Improving Home Exercise Program Adherence in Physical Therapy

Only thirty-five percent of patients fully adhere to their course of care in physical therapy.

I’ll let that sink in.

Most patients aren’t doing their exercises at home. Research cites lack of motivation, patient perception of whether or not they can complete their exercise routine (self-efficacy), and perceived barriers to exercise as the most common affectors of non-adherence. Whatever the cause may be, we as rehabilitation professionals aren’t doing enough to improve patient adherence not only to home exercise programs, but to their course of care at large.

We look at our role as treating patients in the clinic for 45 minutes to an hour, for 2 or 3 times a week. But, our role is much larger: patient perception of ‘physical therapy’ typically encompasses the entire injury recovery process, from initial evaluation to well past discharge. And the fact is, if you can get patients to adhere to their home treatment plan, you can simultaneously improve their outcome and their perception of their physical therapy experience at your clinic.

Albert Einstein once said that the definition of insanity is doing the same thing over and over and expecting different results. And yet, here we are following the same process that we’ve followed for the last 30 years:

  • Create patient’s exercise program

  • Give patient print out of exercise program

  • Ask patient if they did their exercises at home (to which they reply, “Uh, Yeah…” an an all-too-familiar tone of voice)

  • Rinse, Repeat

We know that the majority of our patients aren’t doing their exercises at home, and we aren’t implementing strategies that effect change. The main reason we do nothing is because we believe that we don’t have the capability to improve our patient’s adherence, and there seems to be way too many barriers to overcome. So, our low self-efficacy and our perception of barriers is translating to our patients having low self-efficacy and perceived barriers.

So, much like our patients, we do nothing. It’s a cycle of inaction.

It’s time to break the cycle.

Low self-efficacy and perceived barriers are related; that is, someone who believes that there are many barriers prohibiting them from performing their exercises at home will likely have correspondingly low confidence that they can perform their exercises at home.

As rehab professionals, we can help patients navigate some of their barriers to exercise, and we can help empower them. Here are a few strategies.

1) Provide structure: many patients are not regular exercisers, and one of the biggest barriers for this clientele is that they lack the ability to plan and the behavioral strategies needed to succeed. Talk to your patients about their schedule. Find out when they are busy, if they think they can fit exercise into their day, and when they’ll have time. Most people have a written schedule, whether it be on their smartphone or in a planner. Encourage them to set a time to complete their routine directly into their schedule at a time that works for them.

2) Let them know that they can break up their routine throughout the day. Many people think that exercise is ‘all-or-nothing’. So, if they only have 15 minutes to spare, they might opt to not complete any exercises, because they may feel that it’s unacceptable to not complete their entire routine.

3) Have them track their workouts: Tracking progress is a simple way to increase a patient’s sense of control. It provides a sense of accomplishment that can translate to improved confidence and self-efficacy.

4) Get them goal oriented: Help your patients set short-term, measurable, and attainable goals. Goal-setting improves internal motivation, and achieving short-term goals can further improve self-efficacy.

5) Stay Connected: Let them know that you are available. One of the biggest barriers to exercise is a lack of social support. If your patient knows that you are invested in their recovery, they may feel as if they have the support and guidance they need to succeed.

Obviously, these are very broad strategies. The most important thing to keep in mind is that each patient has unique challenges that need unique solutions, and the one-size-fits-all solutions we’re currently using aren’t helping our patients succeed.

TheraVid is centered around state-of-the-art home exercise software. We let providers develop personalized home exercise plans for their patients faster and easier than ever before. We utilize behavioral change theory and evidence-based techniques to provide each patient with the tools and techniques they need to succeed.

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Ryan Klepps

Physical Therapist, COO & Co-Founder of Strive Labs, Inc.

Somerville, MA