Motivation in the return to work process: a self-determination cluster approach

Motivation may predict return to work (RTW), yet the measurement of motivation needs more scientific evidence. We adopt a dimensional approach, based on the self-determination theory (SDT), distinguishing between amotivation, controlled and autonomous motivation. We seek to explore the presence of these dimensions in sick-disabled patients, and are interested in associations with quality of life, depression, patient's predictions of RTW, and health care provider estimations of patient's motivation.

A cross-sectional study in 336 patients was conducted. Motivation was assessed using the Motivation at Work Scale (MAWS) and examined in relation to patient outcomes, patient's prediction of RTW, and health care provider estimations of patients' motivation. A cluster analysis was performed, and differential associations between motivational profiles were explored.

Cluster analysis revealed four profiles. Highly controlled profiles were most prevalent, reported poorer mental quality of life, and expected a longer time before RTW, regardless of the level of autonomous motivation. Interestingly, the health care provider's estimation was not related to controlled motivation.

Our results show that SDT may help to differentiate people with a work disability regarding their motivation to RTW. Most notably, the devastating consequences of controlled motivation are discussed, and clinical implications are provided.Implications for RehabilitationAssessing the different dimensions of motivation in the context of RTW will be a significant advance as the self-report measures appear to be viable tools.Controlled motivation, which indicates that people are motivated to RTW but only because they "have to", has negative consequences yet a high prevalence and should therefore be addressed by the practitioner.Practitioners should keep in mind that employees are motivated by several motives at the same time, with some being more beneficial than others.Controlled motivation can be converted into autonomous (i.e., good quality) motivation by supporting autonomy of the patient, by supporting their relationships with colleagues, managers, and health care providers and by supporting their feeling of competence in the RTW process.