been highlighted within the research to date have been discussed , there are any number of other personal and situational factors which may impact the ability of a patient to adhere to recommended treatment . It is important that future research systematically examines in situ the personal and situational factors which predict rehabilitation adherence , the direct and indirect effects of psychological need satisfaction ( or thwarting ) and the consequences for psychological wellbeing and clinical outcomes . Such work has the potential to provide a more holistic picture for of the factors influencing rehabilitation adherence and outcomes . It is also important to consider and further explore views , knowledge , and perceptions of adherence it is clear from the research to date that they have a rich insight into factors influencing adherence , and that they utilise a number of strategies that also enable basic psychological need satisfaction . behaviour changes are influenced by cognitive appraisals of personal and situational factors , and these in turn influence perceptions of the injury state and associated behavioural and emotional responses ( Brewer , 2001 Brewer at , 2003 et , 1995 et , 1998 ) It is therefore important that differences and changes in wellbeing and need satisfaction are monitored through the different stages of injury ( onset , rehabilitation and return to play ) Future research should therefore utilise a longitudinal approach to understanding how needs may be satisfied or frustrated throughout the course of the injury ( et , 2010 ) Finally , although we have demonstrated are using many strategies which inadvertently ( and simultaneously ) support adherence and basic psychological need satisfaction , more work is required on educating practitioners through targeted continued professional development . 770

Kingston , Jenkins , Kingston Conclusion The objective of the physiotherapist is primarily to facilitate recovery from injury through movement and exercise , manual therapy , education and advice . It is apparent that , within their advice and support particularly around rehabilitation they simultaneously meet and nurture the basic psychological needs of their patients . Consequently , in accordance with and Ryan ( 1985 2000 ) the benefit to patients of , for example , shared , feedback , resource support , and ongoing communication , is that in addition to directly facilitating recovery , there are wider and simultaneous benefits for patient psychological wellbeing . This chapter has sought to illustrate these benefits and provide some guidance on how these widely used strategies may be more effectively framed to satisfy the basic needs . We have also discussed a number of moderating factors that may influence the relationship between physiotherapy support and adherence to rehabilitation . Developing a consistent and approach to supporting rehabilitation adherence explicitly grounded in motivational theory , empiricism , and descriptions of strategy use by can go a considerable way to help to facilitate patient adherence , promote adaptive behaviours and , and more broadly enhance patient wellbeing . Learning Exercises Why is an understanding of theory , and in particular it of basic needs potentially so helpful for the practicing physiotherapist ?

can have both a direct and indirect influence on patient wellbeing please explain how and why ?

What are the primary factors that influence adherence to rehabilitation guidance ?

Why is personal and collaborative goal setting viewed as such a fundamental skill in supporting adherence of the injured athlete ?

In what ways can the physiotherapist directly support the injured athletes three basic psychological needs ?

How can the knowledge gleaned from this chapter enhance the applied practice of and patient outcomes ?

Further Reading , Penny , Corr , 2010 ) UK chartered personal experiences in using psychological interventions with injured athletes An interpretative phenomenological analysis . Psychology and Exercise , 11 ( Clement , 2013 ) Sport medicine team influences in psychological rehabilitation . In Walker ( The psychology injury and rehabilitation ( 771

Chapter 32 Promoting Adherence to Rehabilitation Through Supporting Patient Levy , Clough , 2008 ) Adherence to sport injury rehabilitation programs an integrated approach . Scandinavian Journal of Medical Science in Sports , 18 ( Miller , 2011 ) A review of return to sport concerns following injury rehabilitation practitioner strategies for enhancing recovery outcomes . Physical Therapy in Sport , 12 ( Stevens , 2010 ) Need satisfaction , and perceived sport outcomes among injured athletes . Journal Sport Psychology , 22 ( Ryan , Patrick , Williams , 2008 ) Facilitating health behaviour change and its maintenance interventions based on theory . The European Health Psychologist , 10 ( Smith , 1998 ) An integrated model of response to sport injury Psychological and sociological dynamics . Journal Sport Psychology , 10 ( References , 2007 ) Collaborative relationship in injury rehabilitation Two case examples . In ( Ed . Psychological bases injuries ( Fitness Information Technology . 2013 ) Psychological antecedents to sport injury . In Walker ( The psychology injury and rehabilitation ( Gross , 2011 ) Effects of exercise therapy on endogenous relieving peptides in pain A systematic review . The Clinical Journal , 27 ( Clement , 2017 ) Preliminary investigation into sport and exercise psychology consultants views and experiences of an interprofessional care team approach to sport injury rehabilitation . Journal of interprofessional Care , 31 ( Becker , Booth , 2007 ) Views of chartered on the psychological content of their practice A survey in the UK . Journal Rehabilitation , 16 ( Penny , Corr , 2010 ) UK chartered personal experiences in using psychological interventions with injured athletes an interpretative phenomenological analysis . Psychology and Exercise , 11 ( Ryan , 2004 ) Intrinsic need satisfaction a motivational basis of performance and in two work settings . Journal Social Psychology , 34 ( 10 ) 2017 ) A knowledge translation intervention for improving patient adherence in physiotherapy practice . Archives , A . 1997 ) the exercise . Freeman Company . A . 2001 ) Social cognitive theory an perspective . Annual Review , 52 ( 772

