#check for understanding

[shortace]

[green-witches-secret]

I would also like to thank my psychology teacher for making a 25 point check for understanding a singular multiple choice question. And the answer was the name of the unit.

[lhlr]

What are the main factors affecting compliance to home exercise programs in the geriatric community being seen in the home?

                Home exercise programs are a major and necessary component to any successful physical therapy plan of care. They serve to supplement the effectiveness of the treatment plan in the time where the patient is away from the clinic, which represents the vast majority of the time. The geriatric community is the primary population being served in the home health community, and it is essential that this group is compliant with their plan of care, particularly the home exercise program, since they are at a significantly greater risk for falling and for suffering a fracture as a result compared to the general population. This discussion will attempt to address what are the primary factors contributing to whether or not this population is adherent to their HEP in the home health setting.

              Another facet that must be considered, especially for the geriatric community, is to address the health literacy component, which is defined as “the ability to read, understand, and act on health information (2)."  Moreso than simply altering the language we use when reviewing exercises in the HEP with our patients (i.e. avoiding terms such as "knee extensions,” when referring to LAQs), the clinician must also be aware of how we assess for recall of our instructions. If somebody cannot remember an instruction or cue you just gave them a few minutes ago or even from the last session, for example, they might become confused, agitated, or embarrassed to the point where they don’t want to even attempt any component of the HEP anymore for fear of appearing “stupid.” (3).

            As with all patients, the ideal strategy is to frame goals that are patient-specific and meaningful for their personal goals, and this is no different for the geriatric community. There are, however, multiple barriers more unique to this population than most outpatient PT clientele. One article from 2006 entitled “Exercise Adherence Following Physical Therapy Intervention in Older Adults with Impaired Balance,” sought out to analyze factors contributing to HEP adherence after completing physical therapy. The researchers developed a survey that was sent out to 556 adults who were 65 years of age or older to inquire if the patients were compliant with their HEP after being discharged from physical therapy; only 179 patients in this pool returned their completed survey back to the researchers. Of this number, 90% of the patients (roughly 500), reported that they had received a program, but that only 37% of this number of patients were still performing the exercises.  This study found that the most common reason for lack of adherence to the HEP was due to a change in health status, suggesting that following up with physical therapy after a change in one’s health to alter the HEP might be beneficial to improve compliance. Some of the other common factors the study group reported influencing their compliance were “no interest, poor health, weather, depression, weakness, fear of falling, shortness of breath, and low outcomes expectation.” While the respondents for the survey were sampled from two programs addressing this balance component and because the respondent’s race or ethnicity were not analyzed , it is unsure whether or not these results can be generalized to the population at large. It was also difficult for the researchers to analyze what exact exercises were in the entire HEP, as the respondents generally just wrote down what they were doing for exercise at that particular time. Even with these limitations, however, the results of this study were found to be statistically significant and are definitely worth considering for future clinical practice. It would appear that barriers played a far more significant role in compliance with performing the HEP as opposed to motivation itself (4).

            It appears that the method in which physical therapists address factors regarding compliance for follow-through with HEPs for the geriatric community might differ from the considerations and motivations affecting the rest of the population. While it is definitely still important to take the motivation of the patient and their specific goals for optimal quality of life into consideration, it seems that it is equally, if not more important, to address these kinds of barriers and fears that the general population might not think about as often. It appears to be also beneficial to discuss potential future changes in health status with our patients as well, and more importantly what kind of actions or adjustments one can take to address these changes. Considering the language that we use (clear and simple instructions with written cues and demonstration as needed), in non-judging and understanding terms appears to also go a long way for successful follow-through in the geriatric population.

 Sources

1. Reuhland J and Shields RK. The effects of a home exercise program on impairment and health-related quality of life in persons with chronic peripheral neuropathies. JAPTA Volume 7, Issue 10, 1997.

2. Eaton, J. A. (2004). Low health literacy seen impacting costs, compliance, outcomes. Physicians Financial News, 22(1), 1.

3. Wierzbicki, B. Three ways to improve patient follow through. The Baker Beacon. Posted on June 6th, 2014. <http://www.bakerrehabgroup.com/three-ways-improve-patient-follow/>.

4. Forkan R, Pumper B, Smyth N, Wirkkala H, Ciol MA, and Shumway-Cook A. Exercise adherence following physical therapy intervention in older adults with impaired balance. JAPTA Volume 86, Issue 3. Published March 2006.

[nunziver]

[teachingela]

[In Practice] One-Minute Essay

Answer the following questions: (1) What is the big point you learned in class today? (2) What is the main unanswered question you leave class with today?

To be answered at the end of class (can be an exit slip).

gives teacher immediate feedback on student learning (or lack thereof)

provides an extra opportunity for reinforcement

From: Wiggins, Grant P., and Jay McTighe. “Thinking Like an Assessor.” Understanding by Design. Upper Saddle River, NJ: Pearson Education, 2006. Print.