Re-thinking patient motivation in clinical rehabilitation encounters: insights from different theoretical perspectives

ABSTRACT

We use analytic pluralism to discuss and analyze a data excerpt from the medical rehabilitation of an inpatient with spinal cord injury and his physical therapist to examine how the concept of motivation is used in clinical practice. We employ three theoretical perspectives in order to explore ways of understanding this concept: Social Determination Theory, Phenomenology, and Narrative Inquiry. We present and argue for multiple ontologies as a new way forward to understanding complex human phenomena such as motivation.

KEYWORDS:

• Analytic pluralism
• medical rehabilitation
• motivation
• qualitative methods
• spinal cord injury

Acknowledgements

The authors thank the participants of the study for their willingness to participate in the original study. We also thank the thoughtful remarks of Brett Smith, PhD on previous drafts of this manuscript.

Notes

¹ We use the term person-centered term rather than patient-centered or client-centered care because a focus on a person includes a socio-cultural and thus more interpersonal approach to care. We follow CARF International’s lead to use person-first language. With the term ‘person’ we include the person-served’ s family and caregivers. (CARF.org).

² For a fuller discussion of SDT, see the recent review by Taylor (2015).

Additional information

Funding

The data cited in this manuscript were part of an original research study funded by the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR), H133F090053.

Notes on contributors

Christina Papadimitriou

Christina Papadimitriou is an Associate Professor at Oakland University, School of Health Sciences. She received her Ph.D. from Boston University, Department of Sociology (2000) and her postdoctoral training from Northwestern University, Institute of Healthcare Studies (2009) and the Rehabilitation Institute of Chicago, Center for Rehabilitation Outcomes Research (CROR). She is an active qualitative rehabilitation researcher who studies person-centeredness in rehabilitation and SCI and peer-health navigation and peer mentoring for persons with physical disabilities in the United States from a social justice perspective. Her work has been funded by NIDILRR; she is methodological consultant in several SCI QUERI studies at the Hines IL Veteran Administration Hospital; and Senior Scholar at George Washington University in the Center for Healthcare Innovation and Policy Research.

David A. Stone, PhD holds three interdisciplinary degrees from Boston University. He has served as director of research at the Fenway Health Center Research Department, director of the Boston Violence Prevention Project at the Harvard School of Public Health, associate director of the Pediatric and Adolescent Health Research Center at the Tufts University School of Medicine, as founding director of the South East European Research Centre at Sheffield, and as the co-founder and director of the Colloquium for Qualitative Research in Health at the Harvard Medical School. He currently serves as chief research officer, professor of interdisciplinary health, and professor of philosophy at Oakland University, and as president of the Institute for Transformational Education and Responsive Action in a Technoscientific Age (ITERATA).

Nick Caddick, PhD, is Research Fellow at the Veterans and Families Institute, Anglia Ruskin University, UK. His research focuses on narrative as a means of exploring the legacy of war and military life for individuals and societies. He specialises in qualitative research methods and is interested in creative combinations of different forms of qualitative analysis.