Extensor Tendon Injury
An Occupational Therapy Perspective
Motivational Interviewing
What is Motivational Interviewing?
Motivational interviewing is described as a client-centered approach that assists with client motivation (Markland, Ryan, Tobin, & Rollnick, (2005). Forcing a behavior pattern may result in conflict between the clinician and the client (Markland et al., 2005). Motivational interviewing produces a positive relationship between clinician and client because it allows the client to express their needs and desires toward change (Rolland & Miller, 1995). This approach encourages clients to peruse a targeted goal and recognize potential problems in reaching that goal (Rubak, Sandbaek, Lauritzen, and Christensen, 2005). “The aim of motional interviewing is to guide the client towards a resolution of ambivalence and inconsistencies in their behaviors in order to build motivation for change” (Markland et al., 2005 p. 813)
Core Principles of Motivational Interviewing
Express Empathy
Roll with Resistance
Develop Discrepancy
Support for Self- Efficacy
Why is Motivational Interviewing important in Hand Injuries?
Progress in a hand injury may be delayed if clients are noncompliant with recommendations provided by the hand therapist, which can result in an early discharge (Flinn& Jones, 2011). The improvement of the injury depends upon self-efficacy within the client and guidance from an occupational therapist (Flinn & Jones, 2011). It is normal for clients to feel stuck or unmotivated after they have encountered an injury (Brainline, 2014) Therefore, motvational interviewing is an appraoch to maintaining determination within a client (Flinn & Jones, 2011).
What is the Motivational Interviewing Process ?
According to Flinn and Jones (2011), there are steps to achieving motivation are which are: Build Intrinsic Motivation which include Establishing Rapport, Setting the Agenda, Exploring Importance of Change, and Enhancing Confidence to Change. The second process is Strengthening Commitment to change which include recognizing the readiness to change and Negotiating a plan.
(Flinn & Jones, 2011)
Benefits of Motivational Interviewing (center for evidence based practice, 2011):
-Allows the client to Identify personal goals and changes
-Improved quality of life for the client
-Positive treatment results
-Decreases the amount of no shows to scheduled appointments
-Increases client engagement
How Can Motivational Interviewing help Felix?
Those with hand injuries may decide to practice in their home, however the problem with this is that they may not have time (Flinn & Jones, 2011). Motivational interviewing is a useful approach for clients to understand the commitment to change and to identify targeted goals and outcomes (Flinn & Jones, 2011). Because Felix is required to wear a splint, he may have trouble staying motivated during his road to recovery. Motvational interviewing is an approach that and help Felix stay on track!
ORAS Skills
Throughout the motivational interviewing process it is important to use ORSA skills, which stand for: open ended questions, reflective listening, summarization, and affirmations(Miller & Rollnick, 2012). Using ORSA skills will furthur enhance the therapist and client relationship. ORSA will allow the OT to gain a better understanding of the client point of view.
Example - On a scale from 0-100, how important is it for you to make this change? Why are you at that number and what 0? which allows them to ellborate on the importance and need for change.
Although motivational interviewing is typically applied to behaviors such as alcohol abuse, or tramatic brain injuries, it has recently been applied to hang injuries (Flinn & Jones, 2011). Motivational interviewing offers an approach that manages behavioral challenges that clients may experience during their hand injury (Flinn & Jones, 2011). Movational Interviewing is a recgonized evidence- based practice for people with behavorial issues, however this technique shows promise to hand injured clients(Flinn & Jones, 2011). Although this appraoch may seem time consuming, it contribues to treatment effectiveness for those who may seem unmotivated at first glance
References
Center for Evidence-Based Practices at Case Western Reserve University. (2006). Retrieved March 01, 2016, from https://www.centerforebp.case.edu/practices/mi
Flinn, S., & Jones, C. (2011). The Use of Motivational Interviewing to Manage Behavioral Changes in Hand Injured Clients. Journal of Hand Therapy, 24(2), 140-146.
Markland, D., Ryan, R. M., Tobin, V. J., & Rollnick, S. (2005). Motivational Interviewing and Self–Determination Theory. Journal of Social and Clinical Psychology, 24(6), 811-831.
Rollnick, S., & Miller, W. R. (1995). What is Motivational Interviewing? Behavioural and Cognitive Psychotherapy Behav. Cognit. Psychother., 23(04), 325.