Physical Therapists' Knowledge And Strategies Of Addressing Home Exercise Program-Related Self-Efficacy

PURPOSE: Despite the benefits of home exercise programs (HEPs) prescribed by physical therapists (PTs), 70% of patients do not perform their HEPs. One of the strongest predictors of performing HEPs is self-efficacy. Currently, research on PTs’ knowledge and strategies for addressing low HEP-related self-efficacy is limited. Therefore, the purpose of this study was to determine PTs’ knowledge and strategies for addressing patients' low HEP-related self-efficacy. METHODS: A nationally representative sample of 50 licensed PTs completed our mixed-method, which included: 1) Quantitative surveys identifying PTs knowledge and barriers to addressing low self-efficacy; and 2) Semi-structured interviews examining PTs use of Bandura’s 4 sources of self-efficacy (mastery experience, vicarious experience, verbal persuasion, and physiological state). We described our quantitative results using descriptive statistics and for our qualitative data we used Braun and Clarke’s 6-phase thematic analysis. RESULTS: Our 50 participating PTs had an average of 15.7 (SD=13.0) years of clinical experience. About half (54.0%; n=27/50) addressed HEP-related self-efficacy. PTs' scored a 42.6% on the knowledge assessment. When discussing the decision to address low HEP-related self-efficacy, PTs verbalized that it is very important, but barriers keep them from addressing their patients' low HEP-related self-efficacy (Theme 1). These barriers included lack of knowledge, prioritization, support from patient or patients’ family, clinic or community resources, and insurance coverage. When participants did address patients' low HEP-related self-efficacy, PTs did not use Bandura’s four sources of self-efficacy. Instead, they used informal strategies that focused on communication (Theme 2) and repeated practice (Theme 3). CONCLUSIONS: Despite acknowledging the importance of self-efficacy, most PTs do not formally address their patients' low HEP-related self-efficacy due to personal, interpersonal, institutional, community, and policy-related barriers. Due to the importance of self-efficacy, it is essential that we identify and implement strategies that address these barriers.