If you haven’t taken some time recently to re-evaluate the role that home exercise programs (HEPs) play in in your OT/PT or SLP practice, it’s time to sit down and do some thinking.
Research is telling us that what we’ve done in the past isn’t working spectacularly..
But, these 5 changes informed by research (and made easy with MedBridge GO) can boost your client’s satisfaction with the therapy experience, their engagement, and ultimately outcomes.
Note: I am a MedBridge affiliate. However, my intention is always to enable to therapists to provide the best care possible. Below I will also share other resources that help you achieve best practices.
Where We Were. (AKA what didn’t work.)
I remember being a new grad and gleefully scrolling through the exercise software at my work and checking every exercise vaguely related to my patient’s condition.
“The more exercises, the more value!”
“How cool that I can just check some boxes and the program generates this professional looking HEP. Neat!”
I had no idea how long the HEP was going to take.
I did not formulate a plan about how this would fit into my patient’s life.
I did not provide reminders.
I maybe went through it once with them…but definitely did not seek feedback on how it was going at home.
I usually did this toward the end of episode of care.
The Results: My patients probably did not do the home exercise program.
I’m not alone in this low patient adherence. From looking at the research, it seems that 30-50% of patient’s participating in HEP is about what can be expected.
So how can we do better?
5 Research-Based Changes to Make to Your HEP Offerings
After reading several studies on what makes patients more likely to participate in home exercise programs, I saw these 5 themes emerging.
Check out the research articles linked with each change and at the very bottom of this article for a fuller explanation of the research.
1.) Go Digital
I live in rural Nebraska and through my gym I get this snazzy app that allows me to track every work out, watch videos of proper form, and even message the gym owner with any questions.
I believe that our therapy patients will start expecting interactive technology like this.
And for good reason.
Studies are showing increased patient satisfaction when interactive technology is provided with education materials. (The article HEP: The Secret Weapon for Better Patient Retention and Satisfaction does a great job of summarizing this.)
2.) Make a Plan for How Much Time It Will Take
The first thing I did with my MedBridge Go app was to plug in what I thought to be a typical home exercise program.
I was shocked to see that the amount of estimated time it would take.
It added up to almost TWO HOURS.
What? I had no idea I was asking so much of my patients.
Talk with your patients about how much time they can see dedicating to a home exercise program. If they are not accustomed to regular exercise, 15 min. might be a realistic starting point.
Or maybe you are working with someone who actually does work out for 3 hours everyday so my initial 2-hour plan might be completely plausible.
(Not convinced by my anecdote? In this study 1/3 of the participants said “if the home-based program requires a lot of time, they tend to prefer drugs by pragmatic reflection.”)
3.) Recommend Fewer Exercises
This is in the same vein as being aware of time.
You should consider limiting the number of exercises.
Because multiple studies have shown that adherence starts to drop once you get into the range of 6-8 exercises. Here’s what one 2009 study found:
“Total number of exercises per session in the HEP is a specific predictive factor for frequency adherence. Subjects who received an HEP including more than 6 exercises have lower odds of frequency adherence (OR = 0.2; CI = 0.1-0.9; p < 0.05) than those with three or less exercises.”
After taking in the research, I would say that 2-3 exercises is a good number to shoot for. Any more than 8 exercises should throw up a red flag.
4.) Send Reminders
Let’s be honest it is hard work to incorporate a new routine into your schedule.
I know that I need all of the reminders I can get.
This 2010 study indicates that HEP can be helpful, but the research is just referring to having a handout to refer to. At the time they hadn’t even conceived of secure texting/push notifications.
Today, the research still has not yet caught up with how text message or push notification reminders specifically impact adherence to HEPs.
But, I think a helpful parallel to look at is how the technology is impacting medication compliance.
Here’s a telling quote from this summary of the research:
“We found that text messaging doubled the odds of patients with chronic diseases sticking to their medication program.”
Imagine the impact on the effectiveness of HEP if we could see those kinds of results.
(Thanks to Dave Kittle of Vinitial, for answering my questions about available research for this section.)
5.) Provide a Feedback Loop
As one might guess, clarifying doubts and questions from patient increased the likelihood that they would initiate their HEP according to this study.
Currently the best way to answer questions is to do so in person, when you introduce the plan and in subsequent sessions. Within the MedBridge GO system, patients can also ask questions within the patient portal.
If you have secure texting with your patients this could be another option for them to ask questions as they are going through the process.
Look for the technology to improve on this over the next few years. Just like is possible in my aforementioned fitness app, I anticipate people will be able to send messages directly from the app itself.
Overview of MedBridge GO and Other Digital HEP Tools
Luckily, some of the resources you are already using are investing in HEPs.
The MedBridge GO app comes with their Premium Plan (save $175). Therapists can craft a home exercise program that is then sent to the client-facing app.
The set up is really simple for the client. When they open the app they see how much time today’s exercises will take. When they are ready, a video will walk them through exercises that are paced so they receive maximum benefit from each movement.
The app then tracks the progress for both the therapist and client can see.
The app was developed with research in mind and therefore helps you achieve all 5 of the aforementioned ways to improve your HEP offerings. (I'm hoping to see even more developments though on #5, "provide a feedback loop."
WebPT Home Exercise Software
WebPT has home exercise program software that allows you to email exercises to patients. This system also has peer-reviewed exercises.
Are there other digital HEP tools that people are using (and enjoying)? Let me know!
Many of these changes are relatively simple. And even if you are using one of the free HEP resources out there, you can incorporate some of the research into your offerings.
But, I’m excited for the advances in technology, like MedBridge Go, that are now allowing us interact with patients on a whole new level and incorporate all of the above best practices.
Helpful research articles on HEPs and therapy:
- The effectiveness of home-based exercise programs for low back pain patients (2016)
- How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study (2010)
- Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study (2009)