Kingston , Jenkins , Kingston , Godfrey , 2013 ) Individual and factors associated with adherence to home exercise in chronic low back pain a systematic review . The Spine Journal , 13 ( 12 ) Bender , Rand , 2004 ) Medication and asthma treatment cost . Current Opinion in Allergy and Clinical Immunology , 20040600000009 , Vickers , 1994 ) Associations between major domains of personality and health , 62 ( Brand , 2021 ) Exercise behavior change revisited theory . In Jones ( Essentials of exercise and sport psychology An open access textbook ( Society for Transparency , Openness , and Replication in Kinesiology . Brewer , Van , Cornelius , 2000 ) Psychological factors , rehabilitation adherence , and rehabilitation outcome after anterior cruciate ligament reconstruction . Rehabilitation Psychology , 45 ( Brewer , Cornelius , Van , 2003 ) differences in to rehabilitation after anterior cruciate ligament reconstruction . Journal Training , 38 ( 2004 ) Psychosocial factors associated with quality of life among individuals attending genetic counselling for hereditary cancer . Journal of Genetic Counselling , 13 ( Clement , 2013 ) Sport medicine team influences in psychological rehabilitation . In Walker ( The psychology injury and rehabilitation ( Scott , 2005 ) Identifying and improving adherence in bipolar disorders . Bipolar Disorders , 101111 Cooper , Smith , Hancock , 2009 ) Patients perceptions of of chronic low back pain Evidence for enhancing patient education and support . Physiotherapy , 95 ( 1998 ) Personality correlates of exercise behaviour , motives , barriers , and preferences An application of the model . Personal Individual Differences , 24 ( 97 ) Craig , Wright , 2012 ) Nonadherence to prophylactic medication negative attitudes toward doctors a strong predictor . Australian Family Physician , 41 ( 10 ) Ryan , 2000 ) The what and why of goal pursuits human needs and the determination of behaviour . Psychological , 11 ( 01 , 2021 ) and correlates of physical activity and sedentary behavior . In Jones ( Essentials of exercise and sport psychology An open access textbook ( 113 ) Society for Transparency , Openness , and Replication in Kinesiology . 773

Chapter 32 Promoting Adherence to Rehabilitation Through Supporting Patient , 2002 ) Patient adherence and medical treatment outcomes a . Medical Care , 40 ( Hays , Kaplan , Rogers , 1993 ) Physicians characteristics influence patients adherence to medical treatment results from the medical outcomes study . Health Psychology , 12 ( Driver , 2019 ) Exploring considerations regarding the use of psychosocial strategies in practice . Physiotherapy Research International , 24 ( Evans , Hardy , 2002 ) Injury rehabilitation a intervention study . Research Quarterly for Exercise and Sport , 73 ( 2009 ) exercise for osteoarthritis of the knee a of randomized controlled trials . The , 36 ( Anand , 2015 ) The patient working alliance and patient psychological attachment , adherence , outcome expectations , and satisfaction in a sample of patients . Behavioral Medicine , 41 ( A . 2009 ) Behavioral indices in medical care outcome the working alliance , adherence , and related factors . Journal Internal Medicine , 24 ( Owen , Cheng , 2013 ) Real relationship , working alliance , and outcome in counseling and psychotherapy . Counselling Psychology Quarterly , 26 ( Bennett , Paul , Gilbert , 2007 ) The working alliance . Patient Education and Counseling , 66 ( Reyes , Osborne , 2017 ) The working alliance Theory , research , and future possibilities . Patient Education and Counseling , 100 ( Goddard , Roberts , 2020 ) Psychological factors involved in adherence to sport injury rehabilitation a systematic review . international Review of port and Exercise Psychology , Gordon , Potter , Ford , 1998 ) Toward a psychoeducational curriculum for training injury rehabilitation personnel . Journal Sport Psychology , 10 ( Brewer , 2013 ) Psychological aspects of rehabilitation adherence . In Walker ( The psychology injury and rehabilitation ( Crocker , Wilson , Mack , 2013 ) Psychological need satisfaction and thwarting a test of basic psychological needs theory in physical activity . Psychology of Sport and Exercise , 14 ( Hagger , 2010 ) an important construct in health psychology research and practice . Health Psychology Review , 774

