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Effectiveness of Psychological Factors on the Efficiency of Physical Rehabilitation
Research Questions
Do Psychological Factors Affect
Rehabilitation?
How do Psychological Factors Affect
Rehabilitation?
Do Health Care Professionals Agree
w/ Scientific Literature?
How Can This Information Be
Implemented Into Improving Treatment?
Project Contents
Major Findings
There is an abundance of evidence of various psychological factors having a relatively significant effect on rehabilitation
Not A Consistent Effect - Due to the vast diversity of how individuals react to psychological factors, injury severity, environmental factors
Differences in pain perception can lead to persistent fear avoidance behavior
Higher levels of self confidence, optimism, motivation lead to greater task completion and home exercise adherence
Stress Diathesis Model - stressed individuals experience greater pain, recover at a slower rate, etc
100% of surveyed health professionals agreed that psychological factors have at least a small effect on rehabilitation based on their experiences
as physical therapists, nurse practitioners, occupational therapists, athletic trainers, health science professors, etc.
Mirror the 3 phases of cognitive behavioral therapy w/ rehabilitation - psychoeducational phase, skill building phase, application phase
Section 1: Literature Review
Using scientific literature to
determine whether this
phenomena exists, ponder the
extent, and the various ways
psychological factors affect rehab
Section 2: Survey of Professionals
Obtaining an understanding of
existence, specific profession, and
justification for their answer
Section 3: Concluding Discussion
Conclusion and implementation
Importance
⚇ Relatively undiscussed factor of
possible rehab efficiency solutions
⚇ Revolutionary phenomena with a
potentially drastic effects / benefits
⚇ Personal, financial, time, and
emotional benefits for individuals
who possess and use the knowledge
to their advantage
⚇ Controllable psychological factors
affect the billions of people in rehab
References
Flanigan 2015, Gillen
2002, Kox 2014,
McNevin 2000, Morris
2011, Linton 2011,
Soares, 2014, Walter
2019, Walton 2018
Tim Joy
Dr. John Guers
Rider University
HSC 490
Spring 2021
�
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1aa5c68c921936fc5b6789c04b4aa8a1
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Rider University Baccalaureate Honors Program Capstone
Joy
Effectiveness of Psychological Factors in Physical Rehabilitation
Timothy Joy
Faculty Advisor: Dr. Guers
Rider University - HSC 490
Spring 2021
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Table of Contents
Introduction ……………………………………………………………………………………… 3
Section 1: Literature Review ……………………………………………………………..……... 5
I.
Understanding of Existence ……………………………………………………………... 5
II.
Determination of Extent …………………………………………………………………. 7
III.
How Psychological Factors Affect Physical Rehabilitation …………………………….. 9
Section 2: Opinions of Health Professionals …………………………………………………… 15
I.
Introduction …………………………………………………………………………….. 15
II.
Methods ………………………………………………………………………………… 15
III.
Results ………………………………………………………………………………….. 17
IV.
Conclusions …………………………………………………………………………….. 19
Section 3: Concluding Discussions …………………………………………………………….. 22
I.
Literature and Survey Conclusion ……………………………………………………... 22
II.
