Patient compliance has been an issue in the medical realm forever and with some cases can be the one thing that prevents a patient from improving and meeting their goals. Patient compliance is also becoming more important as insurance companies are causing shorter treatment sessions, duration and frequency. If there is one thing I have learned from my recent McKenzie training that is immediately applicable to patient care it is how to improve compliance with exercise and therapist advice. Here are my top 5 thoughts for improving compliance and in turn outcomes:
1. Be able to relate patient's pain complaints to function that is meaningful to them. Once the functional limitation that is most important to them is nailed down, prove how your exercises reduces their pain and improves their function.
2. Keep the exercises to a minimum. We are asking patients for something that is most valuable to them in completing their HEP. THEIR TIME. I recommend giving no more than 3 exercises as compliance with exercise decrease at this point. I strive to find the one corrective exercise that affects their symptoms the most. I recommend for them to complete just that exercise multiple times a day. If a patient can't keep up with one exercise a day, that is a patient you will most likely not be able to help because they are not willing to help themselves.
3. Test - Exercise - Retest. Once you have found the exercise that most helps the patient, teach them how to retest to check for improvement and more important lasting carryover so they know if results are lasting. If results are not lasting they know how to fix it already as they know the exercise that causes improvement.
4. Keep the instructions simple. Most of our patients are savy and smart consumers however that does not make them biomechanical experts. I encourage you to keep HEP instructions as simple as possible by giving them the verbal cues you would use to complete the exercise in written form.
5. Use real life examples of exercises. You already have a perfect subject as your patient is standing in front of you. Take advantage of using smartphone technology to record the patients exercise on their phone while they are doing it. This way your cues and exact exercise will be right at their fingertips when they forget what you told them 5 minutes after they leave the clinic. A good adjunct to the video is to have your most used corrective exercises on a powerpoint with instructions and real photos of you doing the exercise. Patients take your instruction more seriously when they know you are involved in their care, we should be past handing out stick figures.
Hold patients accountable for their care! If they won't help themselves, how can we??
