Improving Home Exercise Program Adherence in Physical Therapy

Research shows that only 35% of physical therapy patients fully adhere to their plans of care. I’ll let that sink in for a moment, because that number is staggeringly low. It turns out that most patients simply aren’t doing their prescribed physical therapy home exercise programs—and the most common reasons cited are lack of motivation, questions regarding self-efficacy, and perceived barriers to exercise. While it’s true that our patients are ultimately responsible for being actively engaged in their care, there’s also room for us—as rehabilitation professionals—to do more when it comes to helping our patients complete their home exercise program and their full course of care.

Many PTs are still following an outdated process.

Our jobs don’t end after our patients leave the clinic for the day. In fact, most patients perceive physical therapy to encompass the entire injury recovery process—from initial evaluation to well past discharge, and at every step in between. If you can get your patients to adhere to their home exercise programs, you can simultaneously improve their outcomes and their perception of their experience with physical therapy at your clinic. Unfortunately, though, when it comes to HEPs, many PTs are still following the same process they’ve been using for the past few decades—a process that clearly doesn’t work:

1. Create patient’s exercise program.
2. Give patient a print-out of said exercise program.
3. At each subsequent visit, ask patient if he or she completed the home exercise program (at which time the patient will likely say something to the effect of, “Uh, yeah”).

There’s a better way.

But, there’s a better way—namely, teaching your patients the importance of completing their home exercise programs and empowering them to believe they can do so. First, though, you’ve got to believe that your actions can actually produce the desired results in your patients, because they can. Here are five strategies to help you help your patients:

1. Share how the home exercise program impacts your patients’ functional goals. In other words, help your patients develop the motivation to complete their homework by explaining to them how doing so will actually benefit them. And make it personal by connecting the specific exercises you’re providing with your patients’ motivation for attending therapy. That way, you’ll have buy-in from the start.

2. Provide structure. Many patients aren’t regular exercisers, and one of the biggest barriers for these patients to comply with their home exercise program is that they don’t have the behavioral strategies and habits in place that are necessary for success. So, talk to your patients about their schedules. Learn when they’re busy and when they’ll be able to fit exercise into their day. Then, help patients create a structure for their exercises—and encourage them to enter the times they’ll complete those exercises into their planners or set smartphone reminders to keep themselves on track.

3. Give patients permission to make their HEP work for them. Many patients believe that exercises are all-or-nothing. So, they’ll wait to have an open hour or two before starting their exercises. But, breaking up their routine throughout the day can be an easier way to stay compliant. A quick 15-minutes is better than nothing, and several 15-minute exercise sessions can quickly add up to a full program.

4. Get patients tracking their progress. It’s a great way to help patients improve their sense of control and accomplishment—and that can translate into improved confidence and self-efficacy.

5. Focus on the goals. Encouraging your patients to set short-term measurable and attainable home exercise goals can improve their intrinsic motivation—and achieving one goal will help them gain momentum to complete the next.

6. Make yourself available. A lack of social support can dramatically hinder a patient’s progress, so let your patients know that you’re available to provide support and that you’re invested in their recovery. You may even want to check in with patients after hours to discuss home exercise program progress and answer any questions they may have. Patient engagement software can be a big help when it comes to providing consistent outreach.

Now, these are broad strategies that are meant to serve as a jumping-off point. After all, every patient is unique—and has unique challenges that will require a unique approach. A one-size-fits all solution isn’t going to help your patients succeed. But, by focusing on the patient-provider relationship—and being a source of encouragement and support—you can help your patients overcome their barriers, comply with their home exercise programs, and thus, improve their therapy outcomes.

What strategies have you successfully implemented in your clinic to help improve home exercise program adherence? Share them in the comment section below.