Using Psychogenic to tailor program and Correlation to Pain and Adherence
by Timothy Hui, PT, DPT, DC & Arielle West PT, DPT
Research has shown the positive benefits that customized exercise programs can have on internal motivational factors and self-efficacy as they relate to adherence (1). These types of customized programs can also work to address different personality types across patient populations to help improve adherence along with other factors. It is widely known that adherence to exercise programs, especially with patients undergoing physical therapy, has significant advantages such as improved pain levels and quality of life (2). If motivation and self-efficacy are decreased, adherence to exercise will likely be negatively impacted, thus leading to increases in pain levels and poorer quality of life. Personality types and how they could affect different motivational factors and self-efficacy are not typical pieces of data that are collected and/or analyzed during patients’ physical therapy programs. Plethy places high importance on collecting this type of data for each patient utilizing its healthcare team’s expertise along with the Recupe exercise application.
Recupe is a mobile exercise application integrated with wearable motion sensors that is utilized throughout a patient’s rehabilitation program. Guided, customized exercise programs are provided daily. These programs focus on improving strength and range of motion while simultaneously recording various health data including pain, adherence, and various symptom checklists. Behavioral data is also collected, including the patient’s mood at every exercise session. With this data, healthcare professionals have the ability to completely customize a patient’s home exercise program.
Results
During the onboarding process, members of Plethy’s Patient Success team collected information from each patient prior to the start of their exercise programs, in order to assign one of Rubin’s four personality types to them. The four types of personalities are as follows:
- Upholder -> Conformist
-They take recovery into their own hands, thriving under a set schedule and structure.
- Obliger -> Agreeable
-They are people pleasers, thriving through the relationships they make and guidance of others.
- Questioner -> Skeptic
-They are skeptical about recovery outcomes and methods, needing good reason to conform to protocols.
- Rebel -> Maverick
-They are independent freedom seekers and like to do things on their own terms.
The personality type chosen for the patient was documented and additional data was then collected using the Recupe exercise application throughout the patients’ rehabilitation program. This data consisted of average pain level reported, average time spent exercising per day, and average repetitions of exercises per day. A summary of the results is below:
| Tendency | Upholder' | Obliger' | Rebe'l | Questioner' |
|---|---|---|---|---|
| Avg. Pain | 3.16 | 2.84 | 3.2 | 3.29 |
| Avg. Time Spent | 21.99 | 29.3 | 13.9 | 22.76 |
| Avg. PT Reps | 185.95 | 186.4 | 121.5 | 166.4 |
Discussion
From the results above, there is no clinically important difference in the pain between all four tendencies. There are some differences in Time Spent and Reps, however.
For Time Spent, Obligers spend the most time, while Rebels spend the least. With their decreased time, Rebels also average the fewest reps. Interestingly, Obligers and Upholders average the same number of reps. So, Obligers may be spending more resting between reps than Upholders.
When looking at the PT Reps data these two personality types could be assumed to be the top performers. “Obligers” are known for excelling the most through relationships they form and the guidance they take from others. Therefore, it is possible that this group of people would be likely to demonstrate the most adherence to their exercise program as they follow the guidance of their physical therapist and other healthcare providers in detail. “Upholders” also could be assumed to demonstrate higher adherence to their exercise programs as they thrive off of set schedules and structures. They often have higher amounts of internal motivational factors thus pushing them to complete their prescribed programs more frequently and consistently.
The remaining two personality types, Questioner and the Rebel, averaged fewer PT Reps than the others. Questioners spent more time on their exercises than Upholders, suggesting that more rest time was spent between reps, much like the Rebels. From the data, it could be inferred that these types of personalities demonstrate decreased motivational factors and self- efficacy compared to the other two, therefore negatively affecting their exercise adherence and overall performance.
In summary, different personality types can impact patients’ adherence to their physical therapy exercise programs. With these personality types also come different levels of internal motivation and levels of self-efficacy, also impacting performance and adherence. From the results above, it may be beneficial to place an increased level of importance on the individualization of patient exercise programs (3.) It is also recommended that healthcare professionals provide additional motivational and support options as part of their prescribed exercises in order to create more complete, multi-factorial programs (4).
The professional healthcare team at Plethy Recupe, both interact closely with each client to collect data that can provide many useful and important insights. Patient personalities, motivational and self-efficacy factors are just a few of those insights that can be gathered and used to track and optimize a patient’s progress throughout their rehabilitation journey. This type of data can be helpful when it comes to making important decisions regarding their care to speed recovery and reduce overall costs.
