Patient Empowerment

Introduction  [edit | edit source]

The intention of practising physiotherapists is to facilitate patients to gain long-term independence and sustainable function successfully, facilitating long-term independence is empowerment. Empowerment begins by recognising a patient’s powerlessness or sense of powerlessness. Lack of self-efficacy poses a challenge to the patient asking for help to manage their recovery. The suffering of those in need of healthcare and rehabilitation exemplifies this relationship between patient/client and physical therapists, which is where the facilitation of empowerment begins. Empowerment as a process requires self-mastery and the ability to transcend through suffering by challenging adversity.[1][2][3]

'Empowerment' as a patient/client trait escapes formal definition and clinical application. The suggestion is that empowerment is a multifactorial trait and layered state that relies on multiple concepts, which will be briefly described.

Empowerment Defined

Empowerment is thought to have four (4) dimensions: Meaning, competence, choice, and impact.[4] Choice may have the greatest impact on empowerment. The choice comes from realising there is a way through an obstacle, which allows the individual to forge through a specific challenge. The competence to follow through is pivotal after recognising the choice. Often a wavering competence and compromised internal locus of control are key obstacles to an impactful outcome. Self-efficacy and internal locus of control represent personal influence over the outcome, which reflects choice and competence. This indicates that self-efficacy is a prerequisite for empowerment.

Empowerment is the expansion of freedom of choice and action. It means increasing one’s authority and control over the resources and decisions that affect one’s life. When we exercise real choice, we gain increased control over our lives and can change ourselves.[5] Empowerment may be defined as a complex experience of personal change.[6] The empowerment process is the discovery and development of one’s inherent capacity to be responsible for one’s life.[7] Patient empowerment is helping patients discover and develop the inherent capacity to be responsible for one's own lives.[8]

Drivers of Patient Empowerment[edit | edit source]

Suffering[edit | edit source]

The patient/client in need, presenting to the clinic, may be experiencing a sense of suffering. Suffering is an existential frustration associated with an unavoidable experience threatening existence and loss of personal autonomy. A loss of personal autonomy is thought to be synonymous with a sense of powerlessness. Suffering can be defined as the state of severe distress associated with events that threaten the person's integrity, which induces the perception of impending destruction.[9] Additionally, suffering is commonly associated with pain. People in pain frequently report suffering when they feel it as chronic, dire, out of control, overwhelming, or unknown.[9] However, pain alone does not cause one to suffer. The perception of pain and how it demands more of the person than they can manage better defines the nature of suffering.[9][10] The implication is that the sense of suffering can become a driving and motivational force that enables empowerment.

Locus of Control[edit | edit source]

Powerlessness comes from a loss of internal or external locus of control. Internal locus of control is the perception of one’s control over personal competence and motivation.[11] Outside the parameters of the perception of personal competence and motivation is the external locus of control. A high internal locus of control is the foundation for creating intrinsic motivation that leads to self-efficacy. Competence, autonomy, and locus of control mediate intrinsic motivation and self-efficacy.[12]

Intrinsic Motivation[edit | edit source]

The perception of self-competency shapes intrinsic motivation. Self-competency begins with recognising that a new skill is needed to achieve a positive outcome.[13] Successful attempts and acquisition of new skills and task completion reinforce competency. The reinforcement and continued momentum fuel motivation, which remains a conscious decision to continue creating a cycle that proves to be autonomous.[14]

Self-efficacy[edit | edit source]

Self-efficacy is actualising one’s competency with their skillset to achieve established outcomes with reliance on interaction with their environment.[15] Self-efficacy is also An understanding of personal competence of control and locus of control. Self-efficacy takes active competency over what is perceived as controllable and resourceful to the person.  A locus of control establishes the outcome expectancy, while self-efficacy mobilises specific skills to accomplish the established outcome.

Therapeutic Alliance[edit | edit source]

The therapeutic alliance (TA) refers to a sense of collaboration, warmth, and support between a client and their practitioner. TA is associated with emotional flexibility, interpersonal communication, and trust.[16] Building trust through communication creates patient/practitioner collaboration and builds a relationship that inspires personal motivation toward the goals of therapy. The therapeutic alliance enables a motivating vicarious experience through the coaching and standards the physical therapist sets. Goal flexibility is centred around the patient's needs and allows for appropriate modifications that support those needs. TA enables the physical therapist to transfer knowledge and power to the patient/client and enables the patient to receive the shared knowledge and power.[17] Patient education emphasised empathy that is directed toward personal choices and ideas to help patient empowerment.  Click here to read further on therapeutic alliance.

Conclusion[edit | edit source]

Goal-directed physical therapy is insufficient for sustainable and comprehensive recovery.[16] Patient empowerment begins with patient education and ends with the patient's active participation in their physical therapy. Empowerment takes place with the transcendence and sustainable management of the patient’s impairment or dysfunction by the patient being given autonomy and authority over their rehabilitation and life.

