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Many People with Bad Posture, particularly from sitting all day, display an anterior pelvic tilt. If Your Pelvis is held the anterior tilt position then the hamstrings are being pulled into a lengthened and possibly weakened state. #Change_your_Posture #Change_Your_Life #Physical_Therapy #physiotherapy https://www.instagram.com/p/CJ9Cz_gA-w1/?igshid=1h54fz792owjf
Worcester dance teacher returns to classes after #amputation - #occupational_therapy #physical_therapy http://crwd.fr/2m420LM
RamSham: Ongoing progress with Knee
RamSham: Ongoing progress with Knee
Hello folks! Yesterday, I was supposed to be scheduled for 3rd surgery to remove 30% of meniscus from my right knee. I cancelled it a bit over a week ago at doctor’s office. To make story short, last February, I signed up for outdoor guided rock climbing last February and I couldn’t climb due to little strength in my right leg. I didn’t noticed it by then because I was able to walk and climb…
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(via https://www.youtube.com/watch?v=BPj-yB-Lzq4)
Is adherence a clinically significant measure? An evidence based overview
Ido Rokach, PT
Exercise programs are one of the main evidence based physical rehabilitation interventions for numerous medical conditions. According to motor learning studies, we know today that in order to regain functional capabilities a patient has to perform hundreds of repetitions of a specific task oriented exercise1. The patient must dedicate a lot of time during the day to his physical rehabilitation exercise program.
A problem that physiotherapists frequently encounter is that patients fail to recover from their injury as expected, with no apparent pathological basis predicting such a limited outcome. This problem may occur due to low adherence.
Adherence is defined as “the extent to which a person's behavior corresponds with agreed recommendations from a healthcare provider” (WHO, 2003). In the physiotherapy clinical world, adherence reflects the patient's commitment to the physical rehabilitation program.
Physiotherapists have to come up with creative ways to engage their patients so that they will complete their exercise regimen. As a result, adherence has become the focus of many researchers. Research has revealed that non-adherence is a widespread phenomenon – with “up to 65% of patients being either non-adherent or partially adherent to their home programs”2.
How is adherence measured?
Measuring adherence is quite complex since adherence comprises many elements, including:
1. Keeping appointments.
2. Following advice from the PT.
3. Performing the exercise regimen.
4. The frequency of exercise regimen performance.
5. Performing exercises correctly.
6. Performing more or less what was prescribed3.
Measurements rely mainly on observations in the clinic and on questionnaires filled out at home, with patient diaries and self-report questionnaires being the most commonly reported methods of measuring adherence.
Diaries allow tracking and recording each time treatment activities are performed, including the number of repetitions of each exercise, the duration of application of ice or heat and other self-administered therapeutic methods, etc. Patients are expected to complete their diaries every time they undertake their home program, and bring them to each clinic appointment for checking and updating. The percentage of adherence to the prescribed home program can be calculated from the patient recordings.
The advantages of such dairies are that they can be an aid to adherence by acting as a cue to doing the activities, they are cheap, and they are very simple to use. These advantages, however, can be also viewed as a limitation –“a true objective measurement of the various aspects of patient’s adherence is not being obtained”2.
How can a therapist increase patient adherence?
This million dollar question is key to increasing outcome measures in physical rehabilitation programs. Increasing adherence may be different for each patient and should be tailored to physiological, psychological and social parameters. In general, however, there are a few points to which the physiotherapist can pay attention and make minor adjustments in order to either maintain or increase adherence:
1. Using quantitative measurements in the results4. For example, if the exercise regimen contains aerobic exercises such as walking or running, a pedometer is a good way to increase adherence.
2. Splitting the training into a few shorter (but more intense) sessions is better than one long session of moderate intensity5.
3. Giving less than 6 exercises in a session6.
4. Frequent supervision of exercises provides a higher level of adherence6.
5. Giving explanations and information regarding the exercises increases adherence6.
6. Providing feedback through goal-setting and repeated functional testing7.
At the end of the day it is the patient who is responsible to undertake the exercise regimen for good physical rehabilitation outcomes. The role of the physiotherapist is to implement effective and proven methods to enhance the patient’s adherence to the course of physical rehabilitation.