Kingston , Jenkins , Kingston Hagger , Wood , Stiff , 2009 ) The strength model of failure and behaviour . Health Psychology Review , Hall , 2010 ) The influence ofthe relationship on treatment outcome in physical rehabilitation A systematic review . Physical Therapy , 90 ( Hargreaves , A . 2013 ) Psychology of physical injuries . In Walker ( The psychology injury and rehabilitation ( 216 ) Hayden , Van , 2005 ) Systematic review strategies for using exercise therapy to improve outcomes in chronic low back pain . Annals Medicine , 142 , 2002 ) Views of chartered on the psychological content of their practice A preliminary study in the United Kingdom . British Journal Medicine , 36 ( Hill , Chase , 2021 ) Self , relational , and collective efficacy in athletes . In Jones ( Essentials of exercise and sport psychology An open access textbook ( Society for Transparency , Openness , and Replication in Kinesiology . Brewer , Cornelius , Van , 2014 ) Big five personality characteristics and adherence to rehabilitation activities after surgery A prospective analysis . The Open Rehabilitation Journal , Hodge , 2015 ) Antisocial and behaviour in sport the role of motivational climate , basic psychological needs , and moral disengagement . Journal and Exercise Psychology , 37 ( Holden , 2015 ) Motivational strategies for returning patients with low back pain to usual activities a survey of working in Australia . Manual Therapy , 20 ( Jack , 2010 ) Barriers to treatment adherence in physiotherapy outpatient clinics A systematic review . Manual Therapy , 15 ( 2003 ) The perceived knowledge and attitudes of governing body chartered towards the psychological aspects of rehabilitation . Physical Therapy in Sport , 03 ) Jin , Oh , Li , 2008 ) Factors affecting therapeutic compliance a review from the patient perspective . Therapeutics and Clinical Risk Management , Judge , 2002 ) Relationship of personality to performance motivation a review . Journal Psychology , 87 ( 101037 Kay , Gross , Goldsmith , Cervical Overview Group . 2005 ) Exercises for mechanical neck disorders . Database Systematic Reviews , 20 ( Kingston , Wilson , 2009 ) The application of goal setting in sport in and , Advances in applied sport psychology A review ( 775

Chapter 32 Promoting Adherence to Rehabilitation Through Supporting Patient , 2014 ) to cardiovascular medications . European Heart Journal , 35 ( 46 ) 2003 ) Adherence to rehabilitation in patients with low back pain . Manual Therapy , Locke , A . 2007 ) New developments in and directions for research . European Psychologist , 12 ( Levy , Clough , 2008 ) Adherence to sport injury rehabilitation programs an integrated approach . Scandinavian Journal of Medical Science in Sports , 18 ( 2008 ) health behavior change Developing , testing , and applying theories for interventions . Applied Psychology , 57 ( Locke , 1990 ) Work motivation and satisfaction Light at the end of the , 101111 Locke , 2013 ) New developments in goal setting and task performance . 2010 ) Athletic and sport issues in rehabilitation . Health Sciences . Marshall , 2012 ) An exploration of athletes views on their adherence to physiotherapy rehabilitation after sport injury . Journal Rehabilitation , 21 ( Martin , 2001 ) Who will stay and who will go ?

A review of older adults adherence to randomized controlled trials of exercise . Journal and , 101123 a Martin , Williams , 2005 ) The challenge of patient adherence . Therapeutics and Clinical Risk Management , John , 1992 ) An introduction to the model and its applications . Journal of Personality , 60 ( Stokes , 2015 ) Addition of motivational interventions to exercise and traditional physiotherapy a review and . Journal . 100 ( Burton , Bradley , 2010 ) Interventions for enhancing adherence with physiotherapy a systematic review . Manual Therapy , 15 ( Sharp , 2013 ) A controlled trial comparing graded exercise treatment and usual physiotherapy for patients with neck pain ( the GET UP neck pain trial ) Manual Therapy , 18 ( Hall , 2005 ) imagery use , and adherence to rehabilitation by injured athletes . Journal Rehabilitation , 14 ( Nichols , 2013 ) Satisfaction of basic psychological needs as a mediator of the relationship between community esteem and wellbeing . of Wellbeing , i ' 776