Empowerment is complex and multidimensional. The Takeaway message is

  1. Self-efficacy is a prerequisite for empowerment.
  2. Engagement toward empowerment must explore areas outside of one's comfort zone.
  3. Choice and competence must be specifically directed to increase an internal locus of control and motivation
  4. Vicarious experiences offered by physical therapists and other patients reinforce self-efficacy and empowerment.
  5. Social support and reinforcement complete the transcendence of empowerment

Patient Interview[edit | edit source]

A patient/client interview was conducted to exemplify the complex nature of empowerment. The patient/client, Ellen, demonstrates empowerment through her resilience, self-efficacy, and positive mindset. Ellen exemplifies the importance of self-efficacy, established before her diagnosis of Parkinson's. Her commentary that she controls her diagnosis rather than the diagnosis controlling her reveals that sense of empowerment. Ellen was able to push outside of her comfort zone and engage in a HIIT/CrossFit research programme for patients/ clients with Parkinson's and Spinal Cord Injuries, which is conducted at the "Arkansas College of Health Education Physical Therapy Program". The variability and intensity of the programme, along with the group dynamic, reinforced Ellen's empowerment. The researchers handpicked this interviewee as someone who exemplifies empowerment.


Further Reading[edit | edit source]

Self-management Techniques to Enhance Physical Activity

Patient self-management tools

The OPTIMAL Theory

Lifestyle Medicine, Behavioural Modification and Self Care for Managing Low Back Pain

References[edit | edit source]

  1. Tedeschi RG, Calhoun LG. Posttraumatic growth: conceptual foundations and empirical evidence. Psychological Inquiry, 2014;15(1): 1-18.
  2. Walsh F. Traumatic loss and major disasters: Strengthening family and community resilience. Family Process, 2017; 46(2): 207-227.
  3. VanderWeele TJ. Suffering and response: Directions in empirical research. Social Science & Medicine, 2019; 224: 58-66.
  4. Spreitzer GM. Psychological empowerment in the workplace: Dimensions, measurement, and validation. Academy of Management Journal, 1995; 38(5): 1442-1465.
  5. Riva G, Gaggioli A, Gorini A, Carelli L, Repetto C, Algeri D, et al. Virtual reality as an empowering environment for personal change: the contribution of the applied technology for neuro-psychology laboratory. Anuario de psicología, 2009; 40(2):171-192.
  6. Aujoulat I, d’Hoore W, Deccache A. Patient empowerment in theory and practice: polysemy or cacophony? Patient Education and Counseling, 2007; 66(1): 13-20.
  7. Funnell MM, Anderson RM. Empowerment and self-management of diabetes. Clinical diabetes, 2004; 22(3): 123-128.
  8. Funnell, MM, Anderson, RM, Arnold MS, Barr PA, Donnelly MB, Johnson PD, et al. Empowerment: an idea whose time has come in diabetes education. Diabetes Educ. 1991; 17:37-41.
  9. 9.0 9.1 9.2 Cassell EJ. The nature of suffering and the goals of medicine. Loss, Grief & Care,1998; 8(1-2): 129-142.
  10. Trachsel, L. A., Munakomi, S., & Cascella, M. (2021). Pain theory. In StatPearls [Internet]. StatPearls Publishing.
  11. Ajzen I. Perceived Behavioral Control, Self-Efficacy, Locus of Control, and the Theory of Planned Behavior. Journal of applied psychology. 2002; 32(4): 665–683.
  12. Deci, EL, Ryan RM. The ‘‘what’’ and ‘‘why’’ of goal pursuits: human needs and the self-determination of behaviour. Psychol. Inquiry. 2000;11: 227–268. doi: 10.1207/S15327965PLI1104_01
  13. Deci EL, Ryan RM. Self-determination Theory: When Mind Mediates Behavior. The Journal of Mind and Behavior. 1980; 1(1): 33–43.
  14. Di Domenico SI, Ryan RM. The Emerging Neuroscience of Intrinsic Motivation: A New Frontier in Self-Determination Research. Frontiers in Human Neuroscience. 2017.
  15. Howland T, McGuire C. The development of intelligent behaviour III: Robert W. White. Psychology in the Schools. 2020; 5: 230–239.
  16. 16.0 16.1 Crom A, Paap D, Wijma A, Dijkstra PU. Pool G. Between the Lines: A Qualitative Phenomenological Analysis of the Therapeutic Alliance in Pediatric Physical Therapy. Physical & Occupational Therapy in Pediatrics. 2020; 40(1): 1–14.
  17. Unsgaard-Tondel M, Soderstrom S. Therapeutic Alliance: Patients’ Expectations Before and Experiences After Physical Therapy for Low Back Pain--A Qualitative Study With 6-Month Follow-Up. PTJ: Physical Therapy & Rehabilitation Journal. 2021;101(11):pzab187. doi: 10.1093/ptj/pzab187
  18. Active Hands Rogue Fitness Concept2, Inc. Patient Empowerment. Available from: [last accessed 13/8/2023]