Jack et al recently published an article entitled, “Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review”. As expected, they found that there are a multitude of factors associated to poor adherence by our patients with the statement:
‘There was strong evidence that poor treatment adherence was associated with low levels of physical activity at baseline or in previous weeks, low in-treatment adherence with exercise, low self-efficacy, depression, anxiety, helplessness, poor social support/activity, greater perceived number of barriers to exercise and increased pain levels during exercise.’
The authors recommend that we address the above with appropriate management strategies and come up with realistic treatment plans based on the individual. Of course, we know this.
But, to me, it comes down to why are we really giving HEP?
Is it to TELL the patient that in doing this, he or she will get stronger, improve core strength, increase ROM or more technical and smart phrases as to ‘working these muscles for better scapulohumeral rhythm’?
Bottom line, if I was on the other side of the table, this wouldn’t make me want to run home and do them.
As humans, we typically do things to get an immediate result. Its intuition. It would be much easier to pop a pill and boom, relief in 15 minutes.
Pt may even mention that they could look up exercises online and do not need your advice. Or, “why do I need to pay $25 2x/wk as co-pay to do something on a machine that I already have at my $40/month gym”?
If it were me, I would want to know how to get out of PAIN. Or, pretty much why 95% of patients come to us. Trust me, your patients have tried heat, ice and every cream on the shelf. What they really want is an exercise program (maybe you shouldn’t even call it exercise as this is can be a misnomer to many and scare them away) to give them CONTROL over their symptoms ON-THEIR-OWN; without the use of pills, modalities, and $19.99 products seen on TV at 2 in the morning.
I see it on a daily basis. Giving patients the ability to “help them help themselves” will not only give them more confidence in your ability to translate your knowledge into the individual, but would make them more adherent to the HEP as it is positive reinforcement for less pain. It doesn’t matter if they are 20 or 80 years old. Less pain will then lead to ‘getting stronger, improve core strength, increase ROM or more technical and smart phrases as to ‘working these muscles for betterscapulohumeral rhythm’?’
What are your thoughts? How adherent are your patients to the HEP?