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7 Tips You Can Use to Help Patients Improve Self-Efficacy
By: Manpreet Cheema, MScPT Student, Editor: Nataliya Zlotnikov MSC, HBsc

Self-Management vs. Self-Efficacy, Which Witch is Which?

What is the difference between self-management and self-efficacy? Anyone? 

Self-management is the task that individuals must undertake to live well with one or more chronic conditions.

These tasks include having the confidence to deal with medical management, role management, and emotional management of their conditions" (National Academy of Sciences, 2004).

While self-efficacy is the confidence a person has in their ability to achieve a desired outcome. 

Meaning that for a patient to be able to successfully self-manage their condition(s), they must first have self-efficacy.

What does that mean for us as rehab and healthcare practitioners?

We all know that HEP adherence is a real problem in our field. A greater sense of self-efficacy can increase adherence to home exercise programs, and improve our patients' well-being and satisfaction. This blog will give you some excellent tips on how to help your patients grow their self-efficacy!


What Is Self-Efficacy in Health?

Persons living with chronic conditions and chronic pain may have difficulty managing their condition(s) due to a number of factors.

Rather than focusing only on the condition and biomedical model, incorporating the biopsychosocial model can help rehab professionals better understand their patient's perspectives of the condition.

Patients with low self-efficacy may have difficulty adhering to home exercise programs and lack the confidence to control their pain and get back to normal activities.    

Listen to Carolyn Vandyken show us how we can engage our patients and help them build self-efficacy and resilience and achieve results. 

Why Self-Efficacy Should Always Be a Major Goal With Our Patients 

Learn More with Carolyn

How Are Self-Management and Self-Efficacy Linked?

Patients with low self-efficacy may find it more difficult to manage their health condition and may catastrophize their pain. 

Self-efficacy generally predicts one’s ability to cope with daily challenges and adapt after confronting stressful events. Persistent pain and injury can be perceived as stressful events! Patients with higher levels of self-efficacy may cope better with chronic pain than those with lower levels. 

Keeping this in mind, it is quite clear that we need to help our patients improve their self-efficacy, how do we do this? 

Here are 7 great tips that you can start applying to your practice right away!


7 Tips You Can Use to Help Patients Improve Self-Efficacy


7 Tips You Can Use to Help Patients Improve Self-Efficacy

These 7 tips are outlined in greater detail below.


1. Assessing and Promoting Readiness

We can’t make changes in our lives until we are ready. Similarly, in our practices, we need to make sure our patients are ready to take the necessary steps to manage their health before we try to facilitate and help them improve their self-efficacy.

How can you determine whether someone is ready? Ask! Ask your patient about their treatment goals and then help them align those goals with their daily routines, social activities, and lifestyles.

Identifying potential barriers and possible solutions before they occur may also be beneficial.


2. Improve Patient-Provider Communication 

To improve patient-provider communication we must first know what patients want.

What do patients want?

Data from Hush (2011), Stenner (2018), and Holopainen (2018).

This is all good and well, but how can we achieve this clinically?
How do we validate our patients' feelings and know that they understand what we’re educating them on? 

One way to achieve this is to ask your patients to tell you the key takeaways from the session in their own words.

Another great tool is motivational interviewing (MI), "a counseling method that involves enhancing a patient’s motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient’s own motivations; Listen with empathy, and Empower the patient" (Hall, Gibbie & Lubman, 2012).

MI ensures understanding and reinforces key points made by the client, and is designed to empower people to change by drawing out their own meaning, importance, and capacity for change (Motivational Interviewing Network of Trainers, 2021). It can help foster patient-provider communication so the conversation isn’t one-sided. 


3. Create Positive Memories With the Movement 

Patients may recall one event which triggered their injury or pain and may be fearful of repeating that movement to avoid provoking pain. Demonstrating how to do a movement in a way that isn't painful creates a positive memory of the movement and can help reduce fears. 

"Every time we learn a new activity, our brain maps that experience for future reference (Carolyn Vanydken, 2021)."

This concept of body mapping gives your brain a fresh movement experience so that it can go back to creating all types of pleasurable movements and sensations from that body part, not just pain. 

As physiotherapists, we can use remapping exercises to create a brand new map of the painful area.

Cat-cow is an exercise that can be remapped and modified based on what the patient feels comfortable with.

Here’s a sample exercise or remapping from Carolyn Vandyken, available to prescribe to patients from Embodia HEP as part of a Tier 2 and 3 membership.

Remapping to Reduce Tension Using Cat/Cow

4. Use Outcome Measures as a Tool for Educating Patients

Outcome measures can be used to assess a patient’s current status and track their progression over time.

