Improve Home Exercise Compliance

Strategies to Improve Home Exercise Compliance

By: Jennifer Heiligman, PT, MPT

As therapists, we know the importance of our patients taking an active role in their therapy plan of care.  This includes the performance of their prescribed home exercise program (HEP).  Unfortunately, research has shown that non compliance can range from 30-50% for rehab therapy patients.  Low adherence to a home exercise program can lead to poor patient outcomes and the inability of a patient to reach their established goals.  We’ve compiled some strategies that when put into place may help improve your patient’s compliance with their HEP.  

Implement a Patient Contract

As discussed in our previous blog “The Patient Contract: Their Role in Their Plan of Care”, the use of a “Patient Contract” is a great way to educate the patient on what they should expect from therapy and what is expected from them.  The aspects of a patient contract include educating the patient on their condition, working with the patient to establish meaningful and functional goals, making them aware of their prognosis, outlining the responsibilities of the therapist and outlining the responsibilities of the patient themselves.   The goal of using a patient contract is that by educating the patient, they then become more invested in their treatment and recovery.  This is one strategy to use to help improve performance of an HEP.  By knowing they have a responsibility in their recovery, the patient may be more compliant with their home exercises.

Prescribe Fewer Exercises

As therapists we always want to provide our patients with the most comprehensive treatment program as possible.  However, when considering which activities to prescribe as home exercises, less is more.  One study published in the Physical Therapy and Rehab Journal showed that patients prescribed 2 exercises perform better than patients who were prescribed 8 exercises.¹  In another study, patients prescribed 4 or more home exercises had a lower compliance rate than those prescribed 2 or fewer.²   While more research is needed to identify the optimal number of exercises, it appears that to promote increased compliance you may want to keep the number of exercises between 2 and 3.

Update the Exercises Throughout the Plan of Care

Taking the above mentioned studies into consideration, if you are prescribing only a minimal number of exercises, it would be best to update those exercises as the patient progresses with treatment.  The same two exercises prescribed at the initial visit will most likely not still be beneficial after the patient has completed multiple sessions of therapy.  By changing the exercises you also help to prevent boredom.   Patients who are supposed to complete the same activity day in and day out throughout the plan of care may lose interest and stop performing their HEP all together.  Increased compliance may be promoted by switching up the exercises.  If you are an OptimisPT user, you can easily update the HEP by quickly discharging activities that are no longer appropriate and adding new exercises from our large actions library embedded in the EMR.

Include Written and Visual Instructions

Many times patients will not complete home exercises because they feel they are doing the activity incorrectly.  To combat this, you will want to do two things.  First, teach the patient how to complete the exercises while in the clinic.  The Teach Back method is a proven method used in many environments to successfully teach a skill or activity.  This method involves first teaching the patient the activity and then having the patient teach the activity back to the therapist.  This helps the patient successfully learn the activity. Second, it is important to provide clear instructions.  The exercise information that a patient has access to at home should include written directions as well as pictures and/or videos showing the patient how to complete the activity.  Good reference material, like that available in OptimisPT, will make the patient feel more confident in performing the exercises correctly.

Use Technology

Adherence to a home exercise program has been shown to improve when coaching and self monitoring are included in the plan.³  These aspects are generally available when delivering the HEP via an app format.  By using an app, like OptimumMe, the patient has the ability to access their exercise program from just about anywhere on their phone or a tablet.  Reminders from the app are automatically sent to the patient to help them remember that it is time to complete their exercises.  Reminders and easy access can help to improve compliance.  In addition, pictures, videos and instructions are readily available for the prescribed exercises within OptimumMe.  The patient is able to submit comments to their therapist regarding specific exercises.  In return, the therapist is able to respond to the patient’s comments or concerns.  This interaction helps to improve the patient’s confidence in their exercise performance.  Within OptimumMe, the patient will receive “badges” if they complete their exercise program consistently.  This provides encouragement and positive feedback leading to increased compliance.

Provide the Exercises in the Patient’s Preferred Format

While we just discussed how the use of an app in providing the patient’s home exercise program may offer features that lead to improved compliance, you must also consider each patient as an individual.  This means that it would be beneficial to have the ability to provide a home exercise program in multiple formats in order to accommodate for each individual patient’s preference.  Some patients may prefer a hard copy piece of paper to review as opposed to a digital version.  If providing the program in a specific format is going to make the patient feel more comfortable and improve compliance, then go for it!  If you are an OptimisPT user you have multiple options available including a hard copy print out, an emailed version or sending the exercises to the OptimumMe app.

Completing a home exercise program is an integral part of a successful rehab therapy plan of care.  If you find that you are having difficulty with your patients remaining compliant with their HEP, try implementing some of the strategies we have described above.  If you are not using an EMR or your current EMR does not offer features that were discussed, take a look at OptimisPT. 

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References:

¹Henry KD, Rosemond C, Eckert LB. Effect of number of home exercises on compliance and performance in adults over 65 years of age. Physical Therapy. 1999 Mar 1;79(3):270-7. 

²Eckard T, Lopez J, Kaus A, Aden J. Home exercise program compliance of service members in the deployed environment: an observational cohort study. Military medicine. 2015 Feb 1;180(2):186-91.

³Argent R, Daly A, Caulfield B. Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence?  JMIR Mhealth Uhealth. 2018 Mar; 6(3): e47.