5 Behavioural Economic Concepts to Improve Patient Outcomes

5 min read. Posted in Other
Written by Ann-Sophie De Backer info

The major focus in physical therapy usually lies on the hard skills. We can improve back pain by using manipulation techniques, optimize ACL rehab by using strength & conditioning principles etc. Unfortunately, we tend to forget about soft skills that will improve patient autonomy, engagement and experience, which are all important determinants of a positive treatment outcome.

In this blog, you’ll learn about 5 important concepts that will improve all of the above. And if you’re wondering why it is important to know and apply these concepts, think about this quote: “If we have a better understanding of the intrinsic motivations of our patients, we can then leverage those motivations to build self-efficacy, participation and better outcomes”.

This is a quote by Dr. Mike Studer, who made an excellent Masterclass about this topic HERE.


1. Nudge

You may have never heard of this concept before, but it is something that is being used in today’s world more than you can imagine. Nudge describes the phenomenon when choices are made more attractive by being more accessible, convenient, simple or more commonly chosen by peers. Consider these two options: you can either log in on a website by using touch-ID on your phone OR you have to use the URL, your username and password. Which one of these options sounds more attractive to you? Probably the first, right? By only having to use our finger, we save a lot of time and effort, which removes friction and makes it more convenient for us to make a decision.

This is exactly what nudge is about! There are multiple ways in which we can apply this to our physical therapy practice. From the accessibility of our clinic, to the opening hours, it’s critical to make sure they fit well for our patients. We can increase our patient’s physical activity level by giving exercise ‘snacks’ rather than whole programs, which they can perform anywhere and anytime so they literally don’t have an excuse not to do them! Exercise groups and apps with whole exercise videos are other examples of nudge.



2. Gamification

Gamification is all about making something attractive. Things like home exercise programs usually become a lot more fun when game-like elements or a certain level of competition is involved. By making it fun, you can distract patients to participate in something that would otherwise be less desirable to participate in. You can use personal records to keep your athlete shoulder patient motivated, count the days your elderly patient has gone without falling since starting physical therapy, have your patient wear a watch that tells them how many minutes of the day they’ve been active and so on.



3. Choice architecture

By making optimal use of choice architecture, we can influence the decisions our patients will make. One of the easiest ways to do this is by using the recency and primacy effect. The first and last options are remembered the most so if you want your patient to choose the options that are healthy or best for them, it is best to offer these first and/or last. You might ask a not so motivated elderly patient what they would like to focus on in today’s session: strength, flexibility, conditioning or stability.

By offering them multiple options and letting them choose, you’ll increase their motivation, autonomy and make them feel like they are in charge. By offering them in this sequence, the odds are likely that they will choose strength or stability, which you know is important to reduce fall risk in this population. Be careful not to go too crazy on options though. Choice burden or decision fatigue can arise when the number of options are too large, which can possibly make people reluctant from choosing anything at all.


4. Confirmation bias

Confirmation bias is the tendency to search for, interpret and recall information in a way that supports what we already believe. This can apply to physical therapy in a positive and a negative manner. If someone is convinced that doing home exercises will relieve their back pain because they’ve heard great stories from other people, chances are rather big that they will actually have a positive outcome.

However, if someone is truly convinced that turning their head will make them nauseous, they probably will become ill when turning their head. How? Confirmation bias can upregulate your sensory receptors and bias them to be more likely to seek out pain/dizziness/sense of urgency. Unwinding them is tricky but not impossible! In the latter example, it’s important that you let your patient know that you are hearing and understanding what they are saying but that you do want to include this movement to their exercise program in a way that doesn’t cause lasting dizziness so that their brain can learn how to become more comfortable with it again.



5. Familiarity bias

This other form of bias comprises the tendency to persist with something you know or have experienced due to the convenience of familiarity. Think about driving the same route to work each morning, even though there might be multiple possible options, buying the same brand of washing powder despite other/cheaper options, or also staying with the same physical therapist, despite not making much progress.

People are creatures of habit which can make change difficult. For example: you’ve started at a new clinic and are seeing a patient that’s been coming for years. He/she is used to getting a massage each and every time. They don’t get better, but enjoy it nevertheless. You can probably imagine that making them warm for another form of therapy will be hard.


Wrapping up

I hope you can see how these 5 concepts can be valuable in your physio practice. If you want to dive deeper and learn more about behavioral economics, I highly recommend you watch Mike Studer’s Masterclass on the topic HERE.

Want to level up your soft skills?

Mike Studer has done a Masterclass lecture series for us!

“The missing link in patient engagement: Behavioural economics and psychologically-informed techniques”

You can try Masterclass for FREE now with our 7-day trial!

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