July 18, 2024 | Net Health

7 min read

Top Tips to Improve Patient Compliance to Rehab Therapy Home Exercise Programs

As a rehab therapist, you know the vital role a home exercise program (HEP) plays in patient recovery. Yet, despite your best efforts, achieving high compliance rates can be a persistent challenge.

Patients often leave an appointment at your clinic motivated but struggle to maintain that commitment at home. Studies have shown that patient adherence to home exercise programs prescribed by a rehab therapist is just 35% to 50%—even lower for patients struggling with low back pain, the most common musculoskeletal condition in the U.S.

This gap in adherence not only hampers their recovery but also impacts the overall success of treatment plans prescribed by physical therapists, occupational therapists, and speech-language pathologists. Understanding the barriers to compliance and finding innovative solutions is crucial to enhancing patient outcomes and elevating the quality of care you provide.

What is a Rehab Therapy Home Exercise Program?

A rehab therapy home exercise program (HEP) is a personalized set of exercises designed by a rehab therapist to be performed by patients at home. The primary goal of a HEP is to complement in-clinic therapy sessions by promoting continued recovery, improving functional outcomes, and preventing further injury through “physical medicine.”

HEPs are tailored to the specific needs, conditions, resources and limitations of each patient. These home exercises typically target areas that need strength, flexibility, or mobility improvement.

Common exercises include:

  • Strengthening Exercises. These exercises target muscles that need strengthening due to injury, surgery, chronic conditions, or general imbalances within the patient’s kinetic chain.
  • Flexibility and Stretching. These movements are prescribed to improve the patient’s range of motion and reduce muscle tightness and tension.
  • Balance and Coordination. Especially in older adults, balance and coordination exercises enhance stability and prevent falls.
  • Aerobic Exercises. Prescribed cardio workouts promote cardiovascular health and overall fitness improvement.

A typical HEP outlines how often and for how long each exercise should be performed. This schedule is important for ensuring consistency and effectiveness throughout a patient’s entire plan of care.

Programs also typically come with clear, easy-to-follow instructions that ensure patients perform each exercise safely and correctly. This may include written descriptions, illustrations, or video/virtual demonstrations to guide patients through each step of the program.

Why Don’t Patients Comply with Home Exercise Programs?

For rehab therapists, it can be frustrating when patients do not comply with treatments or complete their HEPs. In this frustration, it can be easy to chalk the issue up to laziness or a lack of motivation. However, the causes of noncompliance are often much more complicated.

Patients often face several challenges when it comes to following through on these home-based rehabilitation programs. According to a study published in the National Library of Medicine, there are several reasons patients typically do not fully commit to their HEPs.

Self-Efficacy

This is defined as a person’s belief in their ability to complete a task or achieve a goal. In other words, self-efficacy is about believing in oneself, which is a struggle for some patients. This can be especially true for patients who have suffered an injury or medical emergency that requires a long recovery time.

Threat and Beliefs

The beliefs a patient has regarding their conditions can also impact HEP adherence. For example, one study found that patients who did not perceive their injuries or illness to be serious had lower levels of adherence than those who perceived their condition as a threat to their preferred quality of life.

Locus of Control

Locus of control refers to a person’s perception of the underlying causes of events in her or his life. In other words, is one person’s destiny controlled by themselves or by external forces? Studies show that those who have an “external” locus of control are less likely to adhere to medical interventions, such as a HEP.

Pain

Beyond the psychological factors, the existence of pain is an unsurprising barrier to performing and completing a HEP. Those who experience pain during an exercise are less likely to complete the workout, which isn’t necessarily a bad thing. The inability to immediately provide this feedback to one’s rehab therapist (“It hurts when I do exercises A and C”), however, can slow recovery.

Physical Activity

Patients who are generally more physically active or who identify as such are more likely to adhere to a HEP than those whose baseline activity levels are generally low. Those in the latter group generally require additional levels of motivation, accountability, and perhaps even gamification to complete their home-based rehabilitation programs.

Forgetfulness

It’s not uncommon for patients to simply forget what they’ve been told in the clinic. One study even suggested that patients immediately forget 40% to 80% of the medical information and recommendations they receive from a clinician. This can directly impact adherence to a HEP.

Improving HEP Compliance with Technology

The application of both common and innovative technological tools can significantly enhance home HEP in rehab therapy.

By addressing various barriers while improving communication between patients and rehabilitation professionals, innovations, such as automatic reminders, specialized digital solutions, wearable tech, and FDA-approved remote therapeutic monitoring (RTM) devices (i.e., tracking apps), can boost HEP adherence levels.

Here are several ways technology can play a crucial role.

Digital Reminders and Alerts

Mobile apps and wearable devices can send automated reminders and alerts to patients, ensuring they don’t forget their prescribed physical therapy, occupational therapy, or speech therapy exercises. These reminders can be scheduled based on the patient’s daily routine, making it easier to incorporate exercises into their everyday lives.

Interactive Home Exercise Programs

Digital platforms and apps offer interactive features such as video exercises and demonstrations, which help ensure patients perform all the movements correctly, effectively, and safely. These platforms often include feedback mechanisms that allow patients to report difficulties or ask questions in real time​.

Progress Tracking and Motivation

Apps and wearable technologies (i.e. smartphones and watches) can track a patient’s progress and provide visual feedback, such as graphs and charts, showing their improvement over time. This visual representation can boost motivation by making the benefits of adherence more tangible.

Personalization of Programs

Technology enables the customization of exercise programs to meet individual patient needs. Apps can adjust exercises based on patient feedback and progress, ensuring that the program evolves as the patient improves, which can enhance engagement and compliance.

Telehealth and Virtual Check-ins

Telehealth platforms allow therapists to track HEPs and conduct virtual check-ins with patients, providing guidance, encouragement, and needed adjustments to the exercise program. This continuous interaction helps maintain accountability and support, which are crucial for adherence. When performed using an FDA-approved device (i.e. an approved remote therapeutic monitoring app), rehab therapists may even qualify for reimbursement through Medicare.

Gamification

Incorporating game-like elements into home exercise programs, such as earning points or rewards for completing exercises, can make the process more engaging and enjoyable for patients. This approach can particularly benefit younger patients or those who find traditional exercise routines monotonous.

Social Support and Community Building

Some platforms offer social features and services that connect patients with support groups or enable them to share their progress with friends and family. This community aspect can provide additional motivation and encouragement, helping patients stay committed to their exercise regimen.

Data Integration with EHR Systems

Technology can integrate home exercise data with Electronic Health Records (EHR) systems, allowing therapists to monitor patient compliance and progress more efficiently. This integration ensures that therapists have up-to-date information to make informed decisions about the patient’s plan of care.

The Future of Rehab Therapy Home Exercise Programs

The future of HEPs is one driven by advancements in technology and a shift towards value-based, patient-centered care. As rehab therapists integrate RTM and digital health tools into their practices, they can offer personalized and engaging exercise plans that fit seamlessly into patients’ lives.

These innovations will enhance compliance while also providing real-time access to feedback and support, making it easier for patients to stay on track. Improving HEP compliance will mean better outcomes, faster recovery times, and higher patient satisfaction, which are essential metrics in today’s healthcare landscape.

Therapists can leverage data-driven insights to tailor interventions more precisely, fostering a proactive approach to rehabilitation. As we move forward, the collaboration between patients and therapists, supported by innovative tools, will be key to unlocking the full potential of home exercise programs and delivering exceptional, patient-centered care.

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