Patient adherence to physical therapy regimens is critical to a smooth and rapid recovery. However, adherence to such regimens remains imperfect and influenced by complex factors.
Research dating back to the 1990s had already identified, as barriers, (1) patient-perceived barriers, (2) the lack of positive feedback to patients, and (3) the degree of helplessness felt by patients [1]. Along the same lines, additional research has since confirmed that, for patients with chronic low back pain in particular, adherence to home-based exercise programs could be facilitated by increasing the attractiveness of programs and promoting a feeling of being supported [2]. New technologies improve the efficacy of physical therapy without being able to replace the human relationship between patients and providers. Most recently, research has revealed that, despite progress, barriers to adherence to physical therapy regimens remain. These include time constraints, physical environment (e.g. location), and negative exercise experiences. In addition, the worse the patient prognosis, the worse the compliance on average [1].
Several trends have been identified in patient adherence throughout the years. While no difference has been conclusively identified between men and women, less educated patients have been demonstrated to be slightly more compliant than more highly educated patients [1]. In general, research has also identified that non-compliance is more strongly linked to the characteristics of the illness than to the presence of the illness [1].
Efforts should be made to incorporate an individual’s needs into strategies aimed at boosting their adherence to the physical therapy regimen. As such, factors shown to promote patient adherence include social support and positive exercise experiences. Interventions to this end include behavioral reinforcement and the modification of exercise programs such as to best tailor them to patients, rendering them as enjoyable and convenient as possible [3]. Relatedly, the fewer the exercises, the better the compliance: Adults over 65 years of age who were prescribed 2 exercises were found to perform better than subjects prescribed 8 exercises [4].
This said, strategies should differ depending on whether they are aimed at encouraging short-term supervised or long-term non-supervised adherence: Interventions based on behavioral theory are appropriate for boosting short-term results, whereas a self-regulation approach can be leveraged to enhance long-term results [5].
Broadly, it is critical that physical therapists carefully assess the problems encountered by patients, gravitating towards solutions which incorporate the feedback of patients [1]. Consistently, another study focused on patients suffering from osteoarthritis of the knee has suggested that health care providers need to understand the reasons for patient non-compliance if they are to provide supportive care, while researchers need to focus on qualitative research in order to better understand and ensure patient adherence [6]. Indeed, as a general rule, data has demonstrated that a patient-centered physical therapy program results in higher patient participation, is likely to improve physical activity in less active individuals, and results in greater patient satisfaction [7].
Nonetheless, key challenges remain. First, current theories only partly explain patients’ non-compliance. Second, health care providers should become more informed with research findings overall, in order to make clinical decisions based on up-to-date data [5].
In conclusion, patient adherence to physical therapy regimens requires an individualized tailoring of the regimen, buoyed by additional research.
References
1. Sluijs, E. M., Kok, G. J., Van der Zee, J., Turk, D. C. & Riolo, L. Correlates of exercise compliance in physical therapy. Phys. Ther. (1993). doi:10.1093/ptj/73.11.771
2. Palazzo, C. et al. Barriers to home-based exercise program adherence with chronic low back pain: Patient expectations regarding new technologies. Ann. Phys. Rehabil. Med. (2016). doi:10.1016/j.rehab.2016.01.009
3. HOLT, C. J. et al. Sticking to it: A scoping review of adherence to exercise therapy interventions in children and adolescents with musculoskeletal conditions. Journal of Orthopaedic and Sports Physical Therapy (2020). doi:10.2519/jospt.2020.9715
4. Henry, K. D., Rosemond, C. & Eckert, L. B. Effect of number of home exercises on compliance and performance in adults over 65 years of age. Phys. Ther. (1999). doi:10.1093/ptj/79.3.270
5. Sluijs, E. M. & Knibbe, J. J. Patient compliance with exercise: Different theoretical approaches to short-term and long-term compliance. Patient Educ. Couns. (1991). doi:10.1016/0738-3991(91)90060-I
6. Campbell, R. et al. Why don’t patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee. J. Epidemiol. Community Health (2001). doi:10.1136/jech.55.2.132
7. Bade, B. C. et al. A Patient-Centered Activity Regimen Improves Participation in Physical Activity Interventions in Advanced-Stage Lung Cancer. Integr. Cancer Ther. (2018). doi:10.1177/1534735418781739