Imagine this. You design a treatment program for your patient. It includes all the best exercises that’ll help your patient recover. But it’s not working.
Why?
Because the patient isn’t following the program. He isn’t staying away from the activities that you’ve advised against. And he’s not doing the exercises that you’ve given him.
A patient not adhering to their exercise routines is a common problem in physical therapy rehabilitation. And it can have long-lasting consequences for the patients.
In this article, we’ll discuss six practical strategies to help you improve patient compliance in physical therapy. These are:
- Recognize the Barriers and Identify Patient Biases
- Develop a System for Tracking Patient Compliance
- Establish Rapport
- Talk With Your Patients About the Treatment and Their Role In It
- Choose Simple Exercises and Use PDFs or Written Instructions
- Relate The Exercises To Treatment Goals
You can easily apply these in your practice and you’ll likely see significant results in exercise adherence.
What Is Patient Compliance?
Patient compliance is a measure of the extent to which a patient follows your treatment regimen. In physical therapy (PT) practice, this includes the exercises, activity modifications, and precautions that you have prescribed to your patient.
Patient compliance is the patient’s commitment to the treatment.
It’s also known as treatment adherence or exercise adherence.
Why Is Exercise Adherence So Critical in PT?
Exercise adherence is crucial because it directly impacts patient outcomes.
Multiple studies show that patients who adhere to the exercise program do much better at physical therapy than their counterparts. [Reference]
It also influences your decision making.
If you’re not seeing progress in your patient, you might assume that your chosen treatment regimen isn’t working and change it – even though the lack of progress is because the patient isn’t performing the home exercise programs, not because your approach is flawed.
Is Patient Compliance Easy to Achieve in Physical Therapy?
Getting your patients to comply with their treatment is quite difficult in physical therapy. That’s because PT is mostly active and requires greater participation from the patient, in the clinic and at home, than pharmaceutical treatments.
50-65% of musculoskeletal patients don’t follow their physical therapy treatment schedule. That number is much higher for other conditions.
1 in 4 adults doesn’t exercise enough globally, according to WHO. Also, more than 80% of teenagers aren’t physically active enough.
That goes to show that getting people to follow exercises that they’ve probably never done before is a much harder task than one might think. And to have them do these at home, without supervision, requires a lot of creativity on the part of the physiotherapist.
Patients don’t see immediate results in physical therapy. That’s one of the biggest reasons for non-compliance and also an important reason why you need to encourage adherence to treatment.
Practical Ways to Improve Patient Compliance in Physical Therapy
All patients are different. They have different challenges, goals and baseline levels so the same approaches for improving patient compliance won’t work for every patient.
Nevertheless, here are some practical tips that have been proven to improve exercise adherence and generate results for physical therapy patients:
1. Recognize the Barriers and Identify Patient Biases
If you can identify the barriers that are causing your patient to be non-compliant and remove them, then you make it easy for your patient to follow their treatment program.
One of the primary barriers to patient compliance is a lack of physical activity before the patient came to the physical therapy clinic.
When a person isn’t used to exercising and sticking to an activity routine, it’s harder for them to follow your treatment regimen and thus they prefer to not do the exercises altogether.
Lack of time is another barrier that you need to be aware of. For that, you should design the exercises in a way that the patient can incorporate them into their daily activities. It’ll save them time and they’ll be more likely to follow your program. [Reference]
A non-suitable home environment can also restrict the patient. Perhaps you’ve advised your patient to not use the stairs but they have stairs at home with no option to avoid them.
By evaluating the home environment, either by going to the location or by asking questions and looking at pictures, you can create an exercise program that they can easily do at home.
A lack of self-confidence in exercising on their own, (perceived) foreseen difficulties, and a fear of making the pain worse can also cause non-compliance. [Reference]
Exercise programs are challenging for people to perform on their own without clear feedback about whether they are performing the exercises accurately and safely and without guidance as to how to change the exercises over time.
That feeling becomes exaggerated when the patient is already afraid of exercising.
Counseling them about the red flags to watch out for and educating them about exercise progression can help you overcome this barrier.
A lack of health literacy, misconceptions regarding treatment and disbelief in the effectiveness of the exercises also causes people to not follow them. You can remove this barrier by explaining the rationale behind the treatment to your patient and answering any questions they might have for you.
The patients’ past experience with the disease or physical therapy might also influence how they perceive your treatment. Again, talking to them about it will help you learn about these and overcome them.
Depression, anxiety and a lack of social support are some more barriers to patient compliance with physical therapy treatment.
For this, you might need to bring in a psychotherapist to help improve patient compliance.
2. Develop a System for Tracking Patient Compliance
Tracking exercise adherence by using diaries, phone call check-ins, updates via email and self-report exercise logs can hold your patients accountable for their treatments and encourage them to do the exercises.
These days, Fitbit and smartwatches are excellent for tracking exercise time and performance.
The visual direct feedback from these devices also motivates patients and promotes physical activity. [Reference]
So you can recommend those to your patients and if they already have these, then help them set it up and teach them the best ways to use these smart tools.
You can do a blood test to check if the patient has taken a certain drug or not or check prescription refills.
But checking if your patient has been doing the exercises isn’t that simple because exercises take longer to show results.
