How do we improve rehab adherence ? Factors to consider

In this diagram by Cor-Kinetic (Ben Cormack) - Ben outlines factors that should be considered prior to prescribing a rehabilitation plan for a patient. As you can see in the diagram ; the subheadings are as follows ;

The major subheading I wanted to outline here was adherence to the task at hand. Considering the best exercise is the one that gets done, how do we go about prescribing exercises specific to the patient standing in front of you? Elaborating on this, here are some further factors I want to consider in order to promote the best possible outcomes for the patient by improving adherence;

Making sense of the why

How do we expect our patients to go about and do certain things without relating it back their goals? Prior to this, it is obvious we need a pain diagnosis or things to work on to improve efficiency.

Communication is key, in order to relate the rehabilitation strategy to the patients goal. If we can communicate the why effectively, the patients are more likely to see the connection between the prescribed and the goal task, which may improve adherence.

It also might be worth mentioning that some patients may have negative beliefs about exercise, so what we call the task we prescribe may have an effect on adherence. E.g - Patients specifically stating that they never exercise, so we can call their rehabilitation general movement / practice. 

Confidence to perform the task

How do we make the rehabilitation strategy as easy to comprehend and perform, for that particular person as possible? How do we remove barriers to adherence, prior to the consultation ending?

The task given to the person must allow them to perform it confidently, or else the likeliness the task is being completed is already at risk.

Consider the three types of learners (visual, kinaesthetic and auditory). This means patients may either learn more efficiently by seeing, feeling/doing or listening (they can also be a combination of the aforementioned). Practically ;  this means we may have to video the task with verbal cues to focus on or write the task down, with specific guidelines, rather than just set patients on their way.

The biggest mistake I’ve seen clinicians make over the years is rushing task prescription  to the last few minutes of the consult. This often makes patients feel rushed, and leaves them with a lack of clarity surrounding what they actually need complete.

Access to equipment

This one speaks for itself. Prior to task prescription, a question that needs to be asked is what equipment do you have access to?

Equipment needed for the task at bay needs to be easily accessible or guideline based (E.G - this task can be done with X,Y or Z). The reason being, if the person prefers to vary up the task at hand, they have the option to vary the equipment being used, rather than being rigid with rehabilitation. Whether the task can be variable likely depends on the diagnosis, and psychosocial factors specific to that particular person.

Environmental factors

This ties into the above categories, by considering the environment the person is going to be completing the task In.

If a patient lacks confidence to perform certain exercises in a gym setting, and you are prescribing that exercise which can only be completed in a gym setting, is this going to have a positive or negative effect on the patients adherence.

The task at hand needs to be suitable to a comfortable environment that the person has access to, and again will vary for individuals.

Personality traits

Different personality traits may have an effect on an individuals adherence to exercise, whether that being overly or underly compliant with prescription.

Some people may be overly enthusiastic with the exercise advice you may give, and may double or triple the dosage required for a therapeutic effect - in this instance we may need to tone down the dosage prescribed to them, so they only do a favourable amount.

On the other end of the spectrum - others may only do half of what we prescribe - hence the need to increase the volume communicated to the patient.

Prior to exercise prescription, it may be worth having a conversation about the amount someone usually does or is prepared to do, and tailoring the dosage required from there.

Summarising this blog post, the above strategies are things to consider prior to handing out exercises / tasks / movement opportunities to patients. Without considering some of these factors, we are likely to create barriers to the task at hand, which may negatively affect the patients outcome. This is by no means an exhaustive list, however are some of the things going through my head prior to task prescription.