by Jack Grodon – 28th November, 2018

“How can digital tools empower patients to self-care in physiotherapy?” asks Jack Grodon, Specialist Musculoskeletal Physiotherapist / Fracture Clinic Team Lead at Guy’s and St Thomas’ NHS Foundation Trust, and one of DigitalHealth.London’s Digital Pioneer Fellows. Here, he explores the challenges that may prevent patients sticking to their regimes, and therefore getting good outcomes; and suggests ways that digital tools could help.

Adherence is the key to therapeutic exercise being effective

Therapeutic exercise is known to be effective across a diverse range of physiotherapy practice, and systematic reviews consistently show that exercise is beneficial for key clinical outcomes such as pain, physical function, and quality of life. Self-managed, home-based exercise is a common element of physiotherapy rehabilitation programmes and adherence to these programmes will influence the treatment outcomes. Low adherence has implications for treatment costs and effectiveness.

Low treatment adherence is a challenge across many healthcare disciplines including physiotherapy. In physiotherapy, adherence to self-managed, home-based exercise is fundamental because patients will spend more time away from the Physiotherapist than receiving clinic or hospital based care. It has been suggested that non-adherence with physiotherapy treatment could be as high as 70%, and may be particularly poor for unsupervised home exercise programmes.

What affects adherence to physiotherapy treatment?

Factors that affect adherence to physiotherapy treatment are comprehensive and could relate to; attendance at appointments, following advice, undertaking prescribed exercises, frequency of undertaking prescribed exercise, correct performance of exercises or doing more or less than advised. Reviews have shown that strategies and interventions to aid patient adherence with medical treatment need to be multifactorial and be provided in combination, with considerations towards more convenient care, information, reminders, self-monitoring, reinforcement, counselling, family therapy, psychological therapy, crisis intervention, telephone follow-up, supportive care, home visits, education and work site visits. In physiotherapy, provision of written information and activity monitoring have shown a positive correlation with improved adherence to physiotherapy treatment.  Currently the traditional method of providing written information and activity monitoring in physiotherapy is regularly completed via a paper handout or leaflet. There is significant opportunity for these materials being illegible, lost, forgotten about or generally confusing for patients to understand.

So… how can digital help?

Within physiotherapy there are a rising number of digital health interventions to aid with self-managed, home-based exercise. These platforms are normally web-based or mobile application programmes that often have other integrated functions that include exercise videos, pictures, descriptions, exercise diaries, reminders and ability to record outcome measures. There is massive potential for patients to feel empowered to self-care using these digital tools, which in turn should support improved patient reported outcomes and experience. The hope is that over the next few years digital tools can be embedded within standard daily physiotherapy care to optimise the fantastic and important rehabilitation that Physiotherapists provide.

Note from editor

There are a range of digital tools available to help physiotherapists or other healthcare staff support their patients to adhere better to physiotherapy exercises, and for patients to use independently.

Innovations like MIRA Rehab uses video games to make physiotherapy more fun for all ages, and TrackActive helps clinicians create and monitor exercise programs to help improve recovery. Innovations like MSK assist helps patients effectively self-manage their musculoskeletal conditions. All of these have taken part in the DigitalHealth.London Accelerator, or a digital health accelerator run by AHSNs.

 References

  • Taylor, N. F., Dodd, K. J., Shields, N., & Bruder, A. (2007). Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002-2005. Aust J Physiother, 53(1), 7-16.
  • Walsh, N. E., Brooks, P., Hazes, J. M., Walsh, R. M., Dreinhöfer, K., Woolf, A. D., . . . Pain, B. a. J. D. T. F. f. S. o. C. f. A. a. C. M. (2008). Standards of care for acute and chronic musculoskeletal pain: the Bone and Joint Decade (2000-2010). Arch Phys Med Rehabil, 89(9), 1830-1845. doi:10.1016/j.apmr.2008.04.009
  • Fuentes C, J. P., Armijo-Olivo, S., Magee, D. J., & Gross, D. P. (2011). Effects of exercise therapy on endogenous pain-relieving peptides in musculoskeletal pain: a systematic review. Clin J Pain, 27(4), 365-374. doi:10.1097/AJP.0b013e31820d99c8
  • Essery, R., Geraghty, A. W., Kirby, S., & Yardley, L. (2017). Predictors of adherence to home-based physical therapies: a systematic review. Disabil Rehabil, 39(6), 519-534. doi:10.3109/09638288.2016.1153160
  • Hayden, J. A., van Tulder, M. W., & Tomlinson, G. (2005). Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med, 142(9), 776-785.
  • Sluijs, E. M., Kok, G. J., & van der Zee, J. (1993). Correlates of exercise compliance in physical therapy. Phys Ther, 73(11), 771-782; discussion 783-776.
  • McLean, S. M., Burton, M., Bradley, L., & Littlewood, C. (2010). Interventions for enhancing adherence with physiotherapy: a systematic review. Man Ther, 15(6), 514-521. doi:10.1016/j.math.2010.05.012
  • Peek, K., Sanson-Fisher, R., Mackenzie, L., & Carey, M. (2016). Interventions to aid patient adherence to physiotherapist prescribed self-management strategies: a systematic review. Physiotherapy, 102(2), 127-135. doi:10.1016/j.physio.2015.10.003
  • Reilly, K., Lovejoy, B., Williams, R., & Roth, H. (1989). Differences between a supervised and independent strength and conditioning program with chronic low back syndromes. J Occup Med, 31(6), 547-550.
  • Nelson, B. W., O’Reilly, E., Miller, M., Hogan, M., Wegner, J. A., & Kelly, C. (1995). The clinical effects of intensive, specific exercise on chronic low back pain: a controlled study of 895 consecutive patients with 1-year follow up. Orthopedics, 18(10), 971-981.
  • Kolt GS, Brewer BW, Pizzari T, Schoo AMM, Garrett N. (2007). The sport injury rehabilitation adherence scale: a reliable scale for use in clinical physiotherapy. Physiotherapy, 93:17–22. doi: 10.1016/j.physio.2006.07.002
  • Schroeder, K., Fahey, T., & Ebrahim, S. (2004). How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of randomized controlled trials. Arch Intern Med, 164(7), 722-732. doi:10.1001/archinte.164.7.722
  • Haynes, R. B., Ackloo, E., Sahota, N., McDonald, H. P., & Yao, X. (2008). Interventions for enhancing medication adherence. Cochrane Database Syst Rev(2), CD000011. doi:10.1002/14651858.CD000011.pub3
  • Kings Fund (2016). A digital NHS? An introduction to the digital agenda and plans for
    Kings Fund. Retrieved from https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/A_digital_NHS_Kings_Fund_Sep_2016.pdf

Submit a Comment

Your email address will not be published. Required fields are marked *