I will keep using compliance until someone tells me adherence now has a negative connotation! Anyway, here are 5 More Ways to Ensure Patient Compliance.
1) Challenge the patient to the edge of their ability
- if you give someone an exercise they can barely do, need tons of verbal, tactile, and visual cuing to even resemble what you originally instructed, they're probably not going to do it at home
- in the same manner, if the exercise is so easy that it seems like it's not worth their while, or that it wouldn't "do anything" to help them, that also will reduce compliance
- for motor control/stability exercises, make sure the patient is challenged, physically and mentally, and doesn't hate it!
2) Make every exercise as pain free as possible
- no one wants to do something that hurts, especially often throughout the day
- sometimes patient's have constant pain, in this case, you do not want the exercise to make them worse (red light)
- it may be uncomfortable during the performance, but they should be able to walk off the discomfort within a few minutes or less
- use whatever manual therapy inputs you have up your sleeve to reduce the threat and enhance the movement
- use some kinesiotape to enhance proprioception and reduce threat
3) Simplify their assignment
- if a patient has 5-10 things to do on their first visit, they're unlikely to do them, plus if they get better or worse, you don't really know if it was a particular exercise, the order, etc...
- if they have multiple DNs, still give them a repeated loading strategy to clear up the proximal DP (because that's what they're coming to you for)
- sometimes motor control clears itself up after the pain is removed, saving you some time
- still have DNs after the fire is put out? Then go after the more distal DNs
- I tend to give 1-2 exercises after the eval, then maybe only progress one or both depending on how they did, and how well they can demonstrate them on the second, without adding anything new until the 3rd follow up, if even needed
4) Encourage follow up between visits
- since going cash based, for a majority of my cases, I may not follow up for at least 1 week and after the 2nd or 3rd visit, that stretches to 2 weeks if they are doing well
- however, I tell them to text me, email me, etc... and I will make a point to get back to them
- or schedule sooner if anything changes for the worse
- making yourself accessible (as I do with my blog, social media etc) encourages the patient that your care continues even when they leave your office
5) Connect with your patient
- everyone has a motivation, find it and use it!
- write down the names of your patient's kids, what sports they play, or what they or their spouse do for a living, and ask about it - tip from my buddy Jesse Awenus
- be honest! Most people can relate to honesty over a God complex, and trial and error is more believable than batting 1000
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