The Role of Psychological Facilitators and Barriers to Therapeutic Engagement in Acute, Inpatient Rehabilitation

Objective: Lequerica and Kortte (2010) proposed a model of therapeutic engagement in rehabilitation that indicates there are facilitators and barriers to an individual's engagement in rehabilitation. The current study examines potential personal variables that may play a role in rehabilitation engagement. Design: In this prospective cohort design, 206 adults from 3 inpatient acute rehabilitation hospitals completed the Hopkins Rehabilitation Engagement Rating Scale, Hope Scale, Benefit Finding Scale, Positive and Negative Affect Schedule, Brief Symptom Inventory, and Denial of Illness Scale. Results: Among potential facilitators (hope, benefit-finding, positive affect), positive affect was the only variable that accounted for a significant variance (beta = .24, p < .01) in rehabilitation engagement. Among potential barriers (depressive symptoms, negative affect, denial of illness), only denial of illness accounted for a significant variance (beta = -.24, p < .01) in rehabilitation engagement. Conclusions: The present findings suggest that specific facilitators (positive affect) and barriers (denial of illness) relate to therapeutic engagement in rehabilitation. Interventions that increase positive affect and address denial of illness may provide novel avenues to increase therapeutic engagement. Impact and Implications The current study is among the first to examine the relationships between a number of facilitator variables (i.e., hope, benefit finding, and positive affect) and barrier variables (i.e., negative affect, depression, and denial of illness) with therapeutic engagement in acute, inpatient rehabilitation. Identification of psychological facilitators and barriers that play a role in the rehabilitation engagement process may help in the development of novel interventions to bolster an individual's engagement and overall outcome. This study demonstrates the importance of specific facilitator and barrier variables (i.e., positive affect and denial of illness) in rehabilitation engagement. Clinical interventions, as well as preventative efforts, that increase positive affect and reduce or resolve denial of illness could help optimize engagement during recovery processes and improve rehabilitation outcomes.