How to Improve Home Exercise Adherence in Your Clinic

As therapists, we know that the one thing patients struggle with is…completing their home exercise program (HEP). In fact, research shows that for those with musculoskeletal conditions, non-adherence to a home exercise program has been shown to be as high as 50-65%. Why is this number so high? There are many reasons, but the most common ones given by patients are pain, lack of self-efficacy, and perceived barriers to exercise, such as lack of time or simply forgetting.

Patients who do follow through and complete their home exercise program are significantly better at achieving their goals and tend to demonstrate better outcomes. While the intrinsic factors of a patient definitely play a role in home exercise adherence, there are ways that you, as the physical therapist, can contribute to helping the patient be more likely to complete their home exercise program. The question then becomes…how can you do that?

Let’s take a look at 4 ways you can improve your patients’ adherence to their home exercise program:

  • Educate your Patients

Time and time again, you hear about the importance of patient education when it comes to physical therapy services and in this case, it’s probably the best way for you to encourage your patients to complete their home exercise program. Why? Because much like patient education is the key to getting your patients to buy-in to attending therapy, it’s also the key to helping your patients understand the importance of their home exercise program. HEPs provide many benefits for the patient, the main one being that typically they lead to better outcomes and help patients achieve their goals faster which is why it’s imperative that you explain and help your patients understand these benefits. Not only that, but you’ll also want to relate their home exercises back to the patient’s specific goals and motivation for attending therapy. When you educate on the benefits and incorporate the patient’s own specific goals and motivations, you’ll likely increase the patient’s buy-in to their home program, from the start.

  • Understand your patient’s schedule

Unless your clinic specializes in sports orthopedic or treating athletes, chances are the majority of your patients are not regular exercisers meaning they probably don’t have the necessary behavior strategies in place to follow through with their program. The easiest way to address this barrier is through talking with your patient and learning their schedule. By doing this, you’ll have a better understanding of what kind of the time the patient has to complete their exercises. You can also encourage your patients to note down this time in their planner, phone or on their calendar at work as a reminder to help them stay on track.

  • Make the Home Exercise Program Realistic

Similar to understanding your patient’s schedule, you also have to make sure that the home exercise program you are prescribing your patient will work for them. One of the biggest factors is the number of exercises you are prescribing. Do you typically provide 6-8 exercises for your patient? If so, that might be a major factor as to why your patient’s adherence is so low. Oftentimes when you prescribe a large number of exercises, patients are less likely to complete them due to time constraints and having an all or nothing mentality.

This all or nothing mentality leads to our next point which is, regardless of the number of home exercises you prescribe, you need to let your patient know that it’s okay to not complete all of their exercises at one time. Make sure your patient understands that breaking their exercise routine up throughout the day will still give them improved outcomes and that 10 or 15 minutes of exercise at home is better than no exercise. This understanding can often lead to increased HEP compliance as the patient doesn’t feel that they need to wait for an extended break in their day.

  • Focus on Short-Term, Attainable and Measurable Goals

When initially prescribing the home exercise program, make sure you’re encouraging your patient to set short-term, attainable, and measurable goals. Not only will this improve the patient’s sense of control and accomplishment, but it will likely lead to improved self-efficacy and compliance. This is also an excellent way to make sure you are continually updating the patient’s HEP and that it stays inline with the patient’s goals and motivations as they progress through therapy.

Through implementing these 4 techniques, you are likely to see an increase in your patients HEP compliance; however, remember that every patient is unique so what works for one, may not work for another. One common theme, with all of the above techniques, is that they emphasize improving the patient-provider relationship. When you treat the patient as a whole and really understand their life outside of therapy, you have a greater chance of helping your patient overcome their barriers, increase adherence to their home exercise program and overall achieve better outcomes.

Resources:

https://www.physio-pedia.com/Adherence_to_Home_Exercise_Programs

https://www.researchgate.net/profile/Kelsey-Picha/publication/316041062_A_model_to_increase_rehabilitation_adherence_to_home_exercise_programmes_in_patients_with_varying_levels_of_self-efficacy/links/5a859e28a6fdcc6b1a36130d/A-model-to-increase-rehabilitation-adherence-to-home-exercise-programmes-in-patients-with-varying-levels-of-self-efficacy.pdf

https://www.medbridgeeducation.com/blog/2018/03/4-tips-maximize-home-exercise-program-participation/

https://pubmed.ncbi.nlm.nih.gov/8234458/

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