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?



  1. Hmmm…. interesting observation Harrison… I have actually taken up a PhD research on this topic and have conducted a review of literature and my conclusion is pretty much what you have given here… based on synthesis of qualitative studies. But the challenge is that a lot of people will not take up this ‘help them help themselves’ strategy and have an external locus of control or do not understand their own condition and why exercising or self care is important or even if they do, they do not have the physical ability or social support to do so, or simply that there competing responsibilities do not allow them to adhere…. So as Jack et al suggested adherence is dependent on an interplay of several factors and the challenge is to be able to identify the most important ones and then try and overcome those barriers..

    1. Devdeep,
      Thanks for commenting and making a personal statement based on your experience and research. I think this will always be a battle for any healthcare profession, in terms of prevention or even treating when a disease/symptoms arise. Not sure how much this will change; but I do think individuals are more aware of their health now than ever (not smoking, anti-obesity rants, avoid sustained sitting due to not only LBP but increase risk of cardiovascular disease, etc). This next generation may be different…

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