Influence of beliefs, mood and aversive feedback on adherence to a physiotherapy simulation

This pilot study aimed to assess the contribution of self-efficacy (SE) and outcome expectations (OE; which have a cognitive influence on behaviour) and mood and pain (which have an automatic influence on behaviour) on performance on a physiotherapy simulation. Thirteen participants were randomly assigned to two experimental conditions; auditory (aversive) or visual feedback (informational). To achieve virtual recovery from their simulated shoulder injury, participants needed to repeat simulated movements (controlled by a computer key) at a steady speed over an extended period of time. Feedback on their performance was given either in auditory form (a loud ‘scream’ whenever a physiotherapy ‘movement’ was performed, that decreased in volume as they recovered) or visually (an on-screen vertical red bar which reduced in height as they recovered). This manipulation was designed to enable separation of the informative value and the aversive component of pain in real therapy. The participants completed questionnaires that assessed SE, OE, and mood at baseline, at five points during the simulation and when finished. Non-parametric correlations and ANOVAs were conducted. Those in the visual condition adhered better than those in the auditory condition (effect size 0.39). SE and OE were weakly related to adherence until the last assessment during the simulation (effect sizes ranged from 0.03 to 0.77). Positive mood was related to adherence at every questionnaire point with a large effect size at baseline and the last three assessment points. This pilot study suggests that variables with an automatic influence on behaviour might be important in this physiotherapy simulation