Incorporation Methods Into Treatment .………………………………………………... 23
References ……………………………………………………………………………………… 25
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Introduction
The field of physical rehabilitation has exploded over the last 50 years, with an increased
understanding of anatomy, exercise physiology, kinesiology, therapy, etc. revolutionizing the
field. A relatively under discussed topic with an arguably substantial effect on physical
rehabilitation is psychology. An entire field of psychology, sport psychology, primarily focuses
the effects of psychological principles on sport performance. There is an undeniable role of
psychology in physical performance; certain psychological factors can massively impact physical
performance, for better or for worse. A logical deduction would be that the same effect of
psychological factors could possibly be applied towards the efficiency of physical rehabilitation,
but substantial research would be required to substantiate this possibility. In line with this
specific research, in a groundbreaking research study, it was found possible that the voluntary
activation of the sympathetic nervous system via training of mediation, breathwork, and cold
exposure can result in epinephrine release and subsequent suppression of the innate immune
response in humans in vivo (Kox 2014). This study has numerous major implications regarding
possible alternative factors that could affect the efficiency of physical rehabilitation. From this
study, the question arises whether or not exercises such as meditation, breathwork, and cold
exposure, which primarily affect the mindset of an individual, affect the efficiency of physical
rehabilitation. The consistent performance of meditation, breathwork, cold exposure, and other
similar practices may influence or change thought processes in reaction to stimuli through the
rewiring of neural pathways. Ultimately, to rephrase the question, does an individual’s mindset
have an effect on the efficiency of their physical rehabilitation, and if so, to what extent? The
question of why, or why not does this phenomenon occur, arises as well. The questions can
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extend beyond causal factors, an additional question could be asked whether or not the mindset
of an individual be trained and developed in order for an increased efficiency of their physical
rehabilitation? Through a thorough background literature review, a more definitive viewpoint on
the topic specifically from the viewpoint of various sources from the scientific community will
be established. Based on prior research, it can be hypothesized that various exercises that alter an
individual’s mindset, and therefore the mindset of an individual, can affect the efficiency of their
physical rehabilitation, which can be developed and trained. This hypothesis will be verified with
a literature review, then a concise study will be conducted in order to get a perspective on the
topic from health professionals specifically, with this capstone project being concluded with a
final discussion.
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Section 1: Literature Review
I.
Understanding of Existence:
The first understanding that needs to be obtained is the existence of this possible
phenomenon; whether or not psychological factors can affect the efficiency of physical
rehabilitation. Multiple studies will be analyzed to obtain a definitive viewpoint of the concept
from professionals of the scientific community.
A key takeaway from a research study with the goal of determining any psychological
and/or social factors that may have some sort of effect on physical activity engagement after
suffering a stroke, was that the researchers determined that some of the psychological factors that
were found to be particularly relevant towards increasing physical activity engagement
behaviour were self efficacy, greater perceived locus of control for recovery, personal perception
of exercise competence, interest in exercise, a lack of perceived motivational barriers,
self-determination, and beliefs about positive and negative outcomes of being physically active
(Morris 2011). Social factors such as family, medical professional, and peer support were also
found as a determinant for having some sort of effect on physical activity engagement in the
same study as well, but these specific factors aren’t the subject of focus in this particular research
analysis.
Morris’ research study’s conclusions help provide answers to questions proposed in this
research study via logical deductions. The study has suggested that these psychological factors
have an influence on physical activity engagement, and it can be assumed that an increase in
physical activity engagement would correlate with an increased efficiency in physical
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rehabilitation, with an arguable causal relationship. However, while these psychological factors
in this study (self efficacy, greater perceived locus of control for recovery, etc.) are malleable,
and are able to be enhanced, there are two inhibiting factors towards finalizing the claim that
physical rehabilitation is drastically affected by these psychological factors.
First, there needs to be a more definitive link between these psychological factors and
physical rehabilitation efficiency, not just physical activity engagement. If a clear link has been
found, the second issue arises, which is that an understanding of the extent to which these
psychological factors affect physical rehabilitation, and in what way, is required to get a more
comprehensive interpretation of this concept.
To firstly further establish a link, a study was performed focusing on the impact of self
talk, a practice shown to influence athletes’ thoughts, feelings, and behaviors, on psychological
and performance outcomes of junior sub-elite athletes. The study found that specific targeted self
talk interventions may aid and improve junior athletes’ performance and psychological states
(Walter 2019). Additionally, in a study examining the effect of depression and cognitive
functioning on rehabilitation efficiency in stroke victim patients, it was found that patients with
higher levels of depressive symptoms used rehabilitation services less efficiently, and that these
patients did not use rehabilitation services for as long in duration as others. The study concluded
with the support of identifying patients with high levels of depressive symptoms to allow for a
more comprehensive assessment, implementation of a more rapid intervention, and an increased
physical rehabilitation efficiency (Gillen 2002).
To finalize the hypothesis that psychological factors affect physical rehabilitation, a
seemingly unrelated study results provided crucial implications to definitively substantiate the
phenomenon. This study consisted of a review of three factors that have been suggested to
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positively influence the ability to develop motor skills in dancers, with the three factors being the
performer's attentional focus, self-control, and practice in dyads (groups). These results alone are
interesting, but not incredibly relevant to this research. However, the study continues and to
paraphrase the additional findings from the study; these factors appear to provide potential
benefits to physical rehabilitation treatment, based on the results gathered from studies of
efficiency of physical rehabilitating adults. The research team maintains that these principles
would also apply to and likely benefit physical rehabilitation patients who are attempting to learn
or relearn a novel or old physical movement or task (McNevin 2000).
