Motivational interviewing in postoperative rehabilitation and chronic disease management: Current findings and future research directions

Abstract

This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing (MI) in addressing anxiety and depression among young and middle-aged patients following percutaneous coronary intervention. It further explores existing evidence and potential future research directions for MI in postoperative rehabilitation and chronic disease management. MI aims to facilitate behavioral change and promote healthier lifestyles by fostering a trusting relationship with patients and enhancing intrinsic motivation. Research has demonstrated its effectiveness in postoperative recovery for oncological surgery, stroke, organ transplants, and gastrointestinal procedures, as well as in managing chronic conditions such as diabetes, obesity, and periodontal disease. The approach is patient-centered, adaptable, cost-effective, and easily replicable, though its limitations include reliance on the therapist’s expertise, variability in individual responses, and insufficient long-term follow-up studies. Future research could focus on developing individualized and precise intervention models, exploring applications in digital health management, and confirming long-term outcomes to provide more comprehensive support for patient rehabilitation.

Key Words: Chronic disease management; Motivational interviewing; Patient-centered; Postoperative rehabilitation; Treatment adherence

Core Tip: Studies have shown good effect of motivational interviewing in post-operative recovery from oncological surgery, stroke organ transplant and gastrointestinal surgery, and in the management of chronic diseases such as diabetes, obesity and periodontal disease. The therapy is patient-centered, flexible, low-cost and easily replicable, but there are limitations such as its implementation being dependent on the skills of the therapist, individual differences affecting effectiveness, and a lack of long-term follow-up studies. Future studies could explore its individualized and precise intervention model, its application in digital health management, and validate its long-term effects, to provide more comprehensive rehabilitation support for patients.

INTRODUCTION

A recently published study by Meng et al[1] provides compelling evidence for the efficacy of music therapy combined with motivational interviewing (MI) as an intervention for young and middle-aged patients experiencing anxiety and depression after percutaneous coronary intervention (PCI). The study, which included 43 patients in each group, revealed that this combined approach significantly reduced anxiety and depression compared to music therapy alone in patients who had experienced a myocardial infarction post-PCI. Additionally, it facilitated the adoption of healthier lifestyle behaviors, including improved activity levels, dietary habits, medication adherence, social engagement, body mass index management, and smoking cessation.

These results are consistent with prior findings indicating the effectiveness of MI in enhancing adherence to pacemaker-specific care practices, improving emotional intelligence, and fostering dispositional optimism in patients with permanent pacemakers[2]. MI has also been shown to reduce symptom burden and promote self-care in patients with heart failure[3,4]. However, the study by Meng et al[1] predominantly involved male participants, and there was some evidence of gender differences in self-care behaviors[5,6]. This raises the need to evaluate whether gender differences influence the outcomes of MI interventions.

MI is a patient-centered communication technique grounded in the principles of compassion, acceptance, evocation, and partnership[7]. These principles involve acknowledging and respecting patient emotions and choices, facilitating the discovery and clarification of motivations for change through reflective dialogue and open-ended questions, and collaboratively setting realistic goals to build confidence in behavioral changes. Beyond psychiatric-psychological rehabilitation, such as improved psychosocial functioning in schizophrenia spectrum disorders[8], MI has proven valuable in contexts requiring behavioral modifications during recovery[9]. These include postoperative recovery as partially demonstrated by Meng et al[1], chronic disease management[10,11], and reducing substance use[12].

This editorial further evaluated the existing evidence based on the utilization of MI in postoperative rehabilitation and chronic disease management. Additionally, it proposed potential directions for future research, emphasizing both the strengths and limitations of this intervention.

APPLICATIONS OF MI

Basically, literature demonstrates that MI is an efficacious approach to modifying behavior in medical practice[9]. On the other hand, increasing recent work showed inconsistent conclusions on its effectiveness upon some behavioral changes, such as smoking cessation[13,14]. It is therefore necessary to establish whether the approach is consistently effective for the management of different postoperative and chronic disease patients.

In postoperative rehabilitation

Post-operative rehabilitation of oncology patients: A randomized exploratory trial demonstrated that a six-session self-efficacy enhancing MI intervention was more effective than the usual care in regulating emotions, improving self-efficacy, quality of life, confrontational coping, social support and functional capacity among postsurgical non-small cell lung cancer patients[15]. Recent reviews[16,17] and original articles have further concluded that MI has the potential to improve behaviors such as physical activity[18], healthy eating[19,20] and other health outcomes, including body mass index and body weight, as well as the regulation of depression[21], in various settings of intervention for individuals on different cancer care trajectories.

Rehabilitation of stroke patients: The evidence regarding the impact of MI on medication adherence in stroke patients is inconclusive[22]. However, other studies have demonstrated that it can facilitate motivation for rehabilitation[23] and improve depression and enhance quality of life at less than 12 months of follow-up[24]. Further evidence is required to ascertain the impact of this intervention on different behavioral aspects.

Rehabilitation after organ transplant: A randomized controlled trial of a multimodal intervention including MI administered by trained masters-level nurses in adult heart, liver, and lung transplant recipients demonstrated the efficacy of MI in increasing treatment adherence[25]. A recent review additionally indicated that it enhances adherence to the post-transplant immunosuppressant regimen, engagement in other healthy lifestyle behaviors such as fluid intake and regular exercise, and the management of barriers to return to school, such as anxiety and depression in adolescents[26]. Consequently, the current evidence appears to substantiate the potential efficacy of MI as a post-transplant intervention, while further direct evidence is still required.

