Self-efficacy theory
What does self-efficacy mean in the physiotherapy setting?
Physiotherapy not only strives to improve a patient’s physical function, but also helps them believe they are capable of their own recovery. This lies at the core of Albert Bandura’s self-efficacy theory, which he introduced in 1977. In the scope of physiotherapy, the term self-efficacy denotes a patient’s belief in their ability to follow through on a treatment plan, including adhering to exercises, managing symptoms and staying active despite pain. This belief in one’s ability to execute actions to reach desired outcomes, is why belief, or confidence, can be just as important as treatment itself.
Bandura recognised four main sources of self-efficacy:
- Mastery experiences – performing a task successfully increases confidence.
- Vicarious experiences – observing others succeed can help one believe in themself.
- Verbal persuasion – encouragement, notably from trust healthcare providers strengthens belief.
- Emotional and physiological states – reducing fear, anxiety and fatigue can improve confidence and performance.
These principles are highly applicable to physiotherapy education as patients may not need more information, but may require more support in their confidence to execute.
Why self-efficacy matters
Evidence has shown that self-efficacy is beneficial across many health conditions and has been linked to increased treatment adherence, better coping and improved autonomy (Lorig & Holman, 2003). Within physiotherapy, self-efficacy gives patients the confidence to actively participate in their recovery, which is the ultimate goal of patient education.
Similarly, a 2013 longitudinal study in England researching participants with shoulder pain found that pain self-efficacy was a crucial predictor of outcome (Chester et al., 2019). Those with high baseline pain and high pain self-efficacy had better results than those with low pain self-efficacy. Most notably, participants with low baseline pain and low pain self-efficacy had similar outcomes to those with high baseline pain and high self-efficacy. The study also uncovered that participants that anticipated improvement from physiotherapy experienced better outcomes than participants with lower expectations.
Applying Self-Efficacy Theory to practice
The following case example considers how these principles can be applied to patient education.
The physiotherapist identifies that rebuilding confidence in movement is pertinent for Jude’s recovery. This can be achieved by addressing the four sources of self-efficacy:
Mastery experiences
The physiotherapist gives Jude small, achievable movement exercises that he can do well. This helps to build confidence and highlight to Jude that progress is possible and movement is manageable.
Vicarious experiences
The physiotherapist provides anecdotes of other patients in similar situations who were initially apprehensive to move, but overtime were able to regain full range of motion and function of their shoulder. This normalises Jude’s fear and gives him reassurance.
Verbal persuasion
Throughout the sessions, the physiotherapist provides motivating feedback and establishes setbacks as part of the learning journey. This will support Jude’s strengths and help identify areas needing improvement.
Emotional and physiological states
Jude is showing signs of anxiety when tasked with particular exercises. The physiotherapist acknowledges Jude’s feelings and explores why the task is evoking these states. The physiotherapist can also provide breathing techniques to control anxious states. Educating Jude on the healing process also helps to reduce fear of re-injury.
Using these four components of self-efficacy can alter the focus from instructing Jude to allowing Jude to feel in control of his recovery. As he builds his confidence, his enthusiasm to actively participate in therapy will build too.
Active patient education aims to also support and empower, ensuring patients are active participants in their care.
