Patients’ experiences of flexor tendon rehabilitation in relation to adherence: a qualitative study

Abstract

Purpose

To explore patients’ experiences of early active motion flexor tendon rehabilitation in relation to adherence to restrictions and outcome of rehabilitation.

Method

Seventeen patients with a flexor tendon injury in one or several fingers participated in qualitative interviews performed between 74 and 111 days after surgery. Data were analysed using directed content analysis with the Health Belief Model (HBM) as a theoretical framework.

Results

Perceived severity of hand function and susceptibility to loss of hand function affected the participants’ behaviour. A higher perceived threat increased motivation to exercise and be cautious in activities. During rehabilitation, the perceived benefits or efficacy of doing exercise and following restrictions were compared to the cost of doing so, leading to adherence or non-adherence behaviour. Perceived self-efficacy was affected by previous knowledge and varied through the rehabilitation period. External factors and interaction with therapists influenced the perception of the severity of the injury and the cost and benefits of adhering to rehabilitation.

Conclusion

Patient’s perception of the injury, the effectiveness of exercises, context and social support to manage daily life affected adherence to restriction, motivation and commitment to rehabilitation. The HBM as a theoretical framework can be beneficial for understanding factors that influence patients’ adherence.

Implications for Rehabilitation

• Information regarding the injury and consequences for the patient should be presented at different time points and in different ways, tailored to the patient.

• It’ is important to aid patients to perceive the small gradual improvements in hand function to create motivation to adhere to exercise.

• Strategies to reduce the cost of adherence in terms of managing everyday life should be addressed by individually based strategies.

• Instructions regarding exercise and restrictions should be less complex and consider the patient’s individual needs.

Keywords:

• Health belief model
• adherence
• flexor tendon injury
• early active motion
• interviews

Acknowledgement

The authors would like to thank colleagues at the Departments of Hand Surgery in Stockholm, Malmö and Linköping, Sweden for practical support.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the grants from AFA insurance, Sweden [grant number 170246].