The use of the Remotivation Process in an occupational therapy program for breast cancer-related lymphedema: A feasibility study
BACKGROUND: Lymphedema affects a significant number of women with breast cancer. It affects a woman's occupational performance and adaptation, and quality of life. Self-Management Programs (SMP) have been utilized for the long-term management of breast cancer-related lymphedema. The SMP must be incorporated into the woman's daily routine to control lymphedema. Motivation is a key element in the daily performance of the SMP. The Remotivation Process is an occupational therapy intervention that can be used to facilitate motivation. It is grounded in the Model of Human Occupation practice framework.
OBJECTIVE: This dissertation research explored the effect of the Remotivation Process on the motivation of women with breast cancer-related lymphedema to incorporate the SMP in their daily routine. The study also explored the effect of the Remotivation Process on the manifestation of lymphedema, occupational participation, and quality of life.
METHOD: The study utilized a concurrent triangulation design that involved six participants (n=6) from a large metropolitan hospital. The Remotivation Process was used as an occupational therapy intervention for four weeks. A follow-up session was completed after eight weeks. The quantitative study measured adherence to the SMP in terms of frequency of performance of the SMP in a seven-day period, girth reduction, occupational performance through the Model of Human Occupation Screening Tool, motivation through the Volitional Questionnaire, and quality of life through the Lymphedema Quality of Life Inventory. Nonparametric tests were used to compare pre-test and post-test data, including the Wilcoxon signed-ranks test, Friedman's analysis, Mann Whitney-U test, and Spearman's rho. The qualitative study used a semi-structured audio-taped interview that was also guided by the Remotivation Process. The qualitative findings were analyzed using the descriptive phenomenology approach outlined by Amedeo Giorgi. RESULTS: The quantitative analysis showed significant differences in the pre-test and post-test scores in the Model of Human Occupation Screening Tool, Volitional Questionnaire, and the girth of the affected upper extremity. The qualitative findings also reflected these improvements in occupational performance, motivation, and physical manifestation of lymphedema. The quantitative analysis did not show a statistically significant difference in the daily performance of the SMP and scores on the Lymphedema Quality of Life Inventory. However qualitative findings suggested that the participants became more aware of their adherence to the SMP and experienced improved quality of life after the intervention. CONCLUSION: This dissertation research found that the Remotivation Process is a potentially useful occupational therapy intervention that addresses the motivational needs of women with breast cancer-related lymphedema. It can facilitate improvement in the physical manifestation of breast cancer-related lymphedema and occupational participation as well as facilitate the daily performance of the SMP and improvement in quality of life. Though this dissertation research was a feasibility study with a small sample size, the study is a first step in investigating the effect of the Remotivation Process upon a larger and more diverse group of women with breast cancer-related lymphedema.