A Sport Medicine Clinician’s Guide to Improving Patient Adherence through Tenets of Social Cognitive Theory
Main Article Content
Abstract
Patient adherence to rehabilitation, whether following an injury or surgery, is crucial for successful clinical outcomes; unfortunately, adherence is often low. Theory-based interventions have been studied to improve the adherence problem, indicating that a more intentional, theoretically-grounded, practical approach may enhance clinicians’ abilities to promote their patients’ holistic well-being. Among the theories applicable to rehabilitation, Social Cognitive Theory (SCT) has demonstrated success in increasing patient adherence to rehabilitation –a variable critical to achieving successful rehabilitation outcomes and maintaining the patient’s overall health. Conceptually nested within SCT, two key frameworks that have been used to influence adherence are A) Triadic Reciprocal Determinism, and B) Self-Efficacy. The purpose of this paper is to review literature related to SCT and these two frameworks to detail their importance in promoting adherence, with an emphasis on practical, theoretically-based strategies. Thus, findings were compiled to create a guide for sports medicine clinicians to incorporate SCT into their practice. Through applying this guidance, improved patient self-efficacy and adherence to rehabilitation can be feasibly accomplished by sports medicine clinicians in an intentional, evidence-based approach (e.g., through goal setting, use of positive role models, avoiding empty praise, and enhancing social support.)
Keywords:
Social Cognitive Theory, Self-Efficacy, Adherence, Rehabilitation
Article Details
How to Cite
PICHA, Kelsey J.; DISANTI, Justin S.; UHL, Timothy.
A Sport Medicine Clinician’s Guide to Improving Patient Adherence through Tenets of Social Cognitive Theory.
Medical Research Archives, [S.l.], v. 13, n. 8, aug. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6846>. Date accessed: 14 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i8.6846.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Holt NL, Neely KC, Slater LG, et al. A grounded theory of positive youth development through sport based on results from a qualitative meta-study. Int Rev Sport Exerc Psychol. Jan 1 2017;10(1):1-49. doi:10.1080/1750984X.2016.1180704
3. Burt CW, Overpeck MD. Emergency visits for sports-related injuries. Ann Emerg Med. Mar 2001; 37(3):301-8. doi:10.1067/mem.2001.111707
4. 2006-2007 High School Athletic Participation Survey. Accessed 10/3/07.
http://www.nfhs.org/core/contentmanager/uploads/2006-07_Participation_Survey.pdf
5. Kay TM, Gross A, Goldsmith CH, et al. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2012;8:CD004250. doi:10.1002/1465185 8.CD004250.pub4
6. Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Database Syst Rev. 2008;4(CD004376)
7. Fuentes J, Armijo Olivo S, Magee D, Gross D. Effects of exercise therapy on endogenous pain-relieving peptides in musculoskeletal pain- a systematic review. Clin J Pain. 2011;27:365-374.
8. Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther. Jun 2010;15(3):220-8. doi:10.1016/j.math.2009.1 2.004
9. Sluijs EM, Kok GJ, van der Zee J. Correlates of exercise compliance in physical therapy. Phys Ther. Nov 1993;73(11):771-82; discussion 783-6.
10. Kolt GS, McEvoy JF. Adherence to rehabilitation in patients with low back pain. Man Ther. May 2003; 8(2):110-6.
11. Clement D, Granquist MD, Arvinen-Barrow MM. Psychosocial aspects of athletic injuries as perceived by athletic trainers. J Athl Train. Jul-Aug 2013;48(4):512-21. doi:10.4085/1062-6050-48.3.21
12. Truong LK, Mosewich AD, Holt CJ, Le CY, Miciak M, Whittaker JL. Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review. Br J Sports Med. Feb 14 2020;doi:10.1136/bjsports-2019-101206
13. Sciascia A. Prospective assessment of return to pre-injured levels of activity. Theses and Dissertations--Rehabilitation Sciences. University of Kentucky; 2016. https://uknowledge.uky.edu/rehabsci_etds/34
14. Paterno MV, Schmitt LC, Thomas S, Duke N, Russo R, Quatman-Yates CC. Patient and Parent Perceptions of Rehabilitation Factors That Influence Outcomes After Anterior Cruciate Ligament Reconstruction and Clearance to Return to Sport in Adolescents and Young Adults. J Orthop Sports Phys Ther. Aug 2019;49(8):576-583. doi:10.2519/jo spt.2019.8608
15. Brewer B, Cornelius A, Van Raalte J, et al. Protection motivation theory and adherence to sport injury rehabilitation revisited. The Sport Psychol. 2003;17:95-103.
