Tell me if this sounds familiar: you assess a new patient and prescribe them a home exercise program; two weeks later they come back for a second visit frustrated with little to no progress. They do not come back for a third visit. Just what went wrong?
You’re not alone. It seems every therapist has experienced this exact scenario at least once. In fact, this happens so frequently that a lot of research has been conducted over the years to discover the root of the problem. While there are a variety of reasons patients may have to discontinue their therapy, nonadherence to their prescribed home exercise program is a common denominator among them.
In this article we’ll discuss:
- Why compliance to home exercise programs is important
- Common barriers to compliance
- How tracking compliance increases communication, understanding, and motivation
- Conclusion
Why compliance to home exercise programs is important
Home Exercise Programs (HEPs) are one of the most fundamental and important tenets of physiotherapy. Designed to continue a patient’s recovery progress outside of the physical therapy office, an HEP encourages patients to participate in specific exercises.
The benefits of completing home exercise programs
You know your patients need to strengthen their muscles in order to recover, and you know they can only accomplish that by working out those muscles every day. But your patients probably don’t have the time to see you every day (or the stomach for the bill!) so you prescribe an HEP.
Patients can increase their chances for recovery by regularly completing their HEP. Studies show that patients who adhere to their prescribed exercises not only perform better at achieving their physical goals but also demonstrate a greater increase in physical function that those who do not . Patients who regularly perform their prescribed exercises are more likely to continue exercising after physical therapy sessions have concluded, and are less likely to injure themselves a second time. (We’ll discuss this more in the next section.)
Unfortunately, studies have shown that patients typically are not fully compliant with their HEPs with some showing non-compliance to be as high as 50 – 65% for musculoskeletal conditions. (Interestingly, patients who reported lower back pain are the least likely to complete their prescribed programs with non-compliance rates as high as 50 – 70%.)
The outcomes of non-compliance with home exercise programs
What does it mean for a patient to not complete their prescribed exercises? Simply put, they are less likely to have built up the muscular strength required to recover or return to normal function.
Patients who do not comply with their HEP are more likely to experience recurrent injuries or flare-ups. Studies have also shown non-compliance may extend the duration of treatment, negatively impact the therapeutic relationship, and make treatment less effective . These outcomes result in physiotherapists believing their current treatment is not effective which leads to frequent changes to HEPs, which further frustrates patients.
Patient non-compliance should be avoided at every opportunity— but when only 35% of patients actually adhere to their HEPs, it seems almost an impossible task. In order to increase adherence in your patients, you have to understand what is keeping them from completing their HEPs in the first place. In physiotherapy, these obstacles are commonly referred to as barriers.
Common barriers to compliance
Now that we have established the importance of home exercise programs, the benefits of patients fully adhering to them, and the less positive effects of patients not adhering to them, we can discuss some of the reasons why patients may not comply with their prescribed programs in the first place. Fortunately for us, in recent years several studies have examined patient adherence.
Here are some of the most common barriers to compliance:
Patient perception. Many patients start therapy with little knowledge of what physiotherapy entails and are not confident in their ability to achieve their physical goals. Patients who recently experienced an injury may also avoid their HEPs for fear of injuring themselves again.
Pain. Many patients do not participate in physical activities simply because it causes them pain. While it is understandable why patients want to avoid feeling pain, pain can be a byproduct in physiotherapy toward growth and healing.
Lack of support. Patients who do not have a system of support around them are more likely to drop out of therapy before completing their physical goals. In fact, patients who received positive feedback from their physiotherapist were more likely to adhere to their HEP.
Degree of helplessness. Patients who do not feel in control of their health or their health goals are more likely to not adhere to their HEPs.
So knowing this, what can you do to break down these barriers?
How tracking compliance increases communication, understanding, and motivation
The key to overcoming these barriers is communication: patients who kept in communication with their physiotherapists were more likely to adhere to their HEPs. But I know what you’re thinking: I already have such a busy schedule, constantly calling all of my patients feels impossible. Ideally, you should spend more time with patients who are struggling to comply with their prescribed programs. But how can you tell the difference?
Take the recently created remote therapeutic monitoring (RTM) codes that CMS finalized in the 2022 final rule. Remote monitoring can offer physiotherapists a ton of great information that can help them better guide their patients’ care based on the patient’s progress. By tracking patient compliance, you can easily see when your patient is falling behind in their HEP and reach out to address any barriers your patient is facing.
Additionally, by tracking patient compliance you also get a much clearer understanding of the efficacy of the HEP. Just as you can understand patient barriers to compliance, you can also better understand the exercises your patient is struggling with on a daily basis. For example, if a patient only completes half of the prescribed repetitions of a certain exercise, you can focus on barriers related to that specific exercise.
Remember that a patient’s mindset (perception, lack of support, helplessness) is the greatest obstacle toward their physical goals. It’s important to offer as much positive feedback as possible to motivate your patients to continue working towards their goals.
Conclusion
Home exercise programs are at the core of physiotherapy. HEPs are an important method for patients to recover strength and regain function, but their many benefits are only reaped by the small percentage of patients who actually adhere to them.
Physiotherapists must collaborate with patients to overcome patient barriers to compliance. The most common barriers to compliance are related to patient mindset and perception. Identifying patients who are struggling to adhere to their HEP is key in order to communicate with and motivate patients to improve patient outcomes.
Tracking patient compliance is a very simple but effective way to quickly address patient barriers to success towards their physiotherapy goals. Physical therapists can check patient progress in real time and reassess HEPs even when a patient is not in-clinic. Tracking compliance is a proven tool to revolutionize your practice and the patient experience.
ViFiVE’s remote PT platform can help you advance your practice and achieve higher goals with your patients. Contact ViFiVE today for more information on our products.
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