Introduction: Why interaction styles matter in physiotherapy
Healthcare professionals (HCPs) who interact with people living with chronic diseases can significantly influence patients’ motivation, engagement, and self-management. In physiotherapy, where patients rely on guidance to sustain long-term health behaviors, the way therapists communicate and support needs matters as much as technical skill. Self-Determination Theory (SDT) provides a robust framework to understand and shape these interactions by focusing on three basic psychological needs: autonomy, competence, and relatedness. Conceptually, SDT distinguishes four interaction styles: autonomy-support and structure (motivating) and control and chaos (demotivating). The present study investigates whether an SDT-based module embedded in physiotherapy education can shift students’ interaction styles toward more need-supportive approaches.
What the study aimed to uncover
The primary outcome was the (de)motivating interaction styles of physiotherapy students. Secondary outcomes included SDT-based beliefs and self-management support competencies (the 5As model: assess, advise, agree, assist, arrange). By comparing an SDT-based module with standard education, researchers sought to determine if theory-informed training translates into observable changes in future clinicians’ practice-oriented beliefs and skills.
The SDT-based module: structure and delivery
The intervention was embedded in the first-year master’s program at two Belgian universities using a nonequivalent pre-test/post-test control group design. The intervention group engaged in a theory-rich component—covering SDT alongside social cognitive theory and related models—followed by a practice-oriented segment emphasizing self-reflection and peer feedback. Students filmed two treatment sessions (or role-plays) and used the COUNSEL-CCE tool to assess need-supportive versus need-thwarting behaviors. A structured reflection cycle by Korthagen and Vasalos guided deeper learning. In wave 2, the theoretical component was delivered via an online learning path, with participation still mandatory. The control group received no SDT-specific training, though internship feedback and CanMEDS communication roles were part of their experience.
How outcomes were measured
All measures were self-reported Dutch questionnaires. The primary outcome used the SIS-HCP, a vignette-based instrument calibrated for physiotherapy contexts to gauge interaction styles. Secondary outcomes assessed SDT-based beliefs (effectiveness and feasibility of SDT strategies) and self-management support competencies using the SEPSS-36, which covers six subscales aligned with the 5As model. Reliability was established in prior work, with omega values indicating good internal consistency across time points.
Key findings: what changed with the SDT module
The quasi-experimental analysis showed positive Group*Time effects for several outcomes. Notably, the intervention group increased autonomy-support, indicating more meaningful choices and inviting language in patient interactions. While structuring style also trended upward for the intervention group, this effect was only marginal after correcting for multiple tests. More striking were reductions in demotivating styles—control and chaos—among students who received the SDT-based module, compared with the control group, which tended to report increased demotivating interactions over time. These results point to the module’s potential to cultivate a more supportive clinical mindset that can enhance patient motivation and adherence to rehabilitation plans.
Secondary outcomes also reflected gains: effectiveness beliefs about SDT-based strategies improved, and self-management support self-efficacy and performance—especially in the assess and overall competence subscales—rose in the intervention group. Feasibility beliefs and some performance subscales did not show the same clear Group*Time effects; however, overall patterns suggested that education in SDT can translate into more confident and capable future physiotherapists.
Strengths, limitations, and implications for practice
A notable strength is grounding the intervention in a well-established theory with explicit links to patient motivation and behavior change. The study also included a robust baseline measurement, which clarified changes over time. Limitations include reliance on self-reported data, non-randomized group allocation, and a relatively short follow-up period. The context involved only two universities, which may limit generalizability to other health professions or settings. Nevertheless, findings support integrating SDT-based modules into physiotherapy curricula to enhance interaction styles and self-management support competencies, potentially improving patient outcomes in chronic care management.
Practical takeaways for educators and programs
For educators, embedding SDT-based content early in training—coupled with reflective exercises, video-based practice, and structured feedback—can foster more autonomy-supportive interactions and reduce controlling, chaotic tendencies. The approach appears adaptable to online formats, which can broaden accessibility. To maximize impact, programs might ensure explicit attention to all SDT interaction styles and systematically link SDT concepts to the 5As framework for self-management support in clinical practice.
Conclusion: shaping the next generation of patient-centered physiotherapists
This study adds to the SDT-based literature by showing that theory-driven educational modules can meaningfully influence physiotherapy students’ interaction styles and confidence in delivering self-management support. While further research is needed to assess long-term effects and across broader professional contexts, integrating SDT into healthcare education represents a promising route to enhance patient motivation, adherence, and health outcomes in chronic disease management.
