Why patients don’t do their exercises (and how to help them complete their treatment)

“Well, my arm still hurts after two weeks…”

“Does it hurt more or less during exercise?”

“Ummmm… I have to admit I only did the home exercise program twice and then I forgot about it for two days and then I lost the list of exercises.”

If this conversation with a patient sounds familiar, you’re not alone. According to an influential study by E. M. Sluijs et al, up to 75% of patients don’t adhere to their prescribed physiotherapy treatment. And there are some reasons why we should be worried about this number.

The impact of patient adherence on physiotherapy outcome

Patient adherence (also known as patient compliance) has a significant effect on the overall outcome of the treatment. Patients who did all the prescribed exercises regularly recover faster and report less pain.

On the other hand, ignoring the home exercise program or only doing the exercises once in a while can render the entire treatment ineffective and even lead to a higher risk of re-injury. Yes, even the best home exercise program will fail if the patient isn’t actually doing the exercises.

But if home exercise programs are so beneficial, why do so few patients stick to them?

Factors affecting adherence to physiotherapy

The above mentioned study by Sluijs et al. identifies three factors that reduce patient compliance with the exercise program prescribed by a physiotherapist:

• real or perceived barriers (e. g. the exercise plan is too complex or doesn’t fit the person’s lifestyle).
• a lack of positive feedback.
• perceived helplessness.

Other researchers, such as Rob Argent, Kirsten Jack and Martijn F. Pisters et al., have identified a variety of other factors, most notably:

• experiencing pain during physical therapy exercises.
• suffering from depression and/or anxiety.
• the overall length of the treatment (adherence subsides over time).

While we can’t change some of these factors, others are well within our influence.

Strategies to increase patient adherence to exercise

Once we know the factors that reduce treatment adherence in physiotherapy, we can find ways to help patients maintain their motivation and their adherence to the HEP. We’ve listed five proven strategies.

Offer choices

There are very few situations in physical therapy where you just can’t offer a choice. In most cases, you can let your patients choose between several similar exercises or decide how they’ll integrate the HEP into their daily schedule.

Letting patients make their own choices is an invaluable strategy. It reduces the feeling of helplessness and helps patients regain the feeling of control over their bodies and their lives.

Shared decision-making and goal-setting

Physiotherapy is not an interaction between an almighty therapist and a passive patient; it’s a collaboration between two experts. You are an expert on physical therapy and your patient is an expert on themselves.

Think of yourself and your patient as a team that makes joint decisions and works towards common goals. When you work together as a team of equals, you’ll find ways to work around any real or perceived barriers that arise.

Let the patient take responsibility

This strategy builds on the previous one. A patient who doesn’t feel responsible for their health is likely to avoid exercising at home because they expect the therapist to do all the work.

But once a patient has set their own goals, they become responsible for achieving these goals – and responsibility is deeply empowering.

Strive to maximize clarity

If a patient isn’t quite sure how to do an exercise, they perceive it as a barrier and might even ditch the entire HEP. To prevent this and improve exercise adherence, make your instructions as clear as possible (providing the patient with customized written instructions and exercise videos can be quite helpful).

Provide regular feedback

Patients want to know if they’re making progress. They want reassurance that their pain is temporary. They want to know that you care. In short, they need regular positive feedback – otherwise, there’s a risk of early discouragement and frustration.

Fortunately, you don’t have to wait for your next in-person appointment to say some well-deserved words of encouragement. You can establish regular e-mail communication with your patients or opt for chats and video calls.

Find ways to measure patient progress and adherence objectively

Not long ago, therapists had to rely on patients’ self-reports and their own impressions to evaluate the success of a given treatment. Neither of these are objective metrics. Some patients lie about the frequency of their home exercise sessions. Others may underestimate their progress due to depression or other mental health issues.

Today, you can use digital technology to measure patient adherence and evaluate if the prescribed treatment plan is working well.

How technologies can help patients adhere to their home exercise program

There are many ways in which digital technologies can make your work easier (and your patients healthier and happier). Here are just a few.

Neutral, evidence-based progress analytics

Remote physiotherapy software in conjunction with motion tracking devices helps you monitor if the patient is actually doing their HEP – and how well they’re doing it. Patients, on the other hand, benefit from objective data that clearly shows their progress.

Distraction from pain

Distraction is a common strategy for controlling pain, and technology can provide us with highly effective distractions such as video games and VR experiences. This is one of the reasons why gamified physiotherapy treatments can be so beneficial (and one of the reasons why we at Raccoon.World decided to combine gaming and rehab exercises).

Exercise videos and personalized explanations

Exercise videos are a blessing – they make it very, very hard to forget how to do an exercise. In addition, physiotherapy software lets you add personalized notes to each exercise in the HEP.

Staying in touch

Thanks to remote physiotherapy software, you can provide positive feedback as often as your patients need it – and you can also receive immediate feedback from patients.

Maintaining interest even when the treatment is getting too long

Patient compliance with the exercise program prescribed by their therapist tends to decline over time because, sadly, therapeutic exercise by itself is not the most exciting activity out there.

However, gamification can make physical therapy activities fun and motivating for months and months on end.

How Raccoon.Recovery can help you boost patient adherence

We’ve done our best to create a product that helps patients stick to their HEPs until they’ve reached their treatment goals. For this, we’ve combined rehab exercises with gaming to monitor progress, motivate patients and distract them from pain. We’ve also incorporated a library of exercise videos to provide maximum clarity to patients. In addition to this, our software provides ample opportunities for giving and receiving feedback.

To schedule a free demo of Raccoon.Recovery, simply contact us at info@raccoon.world.