Rehabilitation after gastrointestinal surgery: The available evidence suggests that MI may facilitate improved mobilization in patients undergoing elective bowel resections who are undergoing the enhanced recovery after surgery. However, a multicenter superiority trial is still required to confirm this.

In chronic disease management

A recent meta-analysis showed that MI changed the quality of life in individuals with chronic diseases. However, the results varied based on the types of chronic disease, measurement tool, sample group, disease group, age range, and implementers[11]. Some examples are as follows.

Managing people with diabetes: A systematic review of Ekong and Kavookjian[27] has demonstrated that clinical change outcomes from MI-based interventions were most favorable for weight management in type 2 diabetes, based on 14 studies. A more recent systematic review of 21 randomized controlled trials indicated that MI-based telehealth was most effective for improving hemoglobin A1C, systolic blood pressure, diabetes self-efficacy, and physical activity behaviors in individuals with diabetes or prediabetes[28]. The authors emphasized the importance of maintaining homogeneity in the intervention and outcome assessment.

Management of obesity: A meta-analysis of 17 studies conducted by Vallabhan et al[29] indicated that, in adolescents, MI alone is not an effective treatment for overweight and obesity. However, a more recent systematic review and meta-analysis by Amiri et al[30] demonstrated that, among girls and adolescents who participated fully, there was a significant reduction in central obesity. Lutaud et al[31] additionally proposed that MI should be conducted within the context of a comprehensive, interdisciplinary, family-oriented approach, spanning an extended period with regular consultations for children and adolescents with overweight or obesity.

Periodontal management: Although preliminary evidence indicated that the utilization of MI as an adjunct to periodontal therapy might exert a beneficial impact on clinical periodontal parameters, including plaque values, gingival health, and periodontal inflammation[32], the number of randomized controlled trials in this field was limited, with fewer than 10 available. Scholars have called for further high-quality studies utilizing standardized MI interventions to validate its effects in periodontal management[33].

Strengths and limitations

The evidence currently available indicates that the key strengths of MI are its patient-centered approach, which increases patient involvement and control, and its ability to improve adherence. Moreover, the interviews can be adapted to suit the specific requirements of the patient and are applicable to a diverse range of diseases and stages of recovery, making it a highly flexible approach. Furthermore, it is cost-effective and straightforward to disseminate, as it does not necessitate the acquisition of costly equipment or the provision of technical assistance, and is readily trainable and implementable.

However, it is not without limitations. For instance, the efficacy of its implementation hinges on the proficiency of the therapist, necessitating the presence of adequately trained professionals capable of facilitating comprehensive communication with patients. Furthermore, the degree of acceptance of MI varies from patient to patient, which can influence the outcome of the intervention, as suggested by the inconsistent results in some areas. In addition, the majority of studies examining the impact of MI interventions have a limited temporal scope, with long-term effects and sustainability yet to be evaluated.

FUTURE RESEARCH DIRECTIONS

Intervention optimization

The recent work by Meng et al[1] suggests that further discussion of combinations of different intervention modalities is warranted. For MI, in addition to the promising combination with cognitive behavioral therapy[34,35], future-oriented solution-focused brief therapy (SFBT) may also be a beneficial choice. This form of therapy emphasizes identifying the individual’s goals, resources and exceptions and building solutions around these[36]. SFBT has been demonstrated to be a highly efficacious intervention in a range of clinical populations[37], including those with brain injury[38], substance use disorders[39], and post-stroke conditions[40]. It has been shown to facilitate mood regulation[41,42] and behavioral change, and is readily comprehensible to health professionals[43]. Our recent study demonstrated that a six-week short-term SFBT intervention, or its combination with Wuling capsule, can enhance anxiety and sleep quality in adolescents[44]. Another ongoing study of ours also paid attention to the effect of SFBT on reduction of psychological distress and fearful responses to sport in university students with sports injuries. In contrast to MI, which motivates change by exploring an individual’s values and goals, SFBT works directly with the individual to set and achieve specific goals. It can be posited that the two may therefore complement each other.

Interdisciplinary applications

Further research should investigate the potential applications of MI in a broader range of settings, such as geriatric care[45], as age-related factors may influence the efficacy and adherence to the intervention[46]. Additionally, the efficacy of MI in other chronic disease management should be explored. Ongoing studies are investigating the effectiveness of MI in elderly stroke patients[47] and in cardiac rehabilitation following acute myocardial infarction[48].

Technology integration

As MI can be delivered through media well beyond face-to-face conversations[7,10], it is also worthwhile to explore more accessible ways to combine it with digital health technologies (e.g. mobile apps) to facilitate remote support and continuous feedback.

Cultural adaptation

The extant literature indicates a necessity to consider the communication style preferences of depressed patients in different cultures and to adapt the content of the intervention. The culturally adapted version of MI demonstrated superior performance, at least in terms of the primary outcome measure[49].

Long-term follow-up studies

In light of the paucity of evidence regarding the long-term effects of MI intervention, it is recommended that future research be conducted to investigate the long-term effects and sustainability of MI in different patient groups.

CONCLUSION

MI shows considerable promise for application in clinical patients, particularly in the context of postoperative rehabilitation and chronic disease management. It not only regulates the psychological state of patients, but also facilitates health behavior change and enhances treatment adherence and rehabilitation outcomes. Future studies should further explore its individualized and precise intervention models, validate its application in digital health management, and assess its long-term benefits, with a view to providing more comprehensive rehabilitation support for patients.