title: Motivation for change in patients with prolonged musculoskeletal disorders: a qualitative two-year follow-up study.
abstract: OBJECTIVE
  The purpose of this study was to obtain a deeper understanding of the process of motivation for change in patients with prolonged musculoskeletal disorders and to identify factors that might influence change resulting in increased independence.
  
  
  METHODS
  A qualitative two-year follow-up study. Data collection and analysis were performed according to the qualitative case study design. An initial conceptual framework was developed to bound and guide the study. Twenty patients were selected using purposive sampling with respect to motivation level (highly motivated to less-motivated) to create a sample of maximum variation. Data were collected using repeated interviews and standardized scales. The study comprised three data collection periods.
  
  
  RESULTS
  Motivation for change followed different processes depending on the level at entry to the study. The highly motivated patients improved in independence, the moderately motivated ones remained at an unchanged level and the less-motivated patients became more dependent. Central themes of importance to the process of motivation for change were: the utilization of professional networks (healthcare, regional social insurance office), emotional support (nuclear family, close relatives), use of personal coping resources (energy, positive beliefs, problem-solving) and social support at work (employers, colleagues).
  
  
  CONCLUSIONS
  The performance of a structured motivation analysis, including questions about emotional networks and social support at work in addition to the clinical examination of the patient, is recommended. This might guide healthcare professionals when it comes to motivation for change in the patient.
authors.affiliation: Kronoberg Occupational Rehabilitation Service, Växjö, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Grahn
authors.forename: K
authors.initials: K
authors.lastname: Stigmar
authors.forename: C
authors.initials: C
authors.lastname: Ekdahl
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009140:Musculoskeletal Diseases / Q000523:psychology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012959:Socioeconomic Factors