After obtaining and discussing a plethora of evidence that not only supports the notion
that psychological factors have an influence on physical rehabilitation, essentially proving the
phenomena, the question of focus in this research study then shifts from a question of existence
to a question of extent.
II.
Determination of Extent
After this monumental conclusion has been drawn, that psychological factors definitively
have an effect on the efficiency of physical rehabilitation, several important questions emerge.
One of the biggest questions, which will be answered in this particular section, is, to what extent
do psychological factors have an impact on physical rehabilitation. How much of an effect do
psychological factors have? The unfortunate answer is, the extent of psychological factors in
physical rehabilitation can not be provided with a concise and definitive answer. Unsurprisingly,
there is a complete lack of evidence with a convenient answer to this question. Logically, there is
a reasonable explanation for this. Given the vast diversity of psychological factors that all types
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of people might have, the vast diversity of how these psychological factors might affect all types
of people, the vast diversity of various life events that may influence psychological factors, the
vast diversity of physical rehabilitation factors and how different type of people could respond to
them, etc. it is foolish to assume that the psychological factor’s effect on physical rehabilitation
patients could be measured. There’s inherently an infinite amount of variance within these
parameters to accurately define. It is now understood, due to the previous section, that
psychological factors definitively have an effect on physical rehabilitation, for better or for
worse, and that this effect is significant to be noticeable, but unfortunately exact parameters are
impossible to define. The term psychological factors is far too vague to find an accurate answer
to this phenomenon, physical rehabilitation suffers a similar problem, as the physical
rehabilitation can be accurately measured but drastically varies in the area of focus (shoulder
mobility, level of knee pain, etc.). To actually provide an answer on the extent, avoiding a “it
depends” response as much as possible, evidence suggests that the extent of the effect that
psychological factors have on physical rehabilitation is a small to moderate effect for most
patients. That being said, this is completely dependent on the type of physical rehabilitation
required, the severity of the pathology, and other types of factors. And while psychological
factors are obviously not as influential as the actual therapy’s effect on rehabilitation efficiency, a
small to moderate effect is still a significant factor, especially considering the fact that this is a
completely undiscussed major potential sector of the rehabilitation field that could drastically
enhance its efficiency. Ultimately, a more appropriate question would be, how do these various
psychological factors have an effect on the efficiency of physical rehabilitation, rather than
simply, what is the extent of it.
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How Psychological Factors Affect Physical Rehabilitation
In order to gain a better understanding of how psychological factors affect the efficiency
of physical rehabilitation, an optimal strategy would be to redistribute the term “psychological
factors” into first, more definable terms, and into a variety of different terms. Psychological
factors is a purposefully vague term, and breaking down the term into multiple different aspects
allows for both a more concrete and a more specific understanding of how psychological factors
affect the efficiency of physical rehabilitation. Therefore, the following analysis strategy will
involve using literature to examine a specific psychological factor’s effect on a specific
component that contributes to the efficiency of physical rehabilitation.
A particularly imperative, and convenient, study provides evidence of the relationship for
many of these different factors and their effects. Specifically, the research study was created by
David Flanigan and his team, titled, “Psychological Factors Affecting Rehabilitation and
Outcomes Following Elective Orthopaedic Surgery”. The first psychological factor that will be
examined is pain perception. To paraphrase the contents of the study, regarding the psychological
factor of pain tolerance, the fear-avoidance model of pain is considered responsible for the
negative effects of the efficiency of physical rehabilitation. The study continues, noting that in
events when patients experience recurrent pain with particular movements or activities, the
phenomena of pain catastrophizing can occur, which involves an exaggerated negative
psychological response to the recurrent pain or its anticipation. This can lead to kinesiophobia,
where the individual becomes actively avoidant of certain movements out of fear of recurrent
pain or even further injury. This persistent fear-avoidance behavior may contribute to lower
quality rehabilitation and “rehabilitation homework”, doing the necessary at-home stretches,
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exercises, etc. that may lead to a less efficient improvement in physical symptoms (Flanigan
2015). Flanigan et al. also provided Figure 1. in order to re-explain this concept visually.
