Home exercise programs suck. There, I said it. “Do these 3-7 exercises on the days you’re not here” basically translates into “you not going to want do these boring tasks, because I’m telling you to do them”.
The beauty is, that even out of those who do their HEPs, 90% of them will then sit for the other 14 hours of their day. Oh, and if you can then ask me why you’re not getting better after 3 visits that’d be great.
Anywho, this post is about reframing the idea of a HEP. We need to promote them as practice. “I need you to practice lifting, or balancing, or moving properly” and “I need you to practice
moving more frequently and in greater amounts.” Practice, implies improvement and working towards something bigger. Home exercises imply droning away endlessly without progression and without purpose.
Let you’re clients know why they are performing a task on their own precious time. “You’re practicing balancing on one knee (1/2 kneeling) because standing on one foot is too hard for you to perform well right now, but we can eventually progress to that so you will be less likely to fall.” You said what will be practiced, why it’s being practiced, and what it will be progressed to. It is then up to the client to decide if they will do it.
Even asking patients to try and practice their deadlifts sounds better than “do deadlifts”. How do you have patients perform exercises or tasks at home? Have you gotten away from telling patients to do exercises and moved towards helping them come to the conclusion that more activity is likely better for them? If you’ve done an HEP did you adhere the the PT’s guidelines for frequency? Did they even tell you why they chose that frequency? I’d love to hear your answers to this questions.
Always evolve,
Mike
You are making some very solid points. I am a PT student on my first clinical right now, and running into some of the same struggles with compliance. I think putting purpose to the HEP is essential and including them in the decision making process as much as possible. I can’t blame the patients too much after being a non-compliant patient myself. When I was in PT (before I chose to pursue PT as a career), I remember mostly being confused about what exercises to perform. My PT would be very ambiguous about which exercises to do at home, so I just tried exercises at home that we did in therapy. Very good thoughts!