PREDICTING HYPERACTIVE BEHAVIOR AS A CAUSE OF NONCOMPLIANCE WITH REHABILITATION - THE REINFORCEMENT MOTIVATION SURVEY

Non-compliance with therapy is a significant problem in vocational reh abilitation. Large amounts of professional time and money are wasted t reating patients who are unwilling or unable to participate in their o wn rehabilitation. The client with chronic musculoskeletal pain - depr essed, without energy (i.e., ''anergic'') and refusing to attend thera py - is the exemplar of non-compliance. However, clients with chronic pain and other disabilities demonstrate a different a different type o f non-compliance, characterized by chronic hyperactivity and refusal t o decrease behaviors that are known to maintain or increase symptoms. To document the occurrence of hyperactive non-compliance, 80 clients t reated for chronic musculoskeletal pain (CMP) and 41 clients treated f or Post-Polio Sequelae (PPS) were studied prospectively and administer ed the Beck Depression Inventory (BDI) and the Reinforcement Motivatio n Survey (RMS). Forty percent of the CMP clients and 79% of the PPS cl ients who were discharged from therapy demonstrated hyperactive non-co mpliance. CMP clients as a group had significantly elevated BDI and RM S Type A behavior and Negative Reinforcement Motivation scores, while PPS clients as a group had elevated Sensitivity to Criticism and Failu re scores, as compared to controls. Significantly elevated Type A beha vior and Sensitivity to Criticism and Failure scores were associated w ith hyperactive non-compliance as well as completion of therapy. These findings indicate that hyperactive non-compliance is a frequent cause of treatment failure in rehabilitation clients and that the RMS may b e use in identifying potentially non-compliant clients and the form no n-compliance will take. The design of individualized rehabilitation pr ograms to manage non-compliance and maximize the probability of comple ting therapy is described.