Many health professionals have trouble with getting patients to diligently stick to an exercise program. I know this personally from a previous clinical affiliation where I had people look at me dumbstruck when I asked them if they did any home exercises.
With mobile technology growing more and more prominent in the United States, however, I believe that adherence to home exercise plans could be substantially increased through new exciting and creative methods that embrace mobile technology.
I am going to make this post 2 parts. Part 1 will be a brief summary with regards to assessing the results from a research paper to explain why patients may or may not be adherent to home exercises given to them. Part 2 will be about how mobile technology can increase patient adherence by potentially filling in weaknesses that are explained by the research.
Part one: Factors that affect patient adherence to a home exercise program
Explanation of the study
In one study done in Turkey (I believe patient adherence results can be extrapolated from there and applied to the U.S.) by Dmitry Chan and Filiz Can, adherence by patients to physical therapy home exercise programs was studied. The study sought to find out factors that have an effect on patient’s adherence to exercises given to them. The study had 58 women and 24 men from ages 16 to 75. People with learning disabilities, psychological problems, elite athletes and those with acute or chronic impairments over 3 years were excluded from participating in the study. If patients were included in the study, they were given a questionnaire with 25 questions on a 5 point scale to assess their adherence to the home exercise plan given.
According to the results of the study, there were 8 factors that affected patient adherence to home exercise programs:
The 8 factors that affected patient home exercise adherence
- Motivation
- Understanding of exercises
- The role of the exercises given
- The physical therapist’s verbal explanation given
- The visual explanation given
- The overall explanation quality of the therapist
- Reassessment of home exercises
- Satisfaction with the physical therapist
*Note: The study uses the term ‘physiotherapist’ but I consider that and the phrase ‘physical therapist’ as being interchangeable.
In this study, it was also found that only 60% of therapists conducted follow-ups on their patients to make sure they were doing their home exercises, while 16.7% did it rarely and 6.4% did not do any follow-ups.
All of the above factors combine to lead to decreased patient adherence to home exercises given to them. I believe this DOES NOT HAVE TO BE though. I truly believe that with mobile technology, multifarious creative means can be employed to increase patient adherence to home exercise.
Part two: How mobile technology can save the day with patient exercise adherence
According to their “Wireless in America” brochure, the CTIA, an international trade association that represents the wireless communications industry, mobile technology is MASSIVELY expanding in the United States.
The growth of mobile technology in the United States
- “An estimated 98% of U.S. mobile web traffic in 2015 will come from smart phone users, and the number of wireless Internet users in that time is expected to increase from 84 million to nearly 160 million. -Coda Research Consultancy
- “North American wireless data traffic will double almost every year from 2009 through 2014, increasing nearly 50 times during that time.” -Cisco Visual Networking Index, 2010
- “Today, the average smart phone user accounts for 11 times more traffic than the average non-smart phone user. Smart phone users in the U.S. are expected to more than double from 90 million in 2010 to more than 211 million in 2015.” -Informa Telecoms & Media
So it is quite apparent from looking at this data that mobile technology is rapidly expanding in the United States. When I look around, I see just about everyone with a mobile phone, which they use for a variety of purposes.
So now you are probably wondering, how can this technology increase patient compliance to home exercise programs given to them?
3 WAYS IN WHICH MOBILE TECHNOLOGY CAN INCREASE PATIENT ADHERENCE TO HOME EXERCISE PROGRAMS:
SMS REMINDERS
There are already sites out there like http://www.patient-reminders.com/ that use SMS, or text messaging, that allow healthcare providers and patients to better stick to a given exercise program. Where I go to receive my healthcare, they make great use of SMS and sending me reminders. I believe all healthcare professionals should be using this to remind patients to do their exercises or provide any necessary explanations on what to do if needed.
QR (Quick Response) CODES
Those crazy amalgamations of white and black boxes that you seem to see everywhere are called QR Codes. They look like this.
When you have a smartphone scanner that you can download for free from an app store, you can read these things. From there, they can do many things like send you an email, text message, bring you to a site, show you a video, etc.
I believe these can be MASSIVELY useful in helping patients comply with home exercise plans. How could you use them?
QR CODE STAMPER ON HOME EXERCISE PLAN SHEETS
I believe this could be HUUUUUUGGGEEEEEEE for helping patients stick with home exercise plans. You simply select a few exercises for them to do and stamp the QR code on their sheet that corresponds to the exercise. The video could even have a message on it to verbally explain what is happening in the video and why it is important. The person in the video could be giving a proper demonstration of the exercise, which will provide great clarity on what is expected of the patient. So if the patient is unsure of how to perform an exercise or why it is important, all they have to do is pull out their Smartphone, scan the QR code and everything will be explained.
If the patient is prone to losing things easily, perhaps you could even stamp in on their arm or shoulder using a more long lasting and resilient product. Then the patient can simply scan their own arm and they are all of a sudden watching a video on their Smartphone of how to do their home exercises.
I believe the QR code stamper will be massively important in the future of allowing patients to adhere to their exercises.
DON’T FORGET, QR CODE STICKERS
So say you give a patient a new piece of equipment to take home. Say you give them a foam roller for myofascial release, or you give them crutches, or heck, just about anything. You can put a sticker right on that equipment and everything will be explained to that patient in verbally, visually and in written form.
How combining these mobile technologies can help
You have seen the patient and evaluated them.
You hand them a white sheet of paper. You write in pen the name of the exercise and how many reps/sets to do per day. That is it.
Then you take out your QR code stamper and stamp the appropriate exercise. So say you want them to stretch their calves.
You make a youtube video of the proper way to do the home exercise, along with a written and verbal explanation on the video. It is you on the video, so you can really motivate them and everyone else with your own passion. Then you have a QR code that corresponds to this video that you stamp on their sheet.
Then you have a 2 QR codes on the bottom of the sheet; one they can scan to call you and another they can scan to email you if they have any questions.
On top of this, you can use SMS services to keep in touch with the patient and see if they are following the program. If they lose the QR code sheet, you simply email them a copy of the one you made originally to scan.
If you have given them any equipment to use, simply place a QR sticker on it to remind them of the proper way to use it.
IN SUMMATION
I believe through using mobile technology, healthcare workers can take care of all the following problems mentioned earlier that affect patient adherence to home exercises, including:
- Motivation
- Understanding of exercises
- The role of the exercises given
- The physical therapist’s verbal explanation given
- The visual explanation given
- The overall explanation quality of the therapist
- Reassessment of home exercises
- Satisfaction with the physical therapist
Although perhaps a bit difficult to understand and implement at first if one is unfamiliar with SMS, QR codes and other expanding mobile technologies, it is obvious that the mobile market is booming in the United States and Smartphone sales are exploding higher and higher. The benefits of giving patients reminders through SMS and video/written/verbal demonstrations on exercises and equipment through QR codes and stamps will be immense and should not be ignored.
Works Cited:
Chan D, Can F. Patients’ adherence/compliance to physical therapy home exercises. Fizyoter Rehabil. 2010;21(3):132-139