Kingston , Jenkins , Kingston , A . Khan , Nadir , 2020 ) Development and validation of the General Rehabilitation Adherence Scale ( GRAS ) in patients attending physical therapy clinics for disorders . Disorders , 21 ( 2013 ) Autonomy support and control in weight management What important others do and say matters . British Journal Psychology , 19 ( Kelt , 2000 ) Sport perceptions of psychological strategies in sport injury rehabilitation . Journal Rehabilitation , A . 2007 ) Rehabilitation adherence in sport injury sport perceptions . Journal of Sport Rehabilitation , 16 ( Pearson , 2000 ) Patients trust in physicians many theories , few measures , and little data . Journal of General Internal Medicine , 15 ( Peek , Carey , Mackenzie , 2017 ) perceptions of patient adherence to prescribed strategies a survey of Australian . Disability and Rehabilitation , 39 ( 19 ) 2001 ) Associations among perceived autonomy support , forms of , and persistence A prospective study . Motivation and Emotion , 25 ( Pereira , Pereira , 2014 ) Adherence to exercise programs for older people is influenced by program characteristics and personal factors A systematic review . Journal , 60 ( 2005 ) Return to sport after serious injury a retrospective examination of motivation and psychological outcomes . Journal Rehabilitation , 14 ( Miller , 2011 ) A review of return to sport concerns following injury rehabilitation practitioner strategies for enhancing recovery outcomes . Physical Therapy in Sport , 12 ( Stevens , 2010 ) Need satisfaction , and perceived sport outcomes among injured athletes . Journal Sport Psychology , 22 ( 2021 ) Promoting determined motivation for physical activity From theory to intervention work . In Jones ( Essentials of exercise and sport psychology An open access textbook ( Society for Transparency , Openness , and Replication in Kinesiology . Rebar , Gardner , 2021 ) Theories of physical activity motivation . In Jones ( Essentials of exercise and sport psychology An open access textbook ( Society for Transparency , Openness , and Replication in Kinesiology . Robb , Lee , Dobbin , 2013 ) Health and personal resources in older patients with cancer undergoing chemotherapy . Journal Oncology , 777

Chapter 32 Promoting Adherence to Rehabilitation Through Supporting Patient Rowe , 2006 ) Trust relations in health new agenda . The European Journal of Public Health , 16 ( Ryan , 2000 ) Intrinsic and extrinsic motivations classic definitions and new directions . Contemporary Educational Psychology , 25 ( Ryan , 2017 ) theory Basic psychological needs in motivation , development , and wellness . Publications . Ryan , Patrick , Williams , 2008 ) Facilitating health behaviour change and its maintenance interventions based on theory . The European Health Psychologist , 10 ( Ryan , Plant , 1995 ) Initial motivations for alcohol treatment relations with patient characteristics , treatment involvement , and dropout . Addictive Behaviours , 20 ( 94 ) Austin , Andrews , 2007 ) Personality , emotional intelligence , and exercise . Journal of Health Psychology , 12 ( Brewer , Cornelius , Van , and , 2001 ) Psychological skills and adherence to rehabilitation after reconstruction of the anterior cruciate ligament . Journal Rehabilitation , 10 ( 2009 ) the relationship between depressive symptoms and medication adherence among hypertensive African Americans . Health Education Behavior , 36 ( Schwa , A . 2007 ) Health Behavior Constructs Theory , Measurement , and Research . National Cancer institute Website constructs , Hill , 1991 ) Gender differences in social support and physical health . Health Psychology , 10 ( Reid , 2014 ) The roles of and motivation in the prediction of adherence to exercise among patients with coronary heart disease . Health Psychology , 33 ( 11 ) Otto , 2008 ) Perfectionism and achievement goals in athletes Relations with approach and avoidance in mastery and performance goals . Psychology of port and Exercise , Shireman , Sweeney , 2001 ) Using drug claims data to assess the relationship of medication adherence with hospitalization and costs . Psychiatric Services , 52 ( Tan , Shah , De , Harrison , Smart , Mata , A . 2017 ) Improving the patient booking service to reduce the number of missed appointments at East London Foundation Trust Community Physiotherapy service . British Medical Journal Open Quality , Thom , Bell , 2002 ) Patient trust in the physician relationship to patient requests . Family Practice , 19 ( 778

Kingston , Jenkins , Kingston Thomas , A . 2010 ) Is it better to give or to receive ?

Social support and the of older adults . Journals of Gerontology Series Psychological Sciences and Social Sciences , 65 ( De Geest , Hughes , Morrison , 2012 ) A new taxonomy for describing and defining adherence to medications . British Journal of Clinical Pharmacology , 73 ( Wheeler , 2012 ) Personality traits as of adherence in adolescents with type I diabetes . Journal and Adolescent Psychiatry Nursing , 25 ( Smith , 1995 ) A model of psychologic response to athletic injury and rehabilitation . Athletic training sports health care perspectives , Smith , 1998 ) An integrated model of response to sport injury psychological and sociological dynamics . Journal Sport Psychology , 10 ( Wilson , Rhodes , 2021 ) Personality and physical activity . In Jones ( Essentials of exercise and sport psychology An open access textbook ( Society for Transparency , Openness , and Replication in Kinesiology . World Health Organization . 2003 ) Adherence to therapies action . World Health Organization . A . 2021 ) Affective responses to exercise Measurement considerations for practicing professionals . In Jones ( Essentials and sport psychology An open access textbook ( Society for Transparency , Openness , and Replication in Kinesiology . 779