16. Rajati F, Sadeghi M, Feizi A, Sharifirad G, Hasandokht T, Mostafavi F. Self-efficacy strategies to improve exercise in patients with heart failure: A systematic review. ARYA Atheroscler. Nov 2014; 10(6):319-33.
17. Evans L, Hardy L. Injury rehabilitation: a goal-setting intervention study. Res Q Exerc Sport. Sep 2002;73(3):310-9. doi:10.1080/02701367.2002.10 609025
18. Coppack RJ, Kristensen J, Karageorghis CI. Use of a goal setting intervention to increase adherence to low back pain rehabilitation: a randomized controlled trial. Clin Rehabil. Nov 2012;26(11):1032-42. doi:10.1177/0269215512436613
19. Millen JA, Bray SR. Promoting self-efficacy and outcome expectations to enable adherence to resistance training after cardiac rehabilitation. J Cardiovasc Nurs. Jul-Aug 2009;24(4):316-27. doi:10.1097/JCN.0b013e3181a0d256
20. Mendonza M, Patel H, Bassett S. Influences of psychological factors and rehabilitation adherence on the outcome post anterior cruciate ligament injury/surgical reconstruction. NZ J of Physio. 2007; 35(2):62-71.
21. Levy AR, Polman RCJ, Clough PJ. Adherence to sport injury rehabilitation programs: an integrated psycho-social approach. Scandinavian Journal of Medicine & Science in Sports. 2008;18(6):798-809.
22. Sirur R, Richardson J, Wishart L, Hanna S. The role of theory in increasing adherence to prescribed practice. Physiother Can. Spring 2009;61(2):68-77. doi:10.3138/physio.61.2.68
23. Hammer C, Degerfeldt L, Denison E. Mechanical diagnosis and therapy in back pain: Compliance and social cognitive theory. Adv Physiother. 2007; 9:190-197.
24. Bandura A. Health promotion from the perspective of social cognitive theory Harwood Academic Publishers; 2000.
25. Bailey DL, Holden MA, Foster NE, Quicke JG, Haywood KL, Bishop A. Defining adherence to therapeutic exercise for musculoskeletal pain: a systematic review. Br J Sports Med. Mar 2020;
54(6):326-331. doi:10.1136/bjsports-2017-098742
26. Pajares F. Overview of social cognitive theory and of self-efficacy. Accessed June 11th, 2017, http://www.emory.edu/EDUCATION/mfp/eff.html
27. Bandura A. Social foundations of thought and action: A social cognitive theory. Prentice Hall; 1986.
28. Bandura A. The evolution of social cognitive theory. Great minds in management. Oxford University Press; 2005.
29. Bandura A. Social cognitive theory: An agentic perspective Asian J of Social Psychology. 1999;2: 21-41.
30. DiSanti J, Lisee C, Erickson K, Bell D, Shingles M, Kuenze C. Perceptions of Rehabilitation and Return to Sport Among High School Athletes With Anterior Cruciate Ligament Reconstruction: A Qualitative Research Study. J Orthop Sports Phys Ther. Dec 2018;48(12):951-959. doi:10.2519/josp t.2018.8277
31. Bandura A. Human agency in social cognitive theory. Am Psychol. Sep 1989;44(9):1175-84.
32. Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001;52:1-26. doi:10.1146/annurev.psych.52.1.1
33. Brinkman C, Baez SE, Genoese F, Hoch JM. Use of goal setting to enhance self-efficacy after sports-related injury: a critically appraised topic. Journal of sport rehabilitation. 2019;1(aop):1-5.
