4 Tips to Creating a Home Exercise Program Your Patients Will Actually Stick With

I can remember a time early in my clinical practice when I made the mistake of documenting, rather bluntly, a patient’s noncompliance with a home exercise program (HEP). As a result, the patient’s authorization for further visits was denied because the case manager deemed the patient non-compliant. The questions presented themselves:

• “Did I do enough?” 
• “Could I have done more to engage this patient to follow through?” 
• “Why is patient adherence to exercise programs so difficult?” 

Improving patient compliance goes beyond just the HEP; however, having the means to engage patients in care beyond the walls of your clinic is a necessary step in improving (and accelerating) recovery over time.

Necessity is the mother of invention.

With the onset of the COVID-19 pandemic, caseloads around the world disappeared and patients were left with no mode for communication or follow-up in their care—pushing the need for an effective and comprehensive HEP front and center. As James Heather, Chief Scientific Officer of Cipher Skin, stated in the 2022 State of Rehab Therapy Industry report, “PTs have long known that patient adherence and compliance rates are not ideal, but there was no reason to pierce the clinic/home divide—until COVID-19 provided a reason to put devices, apps, and services in homes.

Since then, we’ve continued to witness the rise in digital HEP adoption and usage. Per our aforementioned report:

• 22.5% of rehab therapy professionals reported using a digital HEP for the first time last year; and
• Nearly 18% of respondents stated that they are looking to invest in home exercise program (HEP) software, making it the second-most sought-after piece of technology after EMRs.

We as rehab therapists have an opportunity to connect with our patients on a deeper level outside the clinic with interactive and intuitive software for HEP adherence and outcomes tracking. 

Given the growing popularity of this software—and the opportunity it provides therapists to connect with patients in a meaningful way outside of the clinic—we thought it helpful to provide some guidelines on HEP best practices. Let’s dig in!

1. Seek active engagement with patients.

For many years, the accepted HEP was a piece of paper periodically given to a patient with a few, somewhat applicable, exercises and arbitrary sets and reps with no further follow-up expected. This is no longer the norm, nor is it acceptable. According to our own PT Patient Experience Report, communication (specifically, that which occurs in between visits) is the number one driver of patient-perceived success. What’s more, 83% of patients who received their exercises digitally reported HEP success.

These two data points fit together quite nicely as digital HEPs enable providers to: 

• Effortlessly communicate with their patients, providing encouragement and those between-visit interactions that are so valuable to today’s patients; and 
• Monitor patient progress in real-time—which is a perfect segue to our next tip.

2. Make adjustments when needed.

There is a common saying between patients and physical therapists. We (the PTs) can always tell who has and has not been doing their HEP. But, wouldn’t it be nice to actually have a device that can help you track patient progress when they’re not in the clinic, helping inform your conversations with them the next time they see you? Digital HEP platforms can help therapists gain the inside track on how well their patients are sticking to their exercises, signaling when they may need an extra push or if adjustments are needed to their assigned exercises in order to get them back on track. This direct line of visibility can help therapists make better decisions regarding plans of care, thus boosting patient outcomes in turn. 

3. Less really can be more.

A mentor once told me, “give your patient 10 exercises and they will never do them—but, give your patient three simple and targeted exercises and they’re hooked.” A patient is never more invested than on their first day of therapy when they hurt, they cannot walk, or they want to get healthy. Whatever the reason, the patient is most excited and looking for progress right out the gate. This is your chance to harness that energy and engage your patient in the therapeutic alliance, but if you throw a deluge of exercises with funny names and weird positions at them, that excitement can disappear faster than the current state of peanut butter on grocery store shelves.

It should also be noted that including a brief description of each exercise in your patients’ HEPs is essential to reducing your patient’s learning curve. These overviews can also provide you with an opportunity to provide patients with direction even after they leave the clinic and give specific reminders that can nip patients’ wayward tendencies in the bud.

4. Create exercises that are specific to each person.

Although the HEP should not be overkill in the number of exercises assigned, the exercises given to the patient should not be too easy, or worse, boring. To ensure this doesn’t happen, tailoring an HEP to the individual is paramount. A recent study revealed that when treating chronic low back pain, younger patients preferred a challenging environment with visual and dynamic support while older patients preferred the possibility of supervised guidance for support. This can easily be achieved with a sophisticated HEP platform that not only enables you to work with your patients to build an individualized HEP, but also uses a library of instructional videos to help them better understand how to do each exercise.

The era of remote therapeutic monitoring is at hand.

Plan of care compliance is an issue that goes beyond just HEPs and can apply to the whole continuum of care. A simple handout, handshake, and see ya later will no longer suffice. The time spent following up on HEP adherence, as well as accompanying patient education, is now reimbursable with the new remote therapeutic monitoring (RTM) CPT codes. Not only is RTM now seen by CMS as an integral part of the industry’s shift toward value-based care, but it is also an effective way for practice owners to boost patient satisfaction, engagement, and clinic revenue.

Presently, there are limitless links on the Internet that will flood patients with quick fixes and “best” exercises to help cure their musculoskeletal ailments—often either confusing patients further or encouraging them to stop therapy altogether. But, with digital HEP platforms, rehab therapists have an opportunity to blend in-person care with targeted and efficient remote plans of care to accelerate recovery—and mitigate the urge some patients have to see what “Dr. Google'' suggests.

If you have other HEP tips, feel free to add them to the comment section below!