Figure 1. Conceptual diagram of fear-avoidance behavior as a contributor to persistent pain and poor-quality
rehabilitation (Flanigan 2015).
Steven Linton’s study, “Impact of Psychological Factors in the Experience of Pain”
provides an explanation for this phenomena with an evolutionary perspective. To paraphrase,
Linton’s study argues that “this model”, which was essentially identically outlined in both
Flanigan’s and Linton’s study, suggests that emotional processes, such as consistent worrying
over pain and cognitive evaluations, are the product of a human predisposition and can arguably
be considered as an evolutionary advantage, which was a behavioral process that was adapted in
order to solve problems. The study maintains that because of this evolutionary model, constant
worrying about pain and its implications is an evolutionary problem solving strategy, but is
additionally a factor that can have negative long-term consequences on physical rehabilitation,
due to previously discussed knowledge that persistent fear-avoidance behavior may contribute to
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lower quality rehabilitation and less at home exercise adherence, which is responsible for a less
efficient physical rehabilitation (Linton 2011). Linton’s study produces Figure 3. (but will be
titled Figure 2. in this capstone project for chronological consistency) to provide a visual
representation of this explanation with an evolutionary explanation, titled the misdirected
problem-solving model.
Figure 2. The misdirected problem-solving model
An additional point on pain tolerance, is that there is a possible, theoretical link between
an increased pain tolerance and increased physical rehabilitation efficiency, due to the ability to
endure the pain in order to do more effective stretches, movements, activities, etc, as well as
being able to complete the movements for additional repetitions, sets, and duration.
Unfortunately, professional literature discussing this theory was unable to be found in order to be
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used to either verify, invalidate, or even discuss this possible link between pain tolerance and
physical rehabilitation.
Additional information is able to be reported again from Flanigan’s 2015 research study,
“Psychological Factors Affecting Rehabilitation and Outcomes Following Elective Orthopaedic
Surgery”, specifically on the psychological factors of optimism and self efficacy. To paraphrase
the study, it was found that there is a persistent connection between self-confidence, optimism,
and motivation to recover from injury, and orthopaedic surgical outcomes (Flanigan 2015). This
is an unsurprising and logical connection with minimal psychological background knowledge.
Flanigan provides an excellent explanation that can be paraphrased. The study notes that the
relationship between self confidence/optimism/motivation and task completion was first
explained by Bandura's theory of self-efficacy, with confidence, optimism, and motivation
having a strong association with a higher occurrence of both task completion in rehabilitation
and home exercise adherence (Flanigan 2015). With this information highlighted, a clear
understanding of the importance of self confidence, optimism, and behavior emerges; due to the
fact that it has been repeatedly demonstrated that patients with higher rates of task completion in
rehabilitation and higher home exercise adherence have a much greater injury recovery rate.
Figure 2. of Flanigan’s study provides a visual diagram (but will be titled Figure 3. in this
capstone project for chronological consistency), to allow for a better understanding of how the
effects of low self confidence, pessimism, and low motivation affects physical rehabilitation.
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Figure 3. Conceptual diagram of low perceived self-efficacy and pessimism as personality traits that negatively
influence rehabilitation quality and surgical outcomes. (Flanigan 2015)
Another psychological factor with a significant effect on the efficiency of physical
rehabilitation is stress. Within Linton’s study, the stress diathesis model is discussed. According
to this study, this model, the stress diathesis model suggests that when an individual who is
already under significant psychological stress or whose coping resources are already stretched
thin, experiences significant physical pain, that pain may result in more significant functional
limitations and generate higher levels of emotional distress, than the average person experiencing
normal levels of stress and with a healthy amount of coping mechanisms. (Linton 2011). This
psychological factor appears to potentially have a clear and severe effect on physical
rehabilitation. However, according to Flanigan, the current literature suggests that the magnitude
of improvement may actually be similar among distressed and nondistressed patients (Flanigan
2015). At first, this is a confusing and counterintuitive finding. However, the magnitude of
improvement strictly refers to the amount of improvement achieved throughout the course of
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physical rehabilitation. Most patients generally improve from a very poor physical state to at
least a close to normal physical state due to their therapy, regardless of stress levels. The
significance of stress levels on physical rehabilitation is that stress levels will affect the
efficiency of physical rehabilitation, as well as affecting the difficulty level of improvement.
