An investigation into student physiotherapist's understandings of exercise adherence and their use of motivational strategies to improve exercise adherence in patient groups – a focus group study

Background: In physiotherapy practice, poor patient adherence to treatment has been cited as a principal reason for failure to recover from injury (Bassett 2003). Lack of motivation has been suggested as a contributing factor to this (Sluijs et al. 1993). Although adherence is an important concept in physiotherapy, currently there is no research investigating student physiotherapists' understanding of the concept or how they manage patients who are non-adherent. Objectives: To explore student physiotherapists' understanding of the concept of exercise adherence and their use of motivational strategies in enhancing patient adherence to exercise programmes. Methods: A qualitative design using focus group methodology was employed. Two focus groups (six participants in each) were conducted with 4th year undergraduate physiotherapy students from the University of Limerick. Groups were audio-recorded, transcribed verbatim and subjected to thematic analysis by which prominent themes were identified. Results: Three main themes emerged. In "Perceptions of Adherence" there was variability in the understanding of the concept but the patient-therapist relationship was considered important. Under the theme of "Use of Motivational Strategies" it emerged that students used a variety of motivational strategies on clinical placements. Patient individuality and clinical experience as both a positive and negative factor were found in "Influences on the Use of Motivational Strategies". Conclusions: A theory-practice gap emerged regarding the theoretical knowledge gained in university about adherence and the use of motivational strategies, and its application in clinical practice. The optimum method of delivering education to bridge this gap needs to be explored in future studies.