The level of compliance among patients varies widely. For PTs, it’s easy to chalk it up to individual differences that are largely unaffected by our clinical practice skills.  And in doing so, we can continue to make recommendations on treatment based on the patient’s condition. A lack of adherence in that regard offers some relief to many clinicians, as we can only help those who are motivated and willing to help themselves. But are we doing our patients a disservice by not addressing these psychosocial differences that impact motivation and adherence?

When the patient is a full-time working parent with kids, another family member of their own with declining health, and other life stressors, our 15 minutes, or less, spent discussing a home exercise program likely won’t weigh much on the scale of priorities. Physical therapists have a responsibility to discuss health behaviors with patients, but what is the most effective approach? Although this is emphasized in the Code of Ethics for the Physical Therapist [1] from the American Physical Therapy Association, many PTs still do not routinely discuss healthy behaviors with their patients [2]. However, from the consumer standpoint, most participants (91.3% in a survey of 230 patients) agree that PTs should initiate a conversation about physical activity, maintaining a healthy weight, and smoking cessation [2]. Other topics are included, such as basic nutrition, but this illustrates the role of PTs becoming more predominant in primary care and even extending to the management of chronic conditions [3].

Currently, the economy is pushing for evidence-based medicine and doing what we can to quickly facilitate the healing process measured through validated outcomes to prove our value. After that, the rest lies on the patient to follow their individual home exercise programs, activity modification recommendations, and general health and wellness behaviors. Rather than sending the patient on their way, in order to truly individualize treatment plans, we must educate ourselves on factors that impact patient adherence and treat our patients according to a biopsychosocial framework.By engaging in these conversations, PTs can not only build rapport with their patients, but barriers to plan of care adherence can be identified and addressed. In the following posts, we’ll dig deeper into various psychosocial constructs and discuss the implications in a physical therapy clinic. What have been your experiences as a clinician? What strategies have you found that work or don’t work in various settings?

 

References:
[1] Code of Ethics for the Physical Therapist, APTA
[2] Black B, Ingman M, Janes J. Physical Therapists’ Role in Health Promotion as Perceived by the Patient: A Descriptive Survey. Phys Ther. 2016;96(X):ptj.20140383-. doi:10.2522/ptj.20140383.
[3] Dean E. Physical therapy in the 21st century (Part II): evidence-based practice within the context of evidence-informed practice. Physiother Theory Pract. 2009;25(5-6):354-368. doi:10.1080/09593980902813416.