How effective do you find current home exercise methods?

[Judith Mollet]

my answer fully endorses fyzzio's comments. And if you have a number of patients doing exercises at home is it really realistic to buy in masses of equipment? You can't supply everyone all the time. The only thing I give out free for ever is theraband which costs a lot! Swiss balls have to be bought by patients after they become interested in using them. Using a bit of imagination and correct instruction and motivation anything is possible. And if compliance for some reason is still not enough then the best programm will fail.

[quorthon]

we should also remember the reason why many patients dont comply easily with home exercises programm....I believe the reason might be 2 about it: First of all many therapists dont explain very well the SPECIFIC goals of a home exercise programm, they just give the patients a "passive" treatment regime and they tell them to do a couple of exercises, as a nice "extra"...By doing this many patients dont give full attention and in the long run they abandon completely the home exercises...Secondly there is an trend for many colleagues to prescribe a huge "pack" of exercises which may require inquipment that the patient don have them or cant afford them..Consequently they get frustrated because of this "non-practical" exercises and abandoned also the whole programm....
My opinion is that a patient with a MECHANICAL problem which is responding well to specific forces, should be advised to duplicate this one at home, most of the times it will be only ONE exercise not a dozen of them!!!

[gcoe]

I agree that to be effective most of the time our patients have to exercise and to take on a self management role in exercise. – and it almost doesn’t matter which area of physio you are working in, the evidence points to the importance of physical activity and exercise. However I think we have some very simplistic notions about why our patients do or don’t exercise. There is actually a huge amount of research into the area and as physios, despite often knowing in the clinic how big a problem this is we don’t make use of what is available.

Here are three myths as physios we often hold:

#1 Patients are passive recipients of therapy.

I know we don't like to think we consider patients this way but in practice we often do. Just listen to our language. We talk about the compliant patient vs the non compliant patient or whether the patient complies with our advice. Yet this term compliance (originally a medical term) has been dropped from the literature a long time ago. It has quite paternalistic overtones. The health psychology literature now talks about whether patients adhere or not to advice or exercise. This term suggests a more realistic role for the patient: someone who actively adheres to taking a medication, performing an exercise or undertaking lifestyle change - an active manager of their condition.

#2 It is the presentation of information that matters. If we get the the right way of delivering the info all will be well.

If we only package the information into smaller units, or explain the purposes of exercise better, present the information in better ways eg visual diagrams, using videos or photos etc. etc. we will improve adherence. Yet the health psychology literature doesn’t support this. In contrast, understanding patients perceptions and beliefs about their condition and the treatment eg:

1. Self efficacy (the confidence that one can make a meaningful change)
2. Readiness for change (eg stages of change)
3. Perceptions of illness (eg how big a hold it has on me, what caused it, can I control/cure it)
4. perceptions of the treatment (how beneficial is it vs how harmful may it be)

seems far more important.

#3 If the patient doesn't comply (sic) we blame the patient

If the patient doesn't take our advice and put it into practice we tend to blame them as "unmotivated", "non-compliant". We may then "confront them" and if they still refuse, we withdraw assistance. This tendency to blame the patient often arises out of our frustration with the patients behaviour. Yet the literature seems to suggest that patients often have well-formed and real reasons for not adhering of which the therapist isn't aware. These well formed reasons may be incorrect, in fact they may seem quite bizarre to us but they have been reasoned through by the patient and until these are explored and worked through you may as well hit your head against a brick wall.

I haven't referenced any of this but if you want to know more feel free to get in touch. However here are a couple of general readings that might be worth taking into account:

Adherence to Treatment in Medical ... - Google Books

this chapter in this text is getting a bit out-of-date but it does layout some of the issues around adherence specifically to physiotherapy.

WHO | ADHERENCE TO LONG-TERM THERAPIES: EVIDENCE FOR ACTION

This page has the WHO report on adherence to chronic conditions- a landmark document published in 2003. There are some downloadable PDFs but I warn you it is a massive document. While this is mainly about medications it is also about lifestyle change and makes for great reading about the extent and complexity of the problem. As the management of chronic conditions of one sort or another this is really our key area we deal with this is something we should be much better informed about.