Volume 5:3

 

Increasing Home Exercise Program Adherence for Physical Therapy Clients with Balance and Dizziness Problems in Cheyenne, WY

Emma Stayduhar, SDPT

College of St. Scholastica – Duluth, MN

 

Study Design: Analysis of compliance rates for outpatient clinics in Cheyenne was conducted using a survey. Information about compliance rates, barriers to compliance, barriers to follow-up, and other clinical limitations were compiled. The survey also gave physical therapists a chance to detail relevant methodological successes. The finalized paper was distributed to all participating Cheyenne clinics.

Objectives: The high value of Home Exercise Plans (HEPs) paired with the low level of compliance is a problem. The objective of this research is to identify barriers to adherence and determine effective strategies to increase compliance to HEPs for elderly patients with balance issues.

Background: Physical therapy intervention can improve balance in adults sixty-five years of age and older1,2. Client adherence to exercise prescription can largely determine success3. Adherence rates for elderly clients with balance issues are low in both the short and long term1,2,4. Personal and environmental barriers rather than motivators appear to predict adherence.

Methods and Measures: Review of adherence studies by Forkan et al.4 and Sluijis et al.3 contributed significantly to the development of this research study. Personal interviews conducted with two experts in the field, Dr. Holly Girmus, PT, DPT and Dr. Kathy Blaire, PT, DPT, OCS, helped to establish direction and focus for research. A unique survey was formulated for the purposes of this study to collect data on HEP adherence for patients in Cheyenne, WY. The survey was distributed to seven therapy centers in Cheyenne and was completed by sixteen licensed physical therapists.

Results: The therapists involved in this study perceived the fear of falling to be the greatest barrier to client adherence to HEP, followed by poor health and weakness. Eighty-seven percent of respondents used only print material as the format for HEPs. While 93% of respondents reported using graded exercise in their treatment plan, a lesser 70% reported the use of graded exposure. There is minimal use of audio-visual material and computer-based tools for HEP prescription. Finally, physical therapists (PTs) in Cheyenne are actively getting their clients into exercise facilities and group classes.

Conclusion: Realistic strategies to increase compliance must address issues on two fronts: the time and financial limitations of the physical therapist and barriers unique to the client. Recommendations of this research study include increased use of graded exposure, diversification of HEP material to include dynamic technologies, and increased transition to group classes and personal training. These strategies offer cost effective solutions to low client adherence without imposing unattainable demands on the therapist workload.

 


 

 

The Impact of Physical Therapy on Pain and Disability Associated with Knee Osteoarthritis A Critical Review on Literature

Carla Sy Enriquez, PT, DPT, OCS, DAAPM; Edilberto A. Raynes, MD, PhD – Candidate

Dominican College; Tennessee State University College of Health Sciences

 

Study Design: Knee osteoarthritis is an extremely common musculoskeletal disorder of the lower extremity that results in significant physical impairment and functional limitations. The resulting pain and disability associated with knee osteoarthritis impacts various components of physical function including treatment satisfaction and patient/client quality of life. Therefore, the need to know the efficacy of currently existing interventions in the physical rehabilitation of patients with knee osteoarthritis is essential in the clinical decision-making process involved in the implementation of plan of care for effective management and successful treatment outcomes. This paper also highlights the scientific methods involved in the search of existing literature to capture highly relevant information in the critical analysis of physical therapy treatment for knee osteoarthritis.