Patients’ mental models and adherence to outpatient physical therapy home exercise programs

Abstract

Within physical therapy, patient adherence usually relates to attending appointments, following advice, and/or undertaking prescribed exercise. Similar to findings for general medical adherence, patient adherence to physical therapy home exercise programs (HEP) is estimated between 35 and 72%. Adherence to HEPs is a multifactorial and poorly understood phenomenon, with no consensus regarding a common theoretical framework that best guides empirical or clinical efforts. Mental models, a construct used to explain behavior and decision-making in the social sciences, may serve as this framework. Mental models comprise an individual's tacit thoughts about how the world works. They include assumptions about new experiences and expectations for the future based on implicit comparisons between current and past experiences. Mental models play an important role in decision-making and guiding actions. This professional theoretical article discusses empirical research demonstrating relationships among mental models, prior experience, and adherence decisions in medical and physical therapy contexts. Specific issues related to mental models and physical therapy patient adherence are discussed, including the importance of articulation of patients' mental models, assessment of patients' mental models that relate to exercise program adherence, discrepancy between patient and provider mental models, and revision of patients' mental models in ways that enhance adherence. The article concludes with practical implications for physical therapists and recommendations for further research to better understand the role of mental models in physical therapy patient adherence behavior.

Making sense of blood glucose data and self‐management in individuals with type 2 diabetes mellitus: A qualitative study

“…Nurses can encourage individuals to articulate their mental models by asking questions that assess their beliefs, values and expectations about, as well as experiences with, diabetes mellitus self‐management. Identification of individuals’ mental models will allow the nurse to assess for, and correct, inaccuracies (Rizzo, 2015). Knowledge of an individual's mental model, such as actions they use to “compensate” for eating high carbohydrate foods, will provide the nurse with context as they collaborate with the individual to personalise a self‐management regimen.…”

“…Nurses can encourage individuals to articulate their mental models by asking questions that assess their beliefs, values and expectations about, as well as experiences with, diabetes mellitus self-management. Identification of individuals' mental models will allow the nurse to assess for, and correct, inaccuracies (Rizzo, 2015).…”

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Adherence to Recovery Exercise Program of Scapulohumeral Articulation After Breast Cancer Surgery

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“…Social pressure may also influence farmers to adhere to biosecurity practices (53). In healthcare, besides personal positive experience toward a health program, a family member's positive experience inspires a patient's adherence to the program illustrating a shared mental model (54). A shared mental model is molded through learning, mutual experiences, ideologies or institution and communication (55).…”