Physical therapists are heroes and villains in the story of recovery. At first, they are the villains of the story because they make the patient hurt more. The patient has dutifully been “taking it easy” for a bit after their surgery or accident and they have begun to feel a smidge better. Then they are suddenly being asked to bend, stretch, and move in ways that make the pain come back tenfold. This is, of course, a necessary component in healing and regaining full motion – but it still hurts. Usually it isn’t too terribly hard to motivate a patient to come back for their therapy appointments during this initial stage because it is all too obvious that they desperately need help to get back to their pre-injury state. However, motivating the patient to complete their exercises at home can be quite the challenge. The task of motivation becomes even more challenging once the initial phase of therapy is over and the time for maintenance begins.
While the patient is in your office, you can use a mixture of the good cop/bad cop routine. But what about once they walk out of your office and need to do their exercises at home to get ready for the next appointment? Many patients think they don’t really need to complete all of those exercises, or that you won’t notice if they don’t, or that they don’t have enough time, or any other number of reasons that prevent them from doing what they need to do at home to get better. How do you make sure they follow through?
First, make it as easy to do as possible. Give them cues that will jog their memory and remind them it is time to exercise. Suggest they do their exercises with part of their daily routine such as brushing their teeth, taking a shower, eating a meal, or even going to the bathroom. If they do several small exercises at each of these daily activities, they will have worked in their physical therapy exercises without having to “find time” each day to do them.
Next, make sure they know how to do each of their home exercises completely before letting them leave the first day. If you wait until the end of their session to hand them a flyer and quickly review it, they may say they understand even if they are mostly unclear. Consider yourself a teacher and the patient your student. How many students really ask questions if they don’t understand and want to get out of the classroom? By showing them their “homework” at the beginning of the session and walking them through each exercise, they are more likely to remember the correct method and follow through during the week.
By the end of your therapy relationship, you will know that your patient understands the importance of his or her therapy and how to complete the exercises you have prescribed. What you will not know is if the patient has the motivation to do so. Have you ever heard someone say a picture is worth a thousand words? Find a picture, video, or patient with a similar injury who did not complete their maintenance to show or introduce to your patients. It will likely take years of practice to accumulate samples for a variety of injuries, but you can enlist the help of fellow therapists and doctors to create a database. Show your patients just how badly their recovery can go if they don’t follow through. It is much easier to believe what you are shown than what you are told.
How do you motivate your physical therapy patients?