TIPS IN CREATING HEPs
 
Ways to Improve Exercise Compliance
Start With A Few - Recommending a low number of exercises 1-3 initially is helpful with compliance. [1]
Schedule for Consistency - Setting the exercises as daily or nearly every day can help because repetition helps the patient develop a habit of performing them. [2]  Rehab exercises are typically low level at first and thus daily is usually ok in most circumstances.
Explain and Motivate - The injured worker should know why an exercise or activity needs to be done, and what benefits results from it. Motivation improves compliance with exercise. [3]
Exercise  Review - Have patient perform the exercise in front of you at least once a week.  Is the patient performing the exercise correctly? We can correct the errors and give feedback.  A regular review also helps establish importance of the exercise program to the patient.  Also provide positive feedback and instill confidence to the patient in performing the exercises which helps to improve compliance [4].
Easy Set Up - Rehab equipment that is easy to set up helps to improve compliance. For example using elastic bands attached to doors. Or simply lying on bed to perform stretches, etc. 
Video If available and Keep It Simple - Keep instructions simple and easy to understand. Video instruction and live demo allows for easier understanding of the exercise and has been shown to improve patient retention, acquisition and reduce errors in performing exercises. [5] [6]  Also keeping the number of sets and reps simple with an easy number to remember is helpful, such as 10 reps once a day.

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

[2]  Rejeski WJ, Brawley LR et al. Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability. Med Sci Sports Exerc 1997; 29(8):977-985.

[3]  Friedrich M, Gittler G et al. Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 1998; 79(5):475-487.

[4]  Sluijs EM, Kok GJ, van der Zee J. Correlates of exercise compliance in physical therapy. Phys Ther. 1993 Nov;73(11):771-82; discussion 783-6

[5]  Weeks et. al. Videotape instruction versus illustrations for influencing quality of performance, motivation, and confidence to perform simple and complex exercises in healthy subjects. Physiotherapy Theory and Practice, Volume 18, Number 2, 1 June 2002 , pp. 65-73(9).

[6]  Reo JA, Mercer VS. Effects of live, videotaped, or written instruction on learning an upper-extremity exercise program. Physical Therapy 2004; 84:622-33, http://ptjournal.apta.org/content/84/7/622.full

 

SOME DETAILS ON VIDEO RESEARCH

Dynamic modeling via videotape was more effective than static illustrations for promoting correct form for the exercises [5].  Also, videotape modeling was indicated as more appropriate for encouraging confidence and motivation in an unsupervised exercise environment [6].

Reo JA, Mercer STUDY LOOKED AT NUMBER OF ERRORS [5]

3 groups were looked at:  Live demo (in person), video demo and illustration on paper
Results: Video had half as many errors as illustrations and written instructions
Also, no significant differences found between live demo and video HEP

Weeks et. al. STUDY LOOKED AT ACQUISITION AND RETENTION [6]
2 groups looked at: Video Demo and illustration on paper
Focused on acquisition and retention of a given exercise
Acquisition: can the patient perform the exercise correctly just after being shown it
Retention: Can they perform it correctly after 24 hours


[6]  Reo JA, Mercer VS. Effects of live, videotaped, or written instruction on learning an upper-extremity exercise program. Physical Therapy 2004; 84:622-33, http://ptjournal.apta.org/content/84/7/622.full

 

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