Why patients don’t do their exercises

According to Dean et al (2005), only 37% of patients with low back pain actually do their exercises as prescribed by their health practitioner. This figure is astonishingly low, and obviously will contribute to poor patient outcomes, and low job satisfaction for the practitioner who has a vested interest in patient well-being. A practitioner who is able to get their patients exercising correctly will get better outcomes, have happier patients, and over time this will lead to a greater number of referrals. So why are patients not doing their exercises? Here are a few thoughts…

1. They don’t understand why it will make them better. If you are going to give your patient an exercise then you need to have a very good rationale as to why they are doing it. If they were to ask you, and you couldn’t answer it confidently, then reconsider the exercise. Even if they don’t ask you, tell them why they are doing it. When patients understand the rationale behind it, and how it will make them better, they are far more likely to do it (Sluijs et al 1993).

2. They can’t remember how to do them. A vast number of practitioners still give their patients sheets of paper with stick figures drawn on. Even if the 37% of patients do their exercises, there’s a good chance it will also be done incorrectly. Unclear instructions lead to poor compliance (Sluijs et al 1993). Use of video helps patients understand how to do their exercises correctly (Miller et al 2009).

3. A lack of time. 3 sets of 6 exercises, twice per day, with 3 minutes rest between each exercise? Anyone who works a full time job or looks after a family does not have time for this. More importantly is this actually necessary in order for them to get better? A lack of time is a major reason for non-compliance (Sluijs et al 1993). Keep your exercises to 3 or less as much as possible. If you are really targeted, then this should be more than enough to make a difference.

4. No feedback. If you monitor patient’s adherence to their program and provide them with regular feedback, then they will be more compliant. (Sluijs et al 1993, Escolar-Reina et al 2010). Therefore, have your patients record the completion of their program to help them take control and become more accountable. More importantly give them feedback on their progress by showing their improvements. This helps create rapport, which is also an important factor that leads to greater adherence (Dean et al 2005).

There are other reasons as to why exercise adherence is an issue and they will vary from patient to patient. Good communication is so important to understand the barriers that patients perceive are stopping them from doing their exercises. Only with this understanding can you tailor your approach to ensure that your patients do their exercises, and get better.

REFERENCES

Dean, S. G., Smith, J. A., Payne, S., & Weinman, J. (2005). Managing time: An interpretative phenomenological analysis of patients’ and physiotherapists’ perceptions of adherence to therapeutic exercise for low back pain. Disability & Rehabilitation, 27(11), 625-636.

Escolar-Reina, P., Medina-Mirapeix, F., Gascón-Cánovas, J. J., Montilla-Herrador, J., Jimeno-Serrano, F. J., de Oliveira Sousa, S. L., … & Lomas-Vega, R. (2010). How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study, BMC Health Services Research, 10(1), 60.

Miller, J. S., Litva, A., & Gabbay, M. (2009). Motivating patients with shoulder and back pain to self-care: can a videotape of exercise support physiotherapy? Physiotherapy, 95(1), 29-35.

Sluijs, E. M., Kok, G. J., & van der Zee, J. (1993). Correlates of exercise compliance in physical therapy. Physical Therapy, 73(11), 771-782.