Individuals with higher stress levels will struggle with improvement, and take a longer amount of
time to improve, but will eventually reach the same magnitude of improvement similar to those
with normal stress levels.
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Section 2: Opinions of Health Professionals
I.
Introduction
A literature review, performed in the previous section, provided a plethora of information
specifically from the scientific community. However, in order to solidify a more well rounded
understanding on the topic, the perspective of healthcare professionals is vital. Another
comprehensive evaluation of the role of psychological factors on the efficiency of physical
rehabilitation from health care workers unnecessary. that there will be a relative similarity of
opinion between health care professionals and the previously discussed scientific community, so
a thorough research survey isn’t necessary, but a simple survey of health professionals is. This
survey will only gather three points of data, the participant’s profession, the participant’s opinion
whether or not psychological factors have an effect on physical rehabilitation, and the personal
and professional justification for their previous answer.
II.
Methods
To specifically gauge the opinions of health professionals, in contrast to the scientific
community’s opinions gathered in the literature review, a concise survey was conducted with the
specific purpose of briefly examining a diverse health professional population’s opinion of the
role of psychological factors on the efficiency of physical rehabilitation.
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The same survey was given to all willing participants and was worded in the same exact
way, and the participants were recruited with the attempt to both survey a diverse population of
health professionals, in terms of occupation, and to obtain a large sample size. The survey
request was given as follows:
“Hello [Participant],
My name is Timothy Joy, a senior baccalaureate honors program student at Rider
University completing my capstone project. Within my BHP Senior Capstone Project at Rider
University, specifically examining the possible effects of psychological factors on the efficiency
of physical rehabilitation, I am conducting a concise survey to gauge the opinion of health
professionals on the topic. I genuinely would appreciate a response for this quick survey, but it is
of course optional. No information, other than the information provided in the following two
questions, will be given in the project.
What is your profession?
Do you believe that psychological factors have at least a small to moderate effect on the
efficiency of physical rehabilitation? Additionally, provide a short justification for the answer.
Thank you for your consideration! An additional, and again, completely optional, request would
be to forward this short survey to other health professionals and have them contact me at
joyti@rider.edu. If interested, I would be happy to send the finished project after its completion.
Thank you,
Timothy Joy
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The first question, the request for the profession, simply allows for a knowledge of the
participant’s profession in order for personal assurance that their survey question answers are
coming from a healthcare professional, as well as being able to potentially view any specific
profession’s answers to a question for analysis purposes. This survey allows for us to gauge the
opinions of health professionals over whether or not psychological factors have an effect on
physical rehabilitation, with these answers being able to be contrasted with the scientific
community’s opinion on the topic, which was gathered in the literature review. And lastly, this
survey also provides the participant’s personal and professional justification for their previous
answer, which can be analyzed by profession as well, as well as simply gathering more
information on the topic.
III.
Results
As mentioned earlier, the two objectives of the survey were to concisely gather
information from a large and diverse group of health professionals regarding the topic of this
capstone project. To discuss the diversity of the participants, without revealing any identities,
some of the professions of the participants were: athletic trainers, chiropractors, physical
therapists, nurse practitioners, public health professionals and professors, health science
internship coordinators, occupational therapists, physicians assistant graduate students, physical
therapy graduate students, registered nurses, and health/wellness & physical education
pedagogists. It should be noted that about half of the participants were university professors of
The diversity within these participants is certainly satisfactory, and it can be comfortably
concluded that the diversity of these participants allows for a definitive conclusion from all sides
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of the health professional community, rather than just a possibly biased subsector of the health
professional community. The diversity of the participants in terms of occupation was critical, and
has thankfully been maintained for the survey’s legitimacy.
The survey has provided an unique perspective from fifteen health professionals, and
from the survey an educated opinion of these individuals emerges regarding the existence of the
effectiveness of psychological factors on physical rehabilitation. Unsurprisingly, an unanimous
agreement towards the existence of the phenomena emerged from each of the individual
responses to the survey. Figure 4. shows the 100% frequency rate of agreeing.
