Top 5 Fridays! 5 Things to Consider to Improve Patient Compliance

Ahhh, patient compliance... yes I still call it that, because I do not think there is a negative connotation to it, but whatever you call it, it is paramount that your patient has it, only if they want to get better and stay better.

This post was inspired by a great talk with one of my buddies, your friendly neighborhood Physio, Jesse Awenus! Look sometime next week for a google+ hangout on his thoughts on attending the recent SFMA in Toronto, ON.

Without further ado, here are 5 Things to Consider to Improve Patient Compliance

1) Setting the Stage

after all the initial rapport building throughout the history, it's time to lay down the law so to speak
I tell patients,

"Certain hands on techniques, positions, or motions may rapidly improve your condition, and that decreases an alarm in your head."
this alarm, when triggered decreases your pain threshold, and things that do not normally cause pain, end up doing so - i.e. movement, light touch, etc
research shows the rapid effects of a typical treatment last only 2-4 hours on average
that is what I call "the window of improvement"
the longer you have been in pain, the faster this window tends to close, because your nervous system is very protective of you
I will give you homework to replicate the improvements we make, often it is the same motion/position I put you through as treatment
this homework needs to be performed hourly (sometimes more, sometimes less), this keeps the window of improvement open
assuming I chose the right treatment and you understood how to do it properly, if you leave here feeling better, and it does not hold until the next visit, that is your fault, not mine

you will be surprised at how many patients appreciate not only the empowerment of self treatment, but also your honesty

2) Scheduling

MDT Faculty members noticed they had better outcomes in their courses than in their practices
what was the difference?
for live patients seen in the courses, they were evaluated and treated on consecutive days
they also noticed when looking at their outcomes, that patients evaluated on Monday often did better than patients seen on Friday
the HEP is everything when it comes to locking in the improvement
On visit 1, I make sure to say, "Please follow up with me for your next treatment tomorrow." (if I am not working, I have them see my business partner)

we need to review your homework to see that you are performing it correctly
if I need to make a tweak to the homework, we are much better off doing that sooner than later

even though I heard this at MDT courses for years, only recently in the past 3 years of owning my own practice was this idea implemented
even despite private pay or in the era of $45 copays, patients are very happy to come back the next day if you made rapid changes on day 1
if a patient has a very painful presentation, or a more serious condition like a lumbar lateral shift, I may have them follow up 2 consecutive days, then reduce frequency when I feel like the can self manage with their HEP

3) The Homework

keep it simple
if you can leave it at one repeated loading strategy to perform hourly, leave it at that
compliance is often dependent on simplicity, how can you expect a patient to compliant with 4 exercises if they are barely compliant with one
locking in the improvements for posterior or lateral spinal rapid responders often requires avoidance of flexion loading, poor posture, or prolonged sitting
move it or lose it - and by it, I mean the improvements we just made

4) Follow Ups

First question, "How are you feeling today?"
Next question, "Did you do your homework?"

if you get the apology, "Sorry I didn't do it as much as you want..." - Your answer depends on how they responded to the first question
if better than the last visit, "That's ok, you are doing enough to maintain improvements between visits, good job."
if no change, but they were better when they left, "Don't apologize to me, I already do the things I need to do for myself to feel and move better, you are really apologizing to yourself."

next check to see if they are even performing their homework correctly
if they are, AND they did it often, AND they did not maintain improvement, have them push farther (not harder) into end range, adding a passive overpressure

cervical retraction with maxilla overpressure
lumbar repeated extension in lying with exhale "sags" to go further into extension

5) Maintain Active Listening and Compassion

Am I a hard on my patients? Absolutely! But not without compassion and an extremely positive and encouraging atmosphere
If they come in a bit flared up without trauma

"Great news! Rapid onset means rapid improvement!"
"Don't be discouraged, if we got to a good place before, we can absolutely do that again."

If their pain is intermittent

"That's great! If pain comes and goes, it's actually simple most of the time. We have to avoid the things that bring it on, and repeatedly do the self treatments that keep it away.
this is MDT in a nutshell, and yes, 87% of the time, it works every time.