It is well-known that the field of physiotherapy, like many other forms of healthcare, is not immune to poor patient adherence.
Although the extent of non-adherence isn’t quantified well enough, the problem is fairly recognized and understood. Patient adherence reports are limited to the early 1950s and late 1990s, making them outdated and not statistically accurate or consistent with the current decade or population.
Why is patient adherence to physiotherapy important in the first place? As a clinician, is it necessary to understand the extent of adherence your patient has to his home exercise program? To put things simply, it is very important for therapists to understand the extent of an individual’s loyalty to his exercise for a variety of reasons. Should a patient fail to improve his well-being through treatment, a therapist should know whether it is the fault of the treatment protocol or plainly low adherence. If the problem lies within the patient’s reduced coherence to his HEP, then the therapist has no need to change his protocol, but if the clinician misunderstands and changes his treatment, the client’s prognosis may become poor.
Now that it is understood that low adherence can cause negative effects on the outcome of physiotherapy, let us try to understand the reasons or causes of poor adherence. To understand why it is first important to keep an open mind to the existing problems of society. It is important to understand that depression, anxiety, and various other mental illnesses truly exist and are major problems in the world. According to Kristen et al, the various barriers to physiotherapy adherence are divided broadly into 3 categories, namely, physical barriers, socio-demographic barriers, and psychological barriers. The specific barriers found are, but are not limited to, – low aerobic capacity, low levels of exercise tolerance, low self-efficacy, high levels of depression, anxiety, high degree of helplessness, age, and poor family/financial support.
In order to improve patient adherence rates, the barriers listed above must be addressed and solved up to the therapist’s capacity. Ways in which this can be achieved are actively conversing with patients, identifying behavioral flags, and showing empathy. This is the first step in order to improve patient prognosis and health.
Active use of the FABQ questionnaire can help therapists understand the emotional level of patients which allows for a stronger patient-therapist relationship. Worsening pain during exercise was a barrier to adherence to exercise indicating that strategies to minimize initial pain are important. In most cases, the appropriate use of simple analgesics, heat, or ice coupled with passive physiotherapy treatments, e.g. acupuncture, manual therapy, etc may help to alleviate pain sufficiently to allow patients to adopt more active treatment strategies. Clinicians need to gain a clear understanding of the patient’s pain experience and beliefs about pain and counter those which are maladaptive. Clinicians should reinforce messages which reduce fear or anxiety about pain, e.g. that the presence of pain should not prevent most patients from safely participating in therapeutic exercise and may lead to a reduction in symptoms.
Identification of these barriers during patient assessments may be important in order to adopt appropriate management strategies which help to counteract their effects and improve treatment outcomes. Other ways to improve patient adherence, are displaying a high level of professionalism, and usage of the latest, new and improved technologies that increase a therapist’s credibility and enforces a patient-therapist bond of trust. Questionnaires can be developed to identify certain barriers or to quantify the level of adherence.
Although it is easy to point out the various problems healthcare professionals face, it is not simple to solve. It needs to be accepted that every patient is also an individual, with a unique personality which may hinder their adherence to exercise or therapy. All in all, patient adherence is an active problem that must be addressed and solved with realistic expectations.