SMART REHAB: Home exercise programs using smart phone.

 

Importance of Home Exercise Programs in Physiotherapy practice:

Physiotherapy is an integral part of current treatment methods for many conditions and diseases. We as Physiotherapists see each patient for 2 – 4 hours per week; typically involving a consultation with a series of therapy sessions aimed at providing pain relief, increase in the range of motion; flexibility and strength. As 2 – 4 clinical hours is a small amount of time; Physiotherapists often use Exercise therapy as one of the key components, and discharge patients with a customized Home Exercise Program (HEP) to maintain the long-term therapeutic benefits; most importantly providing a HEP prescription cannot be ignored for successful outcomes.

Despite the health benefits that home exercises offer; a majority of the patients fail to perform their Home Exercises. A study conducted by Chandra et al,2012; reported Home Exercise Non-compliance is as high as 70% amongst the population attending the physiotherapy sessions. This correlates to a non-effective treatment; increased pain; impairment and cost. So, understanding the patient’s behavior, overcoming the patient’s barriers and influencing exercise behavior of the patient is essential for successful treatment outcomes.

A study conducted by Chan et al, 2010; identified factors like age; severity of the condition; patient-therapist communication; duration of the treatment; patient-therapist relationship; therapist rehabilitation monitoring; complexity of the exercises; personal exercise experience; belief in exercises; personal and social motivation; educational background; effect of disease on patients life; gender; cultural norms and personal health beliefs to have an effect of patients’ compliance to physiotherapy home exercise program.

This research data correlates to our regular practice; where we get to hear the most common statements from patients – “I forgot the exercises you told me; I lost my print out of exercises; My sessions are completed, and I am pain-free; why should I exercise?  Exercise gives me pain; etc.” It is easy to say that patients are not doing the home exercise programs; but as Physiotherapy professionals we should work towards helping our patients break their barriers to exercise; bring behaviour change and should focus on the mode of delivering the Home Exercise Prescriptions which can influence the exercise quality performance; motivation; knowledge; goal setting and tracking feedback of the home exercise program.

A recent RCT by Lambert et al; 2017 identified that a group of patients with Musculoskeletal conditions performed their home exercise programs better when the exercises are provided on an app in their smartphones with remote support when compared to another group which received a hand out of the same exercises.

Need for SMART REHAB:

Considering the growth in the number of smartphone users in India and the availability of 3G; 4G networks even in the remote areas; mobile apps can have a positive influence on the health behavior of the clients and encourage the performance of the Home Exercise Programs resulting in better outcomes. There are apps developed for Physiotherapists by Physiotherapists which can enhance the quality of Home Exercise Prescriptions along with several other features. Integrating these apps into the Physiotherapy practice will allow us to save time; share the HEP’s to patients digitally; provide clear instructions; track patients feedback; focus on patient’s functional goals and be available for lightweight professional conversation with patients anytime. These apps have a huge potential of increasing the practice as most of the work can be done through it and the existing data can be accessed anytime from your mobile phone which is always there in your pocket.

Conclusion:

Physiotherapy treatment cannot be confined to 4 walls of a clinic as Exercise therapy; a major component of the treatment extends as a Home Exercise Program. It is essential to explore and absorb technological developments to support us Physiotherapists in treatment routines; to improve the patient-therapist relationship and compliance with the home exercise program for better outcomes.

By,

Dr. Sanjay Poojari (PT),

Co-founder, EndoRush App.

References:

  1. Dmitry CHAN, Filiz CAN. Patient’s adherence/compliance to physical therapy home exercises. Fizyoterapi Rehabilitasyon; 21(3),2010.
  2. Hitee Chandra, Ian Oakley, Hugo Silva. Designing to support prescribed Home Exercises: Understanding the needs of Physiotherapy patients. NordiCHI’12; October 14-17, 2012.
  3. Tara E Lambert, Lisa A Harvey, Christos Avdalis, Lydia W Chen, Sayanthinie Jeyalingam, Carin A Pratt, Holly J Tatum, Jocelyn L Bowden, Barbara R Lucas. An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial. Journal of Physiotherapy; Volume 63, issue 3, July 2017, pages 161-167.