Figure 4. Percentage Agreeance/Disagreeance of the Participants on Psychological Factors Affecting the
Efficiency of Physical Rehabilitation
Within each individual response of the survey, where every participant agreed that
psychological factors affect the efficiency of rehabilitation, lies a justification for their position
on the topic, which has been provided in Chart 1. For brevity, the justifications will not be
repeated, and the implications and discussion of these justifications will be discussed within the
next part, the conclusion.
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Chart 1. Individual justifications for stating that physical rehabilitation is affected by psychological factors
Profession
Justification
Athletic Trainer & Health
Science Professor
Focus, attention, belief in a successful outcome can all be negatively
affected.
Chiropractor
Pain perception affects muscle tension
Physical Therapist
Musculoskeletal rehabilitation is greatly influenced by pain perception
Nurse Practitioner & DNP
Program Director
Strong Mind Body Connection
Physical Therapist
State of Mind Affecting tension and stress, focusing on pain rather than
progress
Health/Wellness &
Physical Education
Pedagogist
Psychoneuroimmunology, psychoneurology - support that the lateralization
and localization of domain phenomena, neurodevelopment, neuroplasticity
Public Health Professional
and Professor
Significant Effects of the Cortisol and Stress Correlation
Health Science Internship
Coordinator
CNS effect of muscle tonicity, brain's ability to modulate rating of perceived
pain centrally
Occupational Therapist
Patient's psychological toughness can positively or negatively affect
progress
Physician's Assistant
Graduate Student
Effect of stress on muscular rebuilding
Registered Nurse
Rehabilitation efficiency is partially determined by motivational factors
Physical therapy graduate
student
Psychological factors are imperative towards habit building
IV.
Conclusion
The two arguably biggest takeaways from the results of this survey are the 100%
frequency rate of agreeing that psychological factors have an effect on the efficiency of physical
rehabilitation among all of the participants, and the individual justifications for each. The fact
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that all of the health professionals agreed that psychological factors affect physical rehabilitation,
with a statistical agreeance of 100%, can lead to a generalization that every health professional,
or 100% of those who are asked, would also agree. This an irresponsible assumption, particularly
because the sample size is quite low, however, the deduction could be made that a
overwhelmingly large majority of health professionals would agree that psychological factors
have an effect on the efficiency of physical rehabilitation. This conclusion mirrors the near
unanimous opinion from the scientific community, which was gathered in the previous section. It
can be concluded that both the scientific and health professional communities essentially
unanimously agree that psychological factors have an effect on the efficiency of physical
rehabilitation, which satisfies the primary purpose for completing the survey. The individual
justifications for the agreeing to the phenomena, provided in Chart 1. are of interest as well.
Although there are not any particularly notable differences of the justifications between the
varying health professionals, there are two points of interest. Firstly, each health professional
provided a different justification, at least semantically. Even disregarding semantics, there is still
a significant variation within the individual justifications of the participants. The second
interesting note is that generally, the responses cover the various different ways that
psychological factors affect the efficiency of physical rehabilitation discussed in the previous
section. For example, the justification that, “the state of mind affects tension and stress - focusing
on pain rather than progress” was directly discussed. However, an additional benefit from the
survey was the collection of previously undiscussed justifications or explanations for the
existence of the phenomena, such as the justification that the, “[the fields of]
psychoneuroimmunology [and] psychoneurology support that lateralization and localization of
domain phenomena, neurodevelopment, [and] neuroplasticity”. While scientific literature
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discussing this justification was not discussed, and this specific phenomena was not found within
the research process of the capstone project, this justification is undoubtedly accurate due to the
Health/Wellness & Physical Education Pedagogist’s experience, and further justifies the notion
that there are dozens of psychological factors that could affect the efficiency of physical
rehabilitation, and there are far more factors than the several discussed within this capstone
project. The specific justification could be researched further in a different study.
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Section 3: Concluding Discussions
I.
