The importance of the home program.

One of the most important aspects of patient recovery while in physical therapy, yet is frequently underperformed, is the home exercise program. Let’s start with an analogy. You have a friend who is hoping to lose weight. He follows up with a nutritionist and is given an outline of the primary faults of their current diet, along with the corrections he needs to make in order to achieve his goal of losing weight. Your friend does awesome with his diet every Monday, Wednesday, and Friday, but he abandons all guidelines and restrictions for the rest of the week. Yet, he is frustrated with his lack of weight loss. From the outside looking in, is it that hard to see why he is not losing weight?
Why is the home program so important?
While in physical therapy, at most, you may attend therapy 1-3x/wk, for approximately an hour. However, the majority of the days (and time) of the week, you are responsible for your care and treatment. The amount of time spent in the clinic is relatively small compared to the amount of time you will spend at work, exercising, etc. Most individuals have significant movement limitations, muscles that are not firing and performing correctly, or spending an extensive amount of time in a poor posture due to work. The amount of time spent in therapy is not enough to completely address the issues that you are experiencing. Furthermore, the changes that you make after being seen in the clinic must be reinforced frequently (daily), in order to avoid backsliding in your progress.
Furthermore, in physical therapy, the ultimate goal of our treatment is for you as patients to not need us (a terrible business model). We want you to progress to the point where you are able to maintain the positive changes made in treatment, manage pain or other symptoms, and be confident in your own treatment. However, getting to this point is a team effort.
Challenges of the home program:
Adherence to a home program is a significant challenge we (as physical therapists) face with our patients every day. Currently, it is estimated that only 35% of patients perform their home exercise program regularly. What does this mean for the other 65% of patients? It means that they will unfortunately experience longer plans of care, longer periods of time in pain, limitations in activities of daily living, slower time returning to function, and greater monetary expenses.
The main challenges that I have heard for adherence to a home program have been time, motivation, and responsibilities.
From your perspective as the patient, I would love to know what other barriers limit your ability to perform your home exercise program so that we can best serve you when designing a plan of care that is realistic in expectations.