It is important to use outcome measures as a tool for educating patients. If a patient scores low on a particular outcome measure, it’s beneficial to explain to the patient what that means.

Two such outcome measures that can be used to assess self-efficacy are The Pain Catastrophizing Scale (PCS) and the Patient Self-Efficacy Questionnaire (PSEQ).

The Pain Catastrophizing Scale (PCS) is used to assess catastrophic thinking relating to pain, while the Patient Self-Efficacy Questionnaire (PSEQ) assesses the level of confidence with specific daily activities.

Both of these (and other) outcome measures can be found and shared with your patients as part of Embodia's outcome measures & flexible questionnaires feature (part of a Tier 2 and 3 membership). 


5. Educate That 'Change Takes Time'

What’s one of the first things we do when we feel pain? Ask Dr. Google! Patients may be looking up their symptoms and have unrealistic expectations about recovery time. One of our jobs as rehab practitioners is to set expectations upfront with patients and provide education that progress may not be linear.  

The Patient Self-Efficacy Questionnaire (PSEQ) mentioned in Tip #4 above can also be used as an educational tool. Patients who score low on this self-efficacy questionnaire may require further education on what the score means and how long it might take to see change. 

How do you determine the number of appointments a patient needs?

We set goals.

A care plan is an estimate of the number of visits, expected outcomes, and goals.

Instead of booking weeks of appointments after the initial assessment, provide education on what a care plan is and that there may not be a change after one visit.

Healthcare meme

6. Encourage Patient Independence 

Rehab practitioners should be cautious about using manual therapy on patients with low self-efficacy because this can create a sense that the practitioner is “fixing them” and may create a dependence. Instead, allowing the patient to take responsibility and help self-manage their condition may be more beneficial.

Encouraging patients to perform exercises independently by following Embodia exercise videos can help boost confidence. 

The benefits a patient gets from using Embodia's home exercise programs

Patients feel motivated to adhere to exercise prescriptions when they receive educational videos explaining their clinical condition and the treatments’ justification. When the degree of difficulty of the exercise program is a barrier to adherence, personalized videos of the patient performing their exercises can be loaded into the patient's HEP to guide them. This feature also helps physiotherapists prescribe exercises that they have modified for specific patients. 


7. Mindfulness and Self-Efficacy 

Pain often has a psychological component, and learning how to regulate emotions can help manage pain. Practicing mindfulness can help with attention control, emotion regulation, and self-awareness. 

Over the last decade, mindfulness has become a huge topic in the scientific community - and for good reason. 

Backed by clinical evidence, mindfulness practice can be used in clinical practice with our patients as well as for ourselves. 

Mindfulness is not just thinking your way out of stress. It’s about paying attention on purpose and non-judgmentally. The positive effects of mindfulness happen because of awareness.

Behavioral and Physiological Positive Impacts of Mindfulness

Research on mindfulness points to numerous behavioral and physiological positive impacts.

If you would like to explore integrating mindfulness into your physiotherapy practice, check out this online healthcare course on Embodia. 


Wrapping It Up

Incorporating these 7 tips into your practice can help patients manage their health and improve their self-efficacy. Patients with high levels of self-efficacy are able to better control their pain and get back to normal activities. As rehab professionals and physiotherapists, this is what we want our patients to be able to do. 

If you would like to learn more about incorporating self-management and self-efficacy into your practice, consider taking this online healthcare course, Managing Mechanical LBP and PGP - Telerehabilitation Friendly, from Carolyn Vandyken, which this blog was written about.

You can also check out the wonderful blog written by Carolyn Vandyken, Body Mapping - Decreasing the Sensitivity of the Nervous System, which was quoted in Tip #3 above. 


Learn More About
Carolyn's Course

Written: 25 Aug 22
Last update: 14 Sept 22 

Carolyn Vandyken

Carolyn is the co-owner of Reframe Rehab, a teaching company engaged in breaking down the barriers internationally between pelvic health, orthopaedics and pain science. Carolyn has practiced in orthopaedics and pelvic health for the past 37 years. She is a McKenzie Credentialled physiotherapist (1999), certified in acupuncture (2002), and obtained a certificate in Cognitive Behavioural Therapy (CBT) in 2017.

Carolyn received the YWCA Women of Distinction award (2004) and the distinguished Education Award from the OPA (2015). Carolyn was recently awarded the Medal of Distinction from the Canadian Physiotherapy Association in 2021 for her work in pelvic health and pain science.

Carolyn has been heavily involved in post-graduate pelvic health education, research in lumbopelvic pain, speaking at numerous international conferences and writing books and chapters for the past twenty years in pelvic health, orthopaedics and pain science.

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