Literature and Survey Conclusion
Ultimately, this capstone project has fulfilled many different objectives. Firstly, it is now
understood, without any reasonable doubt, that psychological factors certainly play a small to
moderate role in the efficiency of physical rehabilitation firstly proven by the collection of a
large amount of scientific evidence, then proven by the collection of evidence from health
professionals via a survey in a later section within the project. The determination of the extent of
this phenomena is essentially impossible to calculate, due to the great variations within the
injury, injury severity, the different effects of psychological factors, and the diversity of
individual’s responses towards different factors. However, in place of an explanation of extent,
the following section provided multiple explanations of how different psychological factors, such
as fear-avoidance behaviors, pain tolerance, optimism and self efficacy, and stress affect the
efficiency of physical rehabilitation. These explanations were further corroborated by the
surveyed health professionals in Section 2, with the provided justifications reinforcing the
previously discussed findings from the literature review and additionally providing some new
possible explanations as well. Overall, this capstone project was an excellent summation of the
effect of psychological factors on the efficiency of physical rehabilitation, proving its existence,
and providing multiple explanations that provide further credence as well as further insight into
how this knowledge can be implemented to further improve the efficiency of physical
rehabilitation.
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Incorporation Methods Into Treatment
With the information discussed in this capstone project, incorporating new procedures
with psychological factors in consideration is in physical rehabilitation treatment plans is
imperative. However, the logistics of this incorporation has been undiscussed and is necessary to
understand in order for the practical implementation of this information, and to fully utilize the
benefits of using psychological factors to the advantage of both the therapist and patient. n entire
comprehensive cognitive behavioral therapy intervention is not necessary for physical
rehabilitation treatments, however, some aspects of the cognitive behavioral process should be
implemented. According to Bosco Francisco Soares’ report, “Psychological Factors Affecting
Physical Disorders Part 2: A General Approach to Treatment” there are 3 important phases of
cognitive behavioral therapy; the psychoeducational phase, the skill building phase, and the
application phase. Physical rehabilitation can be split into 3 phases to mirror these phases.
Soares’ article suggests that during the psychoeducational phase, some important concepts like
the mind-body connection and pain-stress cycle, as well as concepts discussed in this capstone
project, particularly in the “How Psychological Factors Affect Physical Rehabilitation”, should
be introduced to the individual (Soares 2014). The personal recommendation is to have these
concepts be introduced in conjunction with the foundational concepts first introduced at the
beginning of a physical rehabilitation treatment program. Soares continues with describing the
next portion of the program, with the second phase of cognitive behavioral therapy being the
skill building phase. This phase consists of assisting the individual with their cognitive and
behavioral strategy development in order to identify negative psychological factors and to
�Rider University Baccalaureate Honors Program Capstone
Joy 24
counteract them with positive coping alternatives that will allow them regain self-control and
self-adaptation, ultimately increasing the efficiency of physical rehabilitation (Soares 2014).
Lastly from Soares, the application phase is the final step of cognitive behavioral therapy,
consisting of an application of the cognitive behavioral techniques and skills developed
throughout the cognitive behavioral therapy (Soares 2014). And as it can be easily seen, these
phases of cognitive behavioral therapy mirror a similar treatment pattern from physical
rehabilitation, as both therapy programs have identical phases, as these phases are essentially the
phases of the most effective learning programs. Because of these essentially identical phases
within both programs, implementing a cognitive behavioral program with the psychological
factors in mind is surprisingly simple. The key is to implement each phase of the cognitive
behavioral therapy within the corresponding phase in physical rehabilitation for the most optimal
results.
�Rider University Baccalaureate Honors Program Capstone
Joy 25
References
Flanigan, D. C., Everhart, J. S., & Glassman, A. H. (2015, September). Psychological
Factors Affecting Rehabilitation and Outcomes Following Elective Orthopaedic Surgery.
Retrieved April 6, 2021, from
https://journals.lww.com/jaaos/fulltext/2015/09000/psychological_factors_affecting_rehabi
litation_and.6.aspx
Gillen, R., Tennen, H., McKee, T., Gernert-Dott, P., & Affleck, G. (2002, May 25).
