TY - JOUR
T1 - Effectiveness of a theory-driven mHealth intervention in promoting post-surgery rehabilitation adherence in patients who had anterior cruciate ligament reconstruction: A randomized clinical trial
AU - Lee, Sing Yeung Alfred
AU - Yung, Shu Hang Patrick
AU - Ong, Michael Tim Yun
AU - Lonsdale, Chris
AU - Wong, Wai Lung
AU - Siu, Parco Ming Fai
AU - Hagger, Martin S.
AU - Chan, Derwin King Chung
N1 - Funding Information:
The project was funded by grants [ #16172201 ] from the Health and Medical Research Fund, Hong Kong awarded to the corresponding author.
Funding Information:
The project was funded by grants [#16172201] from the Health and Medical Research Fund, Hong Kong awarded to the corresponding author.Our proposed intervention comprised a smartphone application, “ACL-Well”, and incorporated content targeting change in constructs from an integrated theoretical model (Hagger and Chatzisarantis, 2009). The model is based on two prominent theories of motivation from psychology and behavioral science: self-determination theory (Deci and Ryan, 1985) and the theory of planned behavior (Ajzen, 1991). A key prediction of the model is that long-term behavioral adherence and adaptive health/recovery outcomes occur more likely when individuals possess high self-determined motivation (i.e., a motivational pattern characterized by a pattern of high autonomous motivation and low controlled motivation), positive attitudes (instrumental and affective evaluations of the behavior), positive subjective norms (perceived social appropriateness of the behavior), positive perceived behavioral control (PBC; perceived capacity to perform the behavior), and high intention of performing the behavior (Hagger and Chatzisarantis, 2009; Teixeira et al., 2020). The integrated model provides a comprehensive explanation on the determinants of rehabilitation adherence and the process involved (Hagger and Chatzisarantis, 2009), and the psychological pathways of the model have been supported by empirical evidence in the context of rehabilitation from ACL surgery (Chan et al., 2017; Lee et al., 2020). Intervention studies have independently applied the behavior change strategies of SDT (e.g., the provision of clear rationale and meanings of following the treatment) and TPB (e.g., promoting the benefits of engaging in the behaviors) to facilitate adaptive behavioral patterns in various health contexts, including weight management (LaRose et al., 2022), physical activities (Ha et al., 2018), and HIV/AIDS prevention (Siuki et al., 2019). As far as we know, there have not been any theory-driven interventions that applied either the concepts of SDT, TPB, or an integration of both theories to enhance patients' adherence to post-surgery rehabilitation. Using the integrated model to develop a mHealth intervention to facilitate patients’ adherence to post-surgery rehabilitation would offer novel insights valuable to research and practice.
Publisher Copyright:
© 2023 Elsevier Ltd
PY - 2023/10
Y1 - 2023/10
N2 - Rationale: Patients with anterior cruciate ligament (ACL) reconstruction often have poor adherence to post-surgery rehabilitation. Objective: This study applied the integrated model of self-determination theory and the theory of planned behavior to examine the effects of a smartphone-delivered intervention on the recovery outcomes of patients with an ACL rupture during post-surgery rehabilitation period. Additionally, we explored the effects of the intervention on participants with different beliefs toward rehabilitation at baseline. Methods: The randomized control trial recruited 96 eligible participants (M age = 27.82 years, SD = 8.73; female = 39%) who underwent ACL reconstruction surgery. Participants were randomly assigned to an intervention group (n = 41), which received standard post-surgical treatment (usual-care) and smartphone application (“ACL-Well”), or a usual-care control group (n = 55). The primary outcomes were recovery outcomes from ACL surgery measured by knee muscle strength and laxity, and subjective knee evaluation completed 4-month post-intervention. Secondary outcomes were the psychological and behavioral outcomes measured at baseline, at 2- and 4-month post-intervention. Results: ANCOVA indicated no significant between-group differences in primary outcomes: knee muscle strength, knee laxity and subjective knee evaluation, Fs(1, 27 to 55) = 0.01 to 1.36, p =.25 to.99, η2 = 0.01 to 0.03. For the secondary outcomes, growth mixture modelling revealed self-determined treatment motivation declined significantly over the intervention period in the control group (M slope = −0.39 to −0.12, p =.01 to.04), but not in the intervention group (M slope = −0.19 to −0.08, p =.06 to.38). Conclusions: The smartphone application fell short in promoting orthopedic outpatients' recovery outcomes. Yet, it shows some promises as a mean to maintain patients’ motivation and adherence to treatment.
AB - Rationale: Patients with anterior cruciate ligament (ACL) reconstruction often have poor adherence to post-surgery rehabilitation. Objective: This study applied the integrated model of self-determination theory and the theory of planned behavior to examine the effects of a smartphone-delivered intervention on the recovery outcomes of patients with an ACL rupture during post-surgery rehabilitation period. Additionally, we explored the effects of the intervention on participants with different beliefs toward rehabilitation at baseline. Methods: The randomized control trial recruited 96 eligible participants (M age = 27.82 years, SD = 8.73; female = 39%) who underwent ACL reconstruction surgery. Participants were randomly assigned to an intervention group (n = 41), which received standard post-surgical treatment (usual-care) and smartphone application (“ACL-Well”), or a usual-care control group (n = 55). The primary outcomes were recovery outcomes from ACL surgery measured by knee muscle strength and laxity, and subjective knee evaluation completed 4-month post-intervention. Secondary outcomes were the psychological and behavioral outcomes measured at baseline, at 2- and 4-month post-intervention. Results: ANCOVA indicated no significant between-group differences in primary outcomes: knee muscle strength, knee laxity and subjective knee evaluation, Fs(1, 27 to 55) = 0.01 to 1.36, p =.25 to.99, η2 = 0.01 to 0.03. For the secondary outcomes, growth mixture modelling revealed self-determined treatment motivation declined significantly over the intervention period in the control group (M slope = −0.39 to −0.12, p =.01 to.04), but not in the intervention group (M slope = −0.19 to −0.08, p =.06 to.38). Conclusions: The smartphone application fell short in promoting orthopedic outpatients' recovery outcomes. Yet, it shows some promises as a mean to maintain patients’ motivation and adherence to treatment.
KW - ACL
KW - Integrated model
KW - Motivation
KW - Self-determination theory
KW - Social cognition beliefs
KW - Theory of planned behavior
KW - Treatment adherence
KW - mHealth
UR - http://www.scopus.com/inward/record.url?scp=85171131362&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2023.116219
DO - 10.1016/j.socscimed.2023.116219
M3 - Journal article
SN - 0277-9536
VL - 335
JO - Social Science & Medicine
JF - Social Science & Medicine
M1 - 116219
ER -