Abstract
Clinical Pilates (Pilates) is becoming recognised amongst health professionals as a successful rehabilitation tool for treating patients with chronic injury. A strengthening rehabilitation programme can only be effective in reducing pain and resolving injury if patients adhere to their programme. The purpose of this qualitative study was to explore the motivational factors that influenced a patient’s adoption of and adherence to a Pilates rehabilitation programme. The research investigated why patients chose Pilates as their mode of rehabilitation, how patient’s motivation changed over time and how Pilates influenced chronic injury (physical and psychological outcomes). The sample comprised of five female and three male participants aged between 25 to 62 years, with a variety of chronic injuries, and the majority of participants had multifaceted problems. The length of the programmes varied from three months to twenty two months, with an average adherence rate of twelve months. Six of the participants were doing Pilates at the time of the interviews whereas two participants had stopped their programme. Deci & Ryan’s (1985) Self-determination theory was the guiding theoretical perspective, providing the methodological orientation and to a large extent, the interpretation of the findings. Semistructured interviews were employed as the method to answer the research questions and the participants took part in one face to face interview. The interviews were transcribed verbatim and thematic analysis was used to analyse the transcripts. Motivation to adopt a Pilates programme was influenced by three themes: pain, endorsement and attitudes towards starting a Pilates programme. Motivation to continue a Pilates programme was influenced by ten themes: the perceived importance of rehabilitating the injury, knowledge and understanding, patient control, enjoyment, outcomes of the Pilates programme, achievement, goals of rehabilitation, the influence of the Pilates instructor, the studio environment and barriers towards participating in the Pilates programme. Results indicated that participants were extrinsically motivated when adopting a Pilates programme, showing low levels of self-determined behaviour. Participants were motivated to adopt a programme by the recommendation from a health professional or friend and the potential for outcomes such as a reduction in pain. Initially participants lacked personal experience to endorse feelings of perceived competence or relatedness. When continuing a Pilates programme participants exhibited more self-determined motivation generally in the form of identified and integrated regulation. Important motivating factors influencing adherence that emerged were when participants perceived the benefits of a Pilates programme, felt they were in control of their treatment and pain, had a sense of achievement and felt part of a supportive environment. Practical implications have been included to provide health professionals with strategies to facilitate self-determined behaviour. Incorporated in the conclusion are limitations and directions for future research.