During my short career as a physical therapist, I have heard many comments such as “I’m too busy”, “I’m too tired”, ” I have pain”, “I forgot” or “I just don’t want to do them”. These are some of the reasons why people do not perform their home exercise program (HEP). The reasons provided give a small glimpse of how much of physical therapy involves changing patients’ behavior.
Sionnadh McLean, a physