How often do you find out why your patient might want to recover from or better manage an injury or illness? And I mean the real WHY behind their motivation. In this article I will provide some helpful questions to engage patient motivation.

It’s really easy after assessing your patient for you to decide what treatment outcome they can achieve. But is your interpretation of what the patient wants, really what they want?

Getting a clear picture of what your patient expects from treatment is the first step in developing a productive relationship.The next step is to find out why they want that outcome or what they will gain from that outcome.

This is can be more challenging to elicit from the patient as it is values based.

Exploring a patient’s goals and why they are important is a very worthwhile undertaking.

Values and emotions are what drive our decision making. When you’re clear on your patient’s values, you can use them to frame the treatment options you have for them.

Here are some suggestions to help you elicit values

“What will you gain when you (insert goal)?”

“What do you miss most because of this injury/illness?”

“What would be the positive outcomes from achieving (insert goal)?”

“Why are these outcomes important to you?”

It can be quite challenging to engage patients in complying with treatment plans, especially the long term plans. So how can you help your patients want to do their exercises?

There’s one thing I’ve learnt over 30 years of treating patients and that was, my goals for management did very little to improve home exercise program compliance.

Getting a great ROM, increased strength, improved fitness, or muscle balance is not what will motivate patients to exercise. It might look/sound like it will work as they will agree with you but agreeing and taking action are worlds apart.

What I learnt over time was to find out:

What are the positive outcomes of recovering from injury from their perspective? 

Why are those outcomes important?

And lastly what is the evidence they need to know they have achieved their goal?

It’s easier for the patient to see benefit in both treatment and home exercises when they have a clear idea of what they want to achieve and why that’s important to them.

Engagement with ongoing treatment will be easier to agree to when the treatment is about what the patient wants rather than what you want for your patient.

What Are Some Power Phrases To Engage In Compliance?

Sometimes it can be really hard to have your patients engage in their home programs or even to come in for the treatment they need. To help you with this I have put together six ‘power phrases/questions’ that might help you engage patients who are struggling to make the adjustment needed to recovery from injuries.

1. “Out of curiosity what do you miss most about not being able to do …? And why is this important to you?”

Ask the first question and after you listen to the response, ask the second question. The second question is the one they may struggle to answer but is the more important question of the two.

These are great questions to ask when you want to find out what it is that drove the patient to seek help. The real answer lies not in getting rid of pain etc but in regaining what has been lost due to the pain etc and the emotional benefit they want to get back.

The emotional reason that had the patient coming to you is the same reason that they will engage in your treatment plan.

When you have the answer to this question frame your suggestions of what options the patient has in relation to regaining what ever has been lost due to the injury/illness.

2. “(Insert fact). What that means for you is (insert the emotional benefit). Is that correct?”

As an example- “Getting your remedial exercises done. What that means for you is being able to feel the excitement of being back on the court without the annoying pain. Is that correct?”

“Doing your Pilates. What that means for you is feeling confident that you won’t have any leakage when you start running again. Is that correct?”

3. “How will you manage to get these exercises done?”

First of all, remember that giving advice  and providing logic in the management of chronic conditions rarely works. It is more likely to elicit ‘psychological reactance’.

Your aim is to elicit the patient’s own argument for doing remedial work. When sitting in with you and agreeing to a home management plan, they rarely consider how this is going to fit into their lives.

I’ve done exactly the same thing when I was in the patient role. The physiotherapist I was seeing was fantastic and asked me to do these exercises three times/day. I agreed and by the end of the first day I hadn’t done any of them!

It wasn’t because I was being difficult or didn’t think they would help. It was because I hadn’t considered beforehand how they would fit into my day. This has happened to me a number of times and I can see how easy it is to not get remedial work done.

When you deliver your plan, ask your patient how they will manage to get it done. It will make your patient think about the plan in the context of their daily lives.

4. “What options do you have to…?”

This question will engage the patient in thinking about treatment options. Once you have an answer to this question you can start discussing any potential obstacles to completing the tasks. How can you best support your patient achieve the option that suits them?

Here’s some examples:

• “What options do you have to get up 10′ earlier to do your stretches?”
• “What options do you have to incorporate Pilates into your weekly schedule?”
• “What options do you have to get back in for further treatment?”

If they struggle to think of any, let your patient know that you have a few suggestions and they can pick the one that best suits them. Do not ask this question first as you will be directing the patient to what you offer and that may not be what they might come up with.

This question is only to be asked when the patient has nothing to offer.

5. “What has to happen to…?”

This question is all about helping the patient think about potential resistances or obstacles that might occur and what he/she can do to minimise them.

Here is an example – “What has to happen for you to get up from your desk every 30’?”

The patient comes up with the solution rather than you. In this way they ‘own’ it rather than being told what to do.

If they get stuck you can always ask you can revert to the question power phrase 4.

6. “Based on what you said about… I recommend…”

Once you offer your recommendation, ask the patient what you could do to improve this or what they don’t like about your recommendation. There is benefit for having the patient disagree with the initial recommendation so that they have to think about what they are agreeing to. A collaboration effort is usually more effective engaging change than being told what to do.

As in all the other phrases, your aim is to have your patient fully consider treatment options and how they will impact on their life.

It will help both them and you if this consideration and collaboration is done early in the treatment cycle. It will save a lot of frustration on your part and guilt on the part of the patient.

Remember what’s important to the patient is not getting back range of movement, strength, or being pain free etc. It will be regaining what has been lost due to pain, poor ROM, weakness etc.

These power phrases will give you some ideas on how to engage your patients in their rehabilitation. Use them only when in great rapport. Of course you would not ask in order of question 1 to 6. Choose the option that feels the best fit for the situation you find yourself in.

There may be times when the answers they give to your questions are not be what you deem to be the best options for their injury recovery, but it is better that they engage in something rather than doing nothing. As they have a positive engagement in their rehab, they can move towards what you really want them to commit to.

To learn more about motivational tools through effective communication download my eBook

“Improving Patient Motivation In Physiotherapy”

I wrote this eBook in response to the most common question I get asked and that is “How do I motivate my patients?”

If you would like to fine-tune your communication skills when working with resistant patients, you might consider working with a coach or mentor.

Or perhaps your staff would benefit from training in this area.

Contact us, and find out more about what we can offer you

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