Back-care-cise Monitored Therapeutic Exercise Program 
 

The greatest challenge associated with home rehabilitation procedures is overcoming patient inertia and lack of motivation. Half of all people who begin a vigorous exercise program drop out in the first six- 12 months (Martin, 1985). In general, compliance has been found to be lower with vigorous exercise programs than with moderate or lower intensity programs (Sailis, 1986). When it is reduced to five-ten minutes a day compliance can be expected to be considerably higher than for other, more vigorous forms of exercise. There is increased compliance with a home based exercise program as compared with a group based program (King, 1991).  

The Back-care-cise program requires very little effort from you and can improve your clinical results by increasing patient compliance to exercise.  

The three main components that help build compliance 

1.   A method to hold patients accountable                             Doctor's Price List

2.   Short, easy and rewarding end goal

3.   Simple procedures for patients to chart and see progress

 

1. Progress Reports Help Hold Patients Accountable

One of the key components to compliance is accountability via the Patient Progress Reports. With these the patient feels that someone is paying attention to whether or not they are doing the exercises. And it requires little or no time and effort on the part of the doctor.

The program can be as simple as handing the patient a tape and a progress report and asking them to bring the report back a week later. The patient then checks off how they feel doing each exercise, (with four progressing choices for each exercise).  Even more simply they can just check that they did each one, as they are doing them.  You can also have them write comments on the report  regarding any exercises they are challenged by or check off ones that they liked a lot, (which will be used in creating the end goal).   

With this the patient feels that somebody is paying attention to what they are doing and how they are feeling, which short of being there or having them do exercise in your office, is hard to achieve. Your patients now have someone to report to. This can be the doctor or the designated CA. It has been my experience that Patients will sometimes fib about what they have done and not done, but most people will not lie on paper. It all goes back to our school days when we were required to turn in our homework. There was no getting out of it!

When complete it only takes a few moments to look at the progress report, acknowledge them for following through with the videos, and possibly make a brief comment regarding their experience with the exercises.  (perhaps eliminating any that cause undue pain)

 

2. Set an End Goal

Just as it is effective for compliance to treatment recommendations to outline a program of care from the start, it is also effective to outline a program of diminishing frequencies and intensity for home exercise prescription.

It is recommended that you institute the video tape program, in a similar manner that you begin a treatment program -- with a "report of findings" in which you let the patient know what they can expect in terms of time, frequency, duration and monetarily. At this time you give them the end goal. Which is that once they have progressed through one to three videos, and have sufficiently learned the exercises well enough to do them on their own, you will be giving them their own personalized 5 to 10-minute routine that they can perform daily, no longer with the aid of the videos.  This short routine can be comprised of the exercises they checked off as having felt “right” to them, or any you specifically think they should be doing. (more information on each exercise can be found in the Doctors Manual). 

After having worked with the approximately 20 min of exercise on the videos through the earlier stages of treatment, the patient is usually willing and happy to engage regularly in a shorter daily routine as they have now established a habit of exercise. Research has shown that compliance to these shorter routines is quite high. The monitoring process, i.e. progress reports and flexibility exam (described below) will allow the patient to be aware of their improvements which helps them stick with it during the earlier phases until it become habit. The simplicity of the short end goal routine along with the many benefits of how they feel when they do even a few of the exercises regularly, supports their continued compliance. Many patients actually make it a part of their health routines for the rest of their lives.

3. Charting Progress  

A. Flexibility Exam

The motivation to follow through can be enhanced by having the CA do the very easy, three  minute flexibility exam, which gives the patient the opportunity to more concretely see results of their progress as well as provides more substantiation for insurance companies. This brief evaluation and its explanation is included in the Doctor's Manual or the Drs. Starting Kit

It is recommended that the test be performed before they begin with the tapes and every two weeks after that, until they are given their short end goal routine.  These exams along with weekly reviewing of the Progress Reports supports the Program fee  (should you decide to do the whole program rather than just hand out individual tapes). Suggestions for charging and billing are described in Billing Procedures

B. Patient Progress Reports

These simple questionnaires rate patient’s subjective experience of each exercise from one to four. This report, which they simply check off, should be returned to the doctor or CA once a week. 
These reports 
      1) hold the patient accountable 
      2) serve as a feedback communication system, 
      3) make the patient clearly aware of their own progress, 
          and thus motivated their improvements.    

Extended Program Recommendations
For more Details and Scripts to insure best compliance click here

   
Additional possibility for increased compliance to 
Exercise recommendations:

Official Recognition

It has been shown in polls that employees are motivated by a job that not only pays well, but of equal importance is acknowledgement for what they do. Outward acknowledgement can also be used for exercise compliance motivation. For example, a waiting room sign that lists the patient's name under a heading such as "Home Care Successes" with a star after the name for each week of successful completion. Another possibility is enthusiastic office staff acknowledgement of patient after completion of a phase of home rehabilitation, such as moving from tape A to Tape B