In a study done on hip fracture patients who were prescribed a home-exercise program, researchers gave the study subjects calendars to mark when they performed the exercises.
They incentivized participation by giving $1 bills to the study subjects and told them to bring the bill along with the calendar every two weeks.
Since the patients knew that the therapist would look at the calendar, they were encouraged to stick to the exercise regime and mark it on the calendar.
Tracking progress can also be a great way to provide positive feedback. That goes a long way in motivating patients to follow their exercise routine.
3. Establish Rapport
Patient compliance increases with higher satisfaction and trust in your services. That begins with having conversations with your patients and being confident in your treatment regimen.
Bedside manners play an important role here. You should show compassion to your patients and actively listen to their complaints of pain, limited mobility, difficulty in performing tasks and anything else.
Also, chances are that the patients will miss an exercise session or two. You should prepare your patient for this in advance.
Let them know that it’s okay to mess up as long as they talk to you about it so you can fix the issues together.
That’ll help you create a judgment-free zone and make your patient feel at ease in sharing anything with you.
If your patients don’t feel comfortable talking to you about being unclear about an exercise or about the intensity of the program, then that could lead to non-compliance.
Another helpful thing that you can do to establish rapport is to identify what your patient needs you to be and do. For instance, some patients like to be challenged with difficult exercises while others want a cheerleader to tell them that they’re doing great.
You can increase patient adherence to physical therapy by matching your patient’s needs and by providing the exact kind of support that they need.
4. Talk With Your Patients About the Treatment and Their Role In It
You can overcome most of the barriers to patient compliance by simply talking to your patients.
You should help your patient understand how doing the exercises is a critical part of the rehab process. Talk to them about the physiology behind each exercise, the mechanism of injury, how the injured structures are affected and the way the exercises will help them heal.
All of that allows your patients to take ownership of their health and stick to their treatment.
By educating them, you can make them realize that they are in charge of their own rehab, and you are essentially there to just guide them through the process.
That also opens doors for shared-decision making which helps improve patient compliance to your physical therapy regimen.
Shared decision making: this is a process where the healthcare provider (physical therapist in your case), the patient and their family make decisions about their health together. This approach is usually used when the right treatment isn’t obvious and you need to weigh the pros and cons of each option.
Physical therapy works when there’s active participation from the patient. There’s no way around that. Communicate that to your patient in every session.
Put them in the drivers’ seat of their own rehab and you’ll surely increase their adherence to exercises.
5. Choose Simple Exercises and Use PDFs or Written Instructions
You should try to give your patients only a few exercises at a time so that patients can remember to do them. You can also offer handouts or diagrams of how to do the exercises for their home exercise program.
The exercises that you prescribe to your patient might seem simple to you because you’ve known about them for a long time. But that might not be the case for your patient.
Patients’ adherence to PT treatment decreases if the exercises are difficult or too many. Studies show that 70% of patients won’t comply with your physical therapy treatment if you require them to make big lifestyle changes. [Reference]
A 2017 study found that subjects who were given 2 or fewer exercises had a higher compliance rate than those who got 4+ exercises in their home exercise program.
Another major reason for non-compliance is patients forgetting what exercises they had to do, or forgetting the number of reps, or the correct form and so on.
You can tackle this issue by providing written instructions and offering printouts (or PDFs because we don’t live in the 90s).
Also, always prepare your written instructions in a language that your patient will understand.
You should have your patient perform the exercises in the clinic with you one time. That way, you can make any corrections that you need to and it also helps assure patients that they can do the exercises at home, by themselves.
The goal here is to make your patient feel confident enough to do these exercises on his or her own.
I sometimes draw Stick Figures for the patient to explain to them how they can perform certain exercises.
Also, after I’ve explained the exercises to my patients, I ask them to repeat the procedure to me in their own words so I can make sure that they understand it correctly. Then, I write down the instructions in their own words because I find that my patients often understand the instructions much better that way.
6. Relate The Exercises To Treatment Goals
Your patients are much more likely to follow the treatment if it’ll help them get back to something they love.
Always try to identify the patient’s goals first. Then design your treatment in line with those goals. And explain to your patient how each component of the treatment will help them achieve their goals.
You also need to know the patient’s baseline physical activity level before you design the treatment. If you start your inactive patient on a high-intensity exercise routine, you might make them non-compliant.
So while keeping the goals of the patients in mind, you also need to know the demand that their bodies can handle.
Hence personalized approaches are always the best bet.
The Takeaway
There’s no perfect solution to the patient compliance problem you’ll face as a physiotherapist. But you can try a mix of different approaches to see which works for your patients.
Increasing patient engagement with the treatment increases compliance for most physical therapy patients.
You can do that by educating them about the purpose of the prescribed exercises, establishing rapport, through shared-decision making and recognizing barriers to treatment adherence.
To increase patient compliance, you need to increase patient satisfaction. This is the tricky part. Talking to them and understanding their goals is a good start.
At the end of the day, patients have to be willing to follow the treatment and make time for the exercises. You can only do so much but you have to try.
Disclaimer: This article is for informative purposes only. We provide well-researched and authentic information. Do not consider this personalized health advice. Please contact a licensed healthcare professional for medical issues and health concerns.