Exploring physical therapists’ approach to addressing home exercise program-related low self-efficacy: knowledge, strategies, and barriers

Self-efficacy is the strongest predictor of completing home exercise programs (HEPs). How physical therapists address low levels of self-efficacy is unknown. Our objectives were to determine (1) knowledge and confidence in addressing patients’ self-efficacy; (2) strategies used to address low self-efficacy; and (3) barriers. Licensed physical therapists who are actively treating patients in the United States participated in our mixed-methods study consisting of: (1) a survey on knowledge, barriers, and confidence; and (2) interviews on strategies used to address low self-efficacy. Descriptive statistics were calculated on all quantitative data. Braun and Clarke’s 6-phase thematic analysis was used for the qualitative data. All 37 participants believed that self-efficacy impacts HEP completion. The majority (72.9%) reported addressing low self-efficacy. Barriers that impacted the ability to address low self-efficacy (Theme 1) included lack of knowledge, confidence, tools, guidance, and community resources, patients’ past experiences and complexities, inability to follow-up with patients, and reimbursement. Due to these barriers, participants primarily addressed patients’ low self-efficacy <i>via</i> communication (Theme 2) and ensuring successful exercise completion (Theme 3). Instead of using Bandura’s fours sources of self-efficacy (i.e., mastery experiences, verbal persuasion, vicarious experiences, physiological state), participants verbalized addressing low self-efficacy <i>via</i> communication and successful exercise completion. Thus, implementation studies evaluating strategies to overcome the identified barriers are needed. Self-efficacy is the strongest predictor of completing home exercise programs (HEPs) as prescribed. Instead of using evidence-informed strategies, physical therapists primarily address low self-efficacy via communication and ensuring that patients complete exercises successfully by simplifying the exercises and repeating the exercises until able to do them without cues. Barriers that keep physical therapists from using evidence-informed strategies include lack of knowledge, confidence, tools, guidance, and community resources, patients’ past experiences and complexities, inability to follow-up with patients, and reimbursement. Physical therapists’ ability to address low self-efficacy and increase HEP completion, can be improved by resolving clinical barriers (i.e., lack of knowledge) with implementation strategies (i.e., training).