Podlog, Leslie, Burns, Ryan, Dimmock, James a., Jackson, Ben, Hall, Morgan S., and Fritz, Julie M. (2021) Does motivation mediate the relationship between competence perceptions and patient outcomes among individuals with chronic low back pain? A multiple mediation analysis. Disability and Rehabilitation, 43 (7). pp. 953-959.

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Abstract

Purpose: The aim of this study was to examine: (1) motivations of patients with chronic low back pain to attend physical therapy; (2) relationships between competence perceptions, motivational regulations, and pain/disability; and (3) whether patient motivations to attend physical therapy mediate the relationship between competence perceptions and pain/disability.

Methods: A sample of 64 participants completed baseline assessment (1-week prior to initiation of physical therapy) and 6-week follow-up assessment. Differences between motivation variables at baseline were examined using one-way within-person ANOVA. Relationships between competence perceptions, motivation subscales, and pain/disability were calculated using bivariate correlations and multiple mediation analyses.

Results: Participants reported significantly higher levels of autonomous versus controlled motivation (mean difference = 3.5, p < 0.001, d = 2.3) and amotivation (mean difference = 3.6, p < 0.001, d = 2.4). Competence was positively associated with autonomous motivation (r = 0.45, p ≤ 0.05) and negatively associated with controlled motivation (r = −0.26, p ≤ 0.05), amotivation (r = −0.57, p ≤ 0.05), pain (r = −0.35, p ≤ 0.05), and disability (r = −0.34, p ≤ 0.05). Amotivation significantly mediated the competence–pain relationship (Amotivation IE = −0.19, 95% CI (−0.44, −0.06), p < 0.05) and the competence–disability relationship (Amotivation IE = −0.07, 95% CI (−0.17, −0.01), p< 0.05).

Conclusion: Findings highlight the role of competence perceptions in mitigating amotivation for physical therapy and the deleterious implications of amotivation for patient-centered outcomes.

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