Patient Compliance and HEP

adherence

the extend to which a person's behavior (taking meds, following a diet, and/or executing lifestyle changes) corresponds with agreed recommendations from a healthcare provider

two types of adherence/compliance

- in the clinic: attendance, participation

- at home: performance of HEP

lower level fitness at baseline is associated with (BETTER/WORSE) adherence

worse

lower participation during a session is associated with (BETTER/WORSE) future attendance

worse

previous issues with adherence is associated with (BETTER/WORSE) adherence

worse

higher level athletes are associated with (BETTER/WORSE) adherence

better

psychological barriers that are associated with less adherence

- low self efficacy

- baseline depression

- anxiety/stress

- helplessness, less personal control, less stability

- low self motivation

sociodemographic barriers that are associated with less adherence

- age (low and high end)

- worse social/family support

- more perceived barriers to exercise

- lower socioeconomic status

clinical barriers that are associated with less adherence

- presence of comorbidities

- pain at baseline (very patient dependent)

- worsening of pain with exercise

- longer treatment duration

- higher BMI

- higher levels of functional mobility (lower levels of disability)

higher perceived health and function has (BETTER/WORSE) home based adherence

better

patients who had issues with adherence previously have (BETTER/WORSE) home based adherence

worse

strong negative emotions have (BETTER/WORSE) home based adherence

worse

higher self motivation associated with (BETTER/WORSE) home based adherence

better

stronger desire to adhere is associated with (BETTER/WORSE) home based adherence

better

higher baseline physical activity associated with (BETTER/WORSE) home based adherence

better

higher levels of stress associated with (BETTER/WORSE) home based adherence

worse

patients who focused on their injury have (BETTER/WORSE) home based adherence than those who try to not think about their injury

better

if HEP feels doable, adherence is (BETTER/WORSE)

better

if patient perceives PT to be beneficial, adherence is (BETTER/WORSE)

better

more exercises given in HEP is associated with (BETTER/WORSE) home based adherence

worse

PT guided exercise is associated with (BETTER/WORSE) home based adherence

better

how to promote adherence

- education and information

- goal setting

- self-monitoring

- personal feedback

- motivational interviewing

verbal educational information

- educate on diagnosis, prognosis, and plan/purpose

- ensure patient understanding (teach back!)

written educational information

- information on diagnosis and prognosis

- information on treatment plan

written educational information is typically written at what grade reading level

5-8th

motivational interviewing

- technique to assist patient in reaching goals

- question based

- assist patient in finding answers on their own

- questions come from a place of wanting to learn about the patient

What is viewed by PTs as a vital component of the plan of care

HEP

strategies to improve adherence/compliance in HEP

- provide verbal and written instructions

- use of visual aids

- self report

- PT involvement

- wearable devices

- limit # of exercises

web and app based HEPs have (BETTER/WORSE) adherence than paper copy

better

types of wearable devices

- pedometer

- accelerometer

- inertial sensor

# of exercises that have highest adherence rate

2-3

# of exercises that have lower adherence rate

4+

what to do as HEP increases in size

- remove older activities that are no longer needed

- different activities for different days

- create options for each deficit