34. Lisee C, DiSanti J, Chan M, et al. Gender differences in psychological responses to recovery following ACL reconstruction before return to sport. J Athl Train 2020;
35. Bandura A. Self-Efficacy Encyclopedia of Human Behavior. New York Academic Press; 1994. p. 71-81.
36. Bandura A. Self-efficacy: the exercise of control. Freeman; 1997.
37. Everhart JS, Best TM, Flanigan DC. Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc. Mar 2015;23(3):752-62. doi:10.1007/s00167-013-2699-1
38. Bandura A. Self-efficacy-toward a unifying theory of behavioral change. Psychological Review. 1977;84 191-215.
39. Heslin PA, Klehe UC. Self-efficacy. In: Rogelberg SG, editor. Encyclopedia of Industrial/Organizational Psychology. Thousand Oaks: Sage; 2006. p. 705-708.
40. Pajares F. Self-efficacy beliefs of adolescents. vol 5. Self-efficacy during childhood and adolescence. Information Age Publishing; 2006.
41. Maddux J. Self-efficacy, adaptation, and adjustment: theory, reserach, and application. Plenum Press; 1995.
42. Shirzad N, Van der Loos HF. Adaptation of task difficulty in rehabilitation exercises based on the user's motor performance and physiological responses. IEEE Int Conf Rehabil Robot. Jun 2013; 2013:6650429. doi:10.1109/ICORR.2013.6650429
43. Pineau TR, Glass CR, Kaufman KA, Bernal DR. Self-and team-efficacy beliefs of rowers and their relation to mindfulness and flow. Journal of Clinical Sport Psychology. 2014;8(2):142-158.
44. Kaplan RM, Atkins CJ, Reinsch S. Specific efficacy expectations mediate exercise compliance in patients with COPD. Health Psychol. 1984;3(3): 223-42.
45. Stacey FG, James EL, Chapman K, Courneya KS, Lubans DR. A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors. J Cancer Surviv. Jun 2015;9 (2):305-38. doi:10.1007/s11764-014-0413-z
46. Pozehl B, Duncan K, Hertzog M, Norman JF. Heart Failure Exercise And Training Camp: effects of a multicomponent exercise training intervention in patients with heart failure. Heart Lung. Nov-Dec 2010;39(6 Suppl):S1-13. doi:10.1016/j.hrtlng.201 0.04.008
47. Thomee P, Wahrborg P, Borjesson M, Thomee R, Eriksson BI, Karlsson J. Determinants of self-efficacy in the rehabilitation of patients with anterior cruciate ligament injury. J Rehabil Med. Jul 2007; 39(6):486-92. doi:10.2340/16501977-0079
48. Ardern CL, Taylor NF, Feller JA, Webster KE. A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med. Nov 2013;47(17):1120-6. doi:10.1136/bjsports-2012-091203
49. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice. 2016/ 07/03 2016;32(5):332-355. doi:10.1080/0959398 5.2016.1194646
50. Menezes Costa L, Maher C, McAuley J, Hancock M, Smeets R. Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain. Eur J Pain. 2011;15:213-219.
51. Chen HM, Wang HH, Chen CH, Hu HM. Effectiveness of a stretching exercise program on low back pain and exercise self-efficacy among nurses in Taiwan: a randomized clinical trial. Pain Manag Nurs. Mar 2014;15(1):283-91. doi:10.1016/j.pmn.2 012.10.003
52. Gucciardi DF, Gordon S. Construing the Athlete and Exerciser: Research and Applied Perspectives from Personal Construct Psychology. Journal of Applied Sport Psychology. 2009/05/12 2009;21 (sup1):S17-S33. doi:10.1080/10413200802582821
53. Gohner W, Schlicht W. Preventing chronic back pain: evaluation of a theory-based cognitive-behavioural training programme for patients with subacute back pain. Patient Educ Couns. Dec 2006; 64(1-3):87-95. doi:10.1016/j.pec.2005.11.018
54. Storheim K, Brox JI, Holm I, Koller AK, Bo K. Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomized controlled trial. J Rehabil Med. May 2003;35(3):132-40.
55. Vong SK, Cheing GL, Chan F, So EM, Chan CC. Motivational enhancement therapy in addition to physical therapy improves motivational factors and treatment outcomes in people with low back pain: a randomized controlled trial. Arch Phys Med Rehabil. Feb 2011;92(2):176-83. doi:10.1016/j.ap mr.2010.10.016
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