In musculo outpt's a HEP and self management is strongly enforced and is crucial to injury management. One pt with recurrent LBP came to physio with that aim of easing her pain and maximising function. After an initial Ax and Rx she reported feeling much better, eagerly accepted a HEP, and felt good that she was now armed with exercises/stretches to improve her injury. She was then booked in for the next week for a follow-up appointment.
On the next session, the pt reported that she felt worse later that day after the initial Rx, and was at baseline pain during the week. When i asked if she had been doing her exercises/stretches, she reported she had not attempted any of them, and didnt really want to correct her posture. At this point i was thinking "why are you making the effort to come here and not follow advice, and why am i bothering to give you Rx, the results of which will only be maintained with a HEP". She apologised for not doing the exercises, and assured me the next lot of exercises will be performed as much as i prescribed. When it came to the end of the session, we went through the same exercises that she was unable to remember, and i added in one more for a new problem she presented with. 2-3 additional ex's more would be optimal but i suspected i had more chance of getting compliance with 1 vs 3 ex's.
This situation made me wonder what some people really expect from physio, probably just a quick fix Rx then your on your way. Prior to this encounter i thought that people coming to physio would happily receive a HEP and perform it as instructed to maximise their benefit, after all they are going out of their way for Rx. I dont think this pt in particular realised that a chronic injury requires 'chronic' management, that is usually a change in posture and motor control/muscle length etc. With this experience, appreciating how some pt's may feel about physio, i will aim to emphasise a HEP more to hopefully optimize compliance and results.
1 comment:
I think you can just tell whether a patient has been doing his/her exercises or not. When you ask them, their face tells all. Though some patient thinks if they don't do it they'll get into trouble, similar to not doing your homework at school! I mean, it's a benefit for them, not us. It means they get better, more movement and functionality and less physio (less $ if ur paying!).
I agree with the fact when prescribing an exercise program you need to consider compliance as well, but another important aspect is being realistic about it, you can't really expect a patient to be doing his/her HEP 3-4times a day if they work full time. I had a scenario where i really wanted a patient to perform the exercise 4times a day because i knew it would really help with the condition, in the end, i had to customise some of the exercise so she can do them while she's at work (making them more functional and easy to perform)
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