On my current prac I am treating a number of patients with back pain due to poor postural or motor control. Treatment of these patients includes a 'hands-on' element, but the main emphasis has been on prescribing a convenient and simple home program to help strengthen their often VERY poor core stability muscles. However, most of these patients come to their subsequent treatment sessions and have very obviously not done their home program, or have only done it once and not correctly. Obviously this can be very frustrating for the therapist, and it happens not only with back pain patients but patients with any number of problems.
From this experience I have discovered the importance of explanations to patients in terms of treatment progressions and importance of self management. Often they are expecting a quick fix, or a 're-adjustment' to cure their pain, only to have a recurrence of this same pain weeks or months down the track. Often all it takes is a simple explanation of WHY we are getting them to do all of these exercises, and how long they might have to do them for, and then the patient can take more control over their recovery. Simple education can do wonders for compliance, as a number of people I have spoken to have revealed that the reason they don't perform their HEP is that they can't see the relevance of it, and don't understand that muscle activation is not instantly automatic.
For the remainder of this prac, and in future clinical practice I will ensure that each exercise I prescribe a patient is relevant, and the patient knows why they are doing it. Because after all, it's their body!!!
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2 comments:
I think that is a valid point - we are so used to prescribing exercises that can seem very simple and pointless without a reasonable understanding of the pathology and rationale for treatment. I have found that considering things from the patient's viewpoint - don't assume they know things, clarify what they understand by your explanations and explain things they don't understand - can make the world of difference to their attitude to taking an active role in their rehab.
I think it is really important also to explain that the exercises (in most cases - especially core stability type exercises) are beneficial to basically everyone, all the time - not just when they feel pain. Prevention is more effective than the cure and compliance is often lost after the pain is gone, as you said. Explaining the role of continuing the exercises after the pain subsides throughout the rehab process rather than in the last session may be a way to improve their compliance.
Its worth asking your patient why they are doing an exercise when you reassess them-even if you taught them why. That way you are assessing knowledge as well as performance. Often have to assist pt learning (teach)more than once for pt to understand sufficiently to want to comply ie for it to be taken on as their goal rather than yours. Good learning on your part.
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