1. Gordon AM, Magill RA. Motor Learning:Application of Principles to Pediatric Rehabilitation. In: Campbell SK, Palisano RJ, Orlin MN, eds. Physical therapy for children. 4th ed. St. Louis, Mo.: Elsevier/Saunders; 2012:151-174.
2. Sandra Frances Bassett (2003). The Assessment of Patient Adherence to Physiotherapy Rehabilitation. New Zealand Journal of Physiotherapy 31(2): 60-66
3. Kolt G.S., Brewer B.W., Pizzari T., Schoo A.M.M., Garrett N. The sport injury rehabilitation adherence scale: a reliable scale for use in clinical physiotherapy. Physiotherapy. 2007;93(1)
4. Kirk, A., & Feo, P. (n.d.). Strategies to enhance compliance to physical activity for patients with insulin resistance. Appl. Physiol. Nutr. Metab. Applied Physiology, Nutrition, and Metabolism, 549-556.
5. Thøgersen-Ntoumani, C., Shepherd, S., Ntoumanis, N., Wagenmakers, A., & Shaw, C. (n.d.). Intrinsic Motivation in Two Exercise Interventions: Associations With Fitness and Body Composition.Health Psychology.
6. Medina-Mirapeix, F., Escolar-Reina, P., Gascón-Cánovas, J., Montilla-Herrador, J., Jimeno-Serrano, F., & Collins, S. (n.d.). Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: An observational study. BMC Musculoskeletal Disorders, 155-155
7. Grindem, H., Risberg, M., & Eitzen, I. Two factors that may underpin outstanding outcomes after ACL rehabilitation. British Journal of Sports Medicine Br J Sports Med, 1425-1425.
The Challenge Factor – Impact on Rehabilitation Results
Do you go to the gym? How does that work for you? Early morning or on your way back from work; taking your gym bag with you and completing the same training routine 3-4 times a week. Occasionally, you switch it with a gym class (you know what they say – you have to change the training routine to keep it effective). This is boring. This is more like another chore on schedule than something exciting.
I don’t know how many gym members attend the gym on a regular basis, but I’m certain that most of the members do not develop addiction to the training program their gym instructor prescribed. Going from one training device to the next; performing the same thing over and over for weeks-months-years, tends to be not fun, not challenging and mainly – not interesting. The health benefits alone are not big enough to lure most of us to the gym or other alternatives - secretion of pleasure inducing hormones during aerobic exercises is a good start, but it’s not enough for most of us. Why? What is missing? How can we make it more appealing?
Well, how would a Challenge effect the quality of your exercise and your satisfaction?
Here comes the Challenge Factor. Ever played one of those “challenge-your-friend” apps? Ever played social games were your actions were compared to other’s performance? How about having an app that compares your activities to those of your friends? How about climbing a fictional ladder, gathering titles or even actual benefits? Now we’re talking about something challenging. You can already find some apps supporting such ideas, but still – this is not enough. You don’t see many people use such systems, as the main action is still boring – doing that repetitive training. What else can we do? What more is missing?
Here comes the Fun Factor. If it’s fun, if it’s challenging, it will be easy to keep your interest. If it brings a smile to your face and you look forward doing it (as any good game does), it becomes the ultimate solution. Not only do you do it, but you want to do it (and not for that health benefit, simply because it’s fun!).
Professionals call it compliance to training. We can simply call it the reason why I should put the efforts and keep on training – not because it’s good for me – because I enjoy it.
Don’t train - Play. It’s fun, its challenging, it’s great.
Happy Holidays from BioGaming !
BioGaming at the Israeli Association of Physical & Rehabillitation Medicine Annual convention
Roy Tzemah, BioGaming's Chief Physicl Therapist, at the Israeli Association of Physical & Rehabillitation Medicine Annual convention.
