It’s probably our biggest pet peeve as PTs . . . patients not doing their HEP. We’ve all been there. Patient comes into the clinic and says they didn’t do it and funny enough they still have pain! Or even worse they said they did it, but you can tell they are 100% lying.
Unfortunately this is pretty common. A study last year showed non-adherence to HEPs to be as high as 70% in patients with chronic neck pain. Other studies have shown similar numbers.
So we are definitely not the problem though right? It’s up to the patients to do the home exercises, correct? Well, part of that is true. While sometimes, yes patients are their own worst enemy, there are some things we can do to set them up for success. Read on for 4 tips to creating HEPs your patients will actually do!
1.) Give No More Than 5 Exercises
HEPs should consist of no more than 5 exercises, especially at eval! Studies show patients are more likely to complete shorter HEPs. Some studies have even recommended only prescribing a couple exercises at a time. I myself usually keep it to around 4.
To be fair, some people are busy and have a lot on their plate. I mean, we’ve all played just therapist instead of physical therapist a time or two and realized everyone is fighting their own battles. For some, an HEP can feel overwhelming.
One of the top reasons for non-compliance with HEPs is perceived lack of time. The shorter we keep the HEPs the less likely our patients are to think it will take too much time out of their day. Some of our clients don’t even make time for a regular exercise routine, so this is all new to them.
Now as patients get the hang of performing their exercises and making time I think it’s okay for the number of exercises to change. However, it still needs to remain manageable. As we progress our patients and add exercises we should also discontinue the ones that have become easy. Let them spend their time and focus on the exercises really benefiting them. Bottom line is keep things short and sweet throughout your entire plan of care.
2.) Keep It Simple
Much like if an HEP takes too long, patients are less likely to do it if it’s too complicated! I am ALL for creativity, but let’s be honest sometimes we’re out here making exercises and drills way more complicated than they have to be.
Let’s say you give just 4 exercises, only 4, BUT they are the most goddamn complex exercises with a weird setup, or odd motion, or need extra equipment/objects cueing etc, your patient isn’t gonna do them.
This will also save you some heartache in the long run. Let’s say your patient does try your “I need a rocket-science degree to complete this” HEP. Unless you’re working with a very exercise-experienced individual, they’re probably going to do it wrong. Cue both you and the patient being frustrated when they come back and aren’t better.
Again, complexity may change depending on the client or as things go along. For most of us we’re working with people who are new to most if not all the info we’re giving. They shouldn’t need a PT degree to figure out their HEP, that’s why you got yours 😉
3.) Make It Accessible
What do I mean by “make it accessible”? Well it means a few things, but mainly make the HEP achievable for the patient.
For example, don’t give patients an exercise that requires equipment they don’t have. Our patients may not have the means for equipment or a gym membership. It’s unfair to place this burden on them when I guarantee you there are other exercises or modifications to use that will get the desired effect you’re looking for.
Another example may even be based on patient abilities. One I hear a lot from patients is “I can’t lay on my stomach”. If a patient can’t lay on their stomach, even if it’s just based on what they believe, we’re setting them up for failure by giving them exercises in that position. They don’t think they can do it, therefore they won’t. It may be something to work towards as the patient improves, but not something that should be forced on them.
Lastly, make the HEP accessible in their day-to-day routine and setting. Choose exercises they can easily throw in during a break at work, at their desk, while they’re making dinner, etc. Point this out to them too! It seems so simple to us, but again, most of the time the information is new to patients.
I’m also a big fan of telling my patients that in most cases their HEP doesn’t have to get done all at once. In getting to know them and how they spend their day-to-day I’ll frequently make suggestions where they can just quickly throw in an exercise.
Most of the time they say “Oh yeah! I didn’t even think of that!” and they’re really thankful for it. I find some of my most successful patients are the ones that figure how to work in their rehab exercises in small pockets of their daily routine. Some may figure this out on their own, but it certainly helps if we lead them there.
4.) Make It Meaningful
Lastly, and probably the most important is you MUST make the exercises meaningful to the patient. Choose exercises that directly relate to the patient’s goals and TELL them how those exercises help achieve those goals.
Again, you know why you’re choosing a specific exercise for them, but they don’t, and it can make all the difference. I’ve gotten in the habit when going through initial exercise programs of explaining not only the exercise, but how it relates to their goals discussed earlier.
Making HEPs meaningful to the patient improves patient-client relationship in two ways. One, it will get you that initial buy-in from the patient. If the patient knows and sees how their HEP is helping them achieve their goals they’re way more likely to do it.
Their thought process changes from “I guess I’ll do the exercises because they told me to” to “I’m going to do the exercises because I know it will help me achieve xyz”. One is far more convincing than the other and it’s not hard to figure out which.
Two, and maybe even more important, it shows you were listening and that you care about what’s important to them. People are willing to put in the effort that others put into them. If you show you care, 9/10 times they’ll match that energy.
Making effective HEPs means better results for patients. Better results for patients means happier patients. And happier patients means even happier PTs.
I hope you found at least one of these tips helpful. Which did you find interesting or the most important? Or are there other “HEP rules” you live by that you’ve found extremely helpful? Please share in the comments section here and on Instagram @the_pt_page! If you missed the last post here it is! Finally, if you want to make sure you don’t miss any helpful info and tips from The PT Page, make sure to hit subscribe below to get all new posts directly to your inbox!
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