One of the frustrating things for new grads to learn after coming out of school is that we do not get 100% of our patients 100% better. Part of the reason is that with physical therapy moving towards direct access, not all patients have a true neuromuscular problem. Patients with other pathologies come into our clinics as well. Probably one of the biggest issues, however, is patient compliance.
We all know the home exercise program is an essential component of any patient's rehabilitation. We also know that patients more often than not fail to comply with the prescription. A patient's adherence to their HEP allows therapists to progress or adjust patients' treatment plans more accurately. That is why it is essential we educate our patients on the importance of following the instructions. For example, with a repeated motions HEP, the exercise is not only used for treatment, but also diagnosis. Based on how a patient responds, sometimes the motion has to be altered.
Even with all that being said, some patients will still not be compliant. They will come in after you gave them homework regarding exercises to do, necessary liftestyle changes and more, yet, still have significant pain. Upon questioning, you may discover the patient did follow the instructions, whether it be the required frequency or postural changes. Unfortunately, some people will not set completing their exercises as a higher priority. They are in pain, but still have trouble making time for the adjustments. It is frustrating as PT's, but we cannot lose hope. I recommend further education for the patient as a start. The key is making the "light switch on" for the patient. What I like to do is have the patient complete a painful activity, then perform their repeated motions to decrease their pain and then re-test the original activity. Sometimes it then clicks for the patient that they can manage their symptoms. Sometimes, the patient still will not make the necessary changes. We must do our best to help the patient make the commitment to the program.
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