Depressive symptoms and history of depression predict rehabilitation efficiency in stroke
patients. Retrieved April 4, 2021, from
https://www.sciencedirect.com/science/article/pii/S0003999301699490
Kox, M., Van Eijk, L., Zwaag, J., Van den Wildenberg, J., Sweep, F., Van der Hoeven, J., &
Pickkers, P. (2014, May 20). Voluntary activation of the sympathetic nervous system and
attenuation of the innate immune response in humans. Retrieved February 03, 2021, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034215/
McNevin, N. H., Wulf, G., & Carlson, C. (2000, April 1). Effects of Attentional Focus,
Self-Control, and Dyad Training on Motor Learning: Implications for Physical
Rehabilitation. Retrieved April 4, 2021, from
https://academic.oup.com/ptj/article/80/4/373/2842445?login=true#190631603
�Rider University Baccalaureate Honors Program Capstone
Joy 26
Morris, J., Oliver, T., Kroll, T., & Macgillivray, S. (2011, September 11). The importance
of psychological and social factors in influencing the uptake and maintenance of physical
activity after stroke: A structured review of the empirical literature. Retrieved April 14,
2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170904/
Linton, S. J., & Shaw, W. S. (2011, May 01). Impact of Psychological Factors in the
Experience of Pain. Retrieved April 4, 2021, from
https://academic.oup.com/ptj/article/91/5/700/2735743
Soares, A., & 20, O. (2014, September 20). Psychological factors Affecting physical
Disorders Part 2: A general approach to treatment. Retrieved April 1, 2021, from
https://now.aapmr.org/psychological-factors-affecting-physical-disorders-part-2/
Walter, N., Nikoleizig, L., & Alfermann, D. (2019, June 19). Effects of Self-talk training on
Competitive anxiety, self-efficacy, Volitional skills, and PERFORMANCE: An
intervention study with junior Sub-Elite Athletes. Retrieved February 02, 2021, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628429/
Walton, C., Keegan, R., Martin, M., & Hallock, H. (2018, July 3). The potential role for
cognitive training in sport: More research needed. Retrieved February 02, 2021, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6037849/
�
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Baccalaureate Honors Program (BHP) Capstones
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Effectiveness of Psychological Factors in Physical Rehabilitation
Publisher
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Rider University
Contributor
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Guers, John
Relation
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Baccalaureate Honors Program
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Adobe Acrobat PDF
Language
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English
Type
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Capstone
Description
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The field of physical rehabilitation has exploded over the last 50 years, with an increased understanding of anatomy, exercise physiology, kinesiology, therapy, etc. revolutionizing the field. A relatively under discussed topic with an arguably substantial effect on physical rehabilitation is psychology. An entire field of psychology, sport psychology, primarily focuses the effects of psychological principles on sport performance. There is an undeniable role of psychology in physical performance; certain psychological factors can massively impact physical performance, for better or for worse. A logical deduction would be that the same effect of psychological factors could possibly be applied towards the efficiency of physical rehabilitation, but substantial research would be required to substantiate this possibility. In line with this specific research, in a groundbreaking research study, it was found possible that the voluntary activation of the sympathetic nervous system via training of mediation, breathwork, and cold exposure can result in epinephrine release and subsequent suppression of the innate immune response in humans in vivo (Kox 2014). This study has numerous major implications regarding possible alternative factors that could affect the efficiency of physical rehabilitation. From this study, the question arises whether or not exercises such as meditation, breathwork, and cold exposure, which primarily affect the mindset of an individual, affect the efficiency of physical rehabilitation. The consistent performance of meditation, breathwork, cold exposure, and other similar practices may influence or change thought processes in reaction to stimuli through the rewiring of neural pathways. Ultimately, to rephrase the question, does an individual’s mindset have an effect on the efficiency of their physical rehabilitation, and if so, to what extent? The question of why, or why not does this phenomenon occur, arises as well. The questions can extend beyond causal factors, an additional question could be asked whether or not the mindset of an individual be trained and developed in order for an increased efficiency of their physical rehabilitation? Through a thorough background literature review, a more definitive viewpoint on the topic specifically from the viewpoint of various sources from the scientific community will be established. Based on prior research, it can be hypothesized that various exercises that alter an individual’s mindset, and therefore the mindset of an individual, can affect the efficiency of their physical rehabilitation, which can be developed and trained. This hypothesis will be verified with a literature review, then a concise study will be conducted in order to get a perspective on the topic from health professionals specifically, with this capstone project being concluded with a final discussion.
Creator
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Joy, Timothy
Subject
The topic of the resource
Rehabilitation--Psychological aspects