Patient cooperation and satisfaction with at-home exercise programs are essential to achieve successful rehabilitative results.1 However, a large percentage of patients fail to consistently perform the home-based rehabilitative exercises you recommend.2 Despite the time you spend deciding which exercises will be helpful and carefully explaining the procedures, many patients still can't seem to do their part. And yet, you know that if they would just follow your instructions, their injuries or conditions would improve more quickly.
I have found that many patients have certain obstacles to overcome before they can accomplish the exercise goals you are trying to establish. The more obstacles that can be removed, the more likely it is that the exercises will get done. Here are some ways to help your patients succeed.
Minimize the Initial Load
Begin the rehab regimen with only one or two exercises. This minimizes the start-up effort and decreases the amount of time required. Once a patient has been doing one or two exercises regularly for a couple of weeks, additional or more complex exercises can be more easily implemented.
Clarify the Need
Motivation improves exercise compliance.3 Make sure your patient knows why the exercise program needs to be done, and what benefits to expect. Explain that doing the exercise will help your patient better perform the activities he or she enjoys.
Show How, and How Often
Demonstrate the exercise, and then observe the patient doing the same exercise. Correct the patient's movement, speed, range, etc., as needed. When you spend the time to guide them through the proper procedures, patients realize that you believe this is an important part of their care. Patients are then much more likely to do the exercise.2
When a new habit needs to be learned, regular repetition helps.4 Since rehabilitative exercises do not tear down muscles, daily exercising is safe. And any time of the day is fine - what's most important is getting the exercises done. Encourage your patients to exercise whenever it works for their schedule.
Basic Equipment Works Best
Well-designed, easy-to-use home rehab equipment helps to ensure compliance.5 Home equipment should be easy to figure out and set up, and should help guide your patients through the necessary exercises.
Get Others Involved
A spouse or family member should accompany the patient when exercises are taught, in order to help ensure correct and regular performance of each exercise. A second person who wants your patient to get better can be a tremendous ally, one who will provide encouragement and reminders.2
Kudos for Their Efforts
While under your care, all patients must keep a record of their performance in some form of exercise log. Remind them to bring the log to every office visit, so you can see how the exercises are going. Make sure to give them praise and recognition for the exercises they perform.
Monitor Performance
At least once a week, have the patient perform the exercise in front of you. This allows you to confirm that it's being done properly, and you can correct any faults that creep in. A regular review also reinforces in the patient's mind the importance of the exercising and encourages them to continue.
Strive for Quick Benefits
Make sure that the rehab program you are recommending will produce a rapid response, so the patient starts to feel the benefits of the exercising immediately. There is nothing more motivating than the knowledge that the most important exercises are being done. Don't give all patients the same set of exercises; instead, try to start the patient on the most important exercise for his or her condition.2
Add on in Stages
If you implement these suggestions, your patients will be more likely to perform their rehab exercises faithfully. Once they have established the habit of doing one or two exercises, you can use the rehab review to add other exercises. With this method, a patient can gradually develop a good general-fitness and spinal-health exercise program while under your care. Word will soon get around your community that you care enough about your patients to help them establish a regular health and exercise program. This will help build your practice, and also improve the reputation of chiropractic for years to come.
References
- Chen CY, Neufeld PS, et al. Factors influencing compliance with home exercise programs among patients with upper-extremity impairment. Am J Occup Ther 1999;53(2):171-180.
- Kamiya A, Ohsawa I, et al. A clinical survey on the compliance of exercise therapy for diabetic outpatients. Diabetes Res Clin Pract 1995;27(2):141-145.
- Friedrich M, Gittler G, et al. Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 1998;79(5):475-487.
- Rejeski WJ, Brawley LR et al. Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability. Med Sci Sports Exerc 1997;29(8):977-985.
- Stenstrom CH, Arge B, Sundbom A. Home exercise and compliance in inflammatory rheumatic diseases: a prospective clinical trial. J Rheumatol 1997;24(3):4700-476.
Kim Christensen, DC, DACRB, CCSP, CSCS
Director, Chiropractic Rehabilitation and Wellness Program
PeaceHealth Hospital
Longview, Washington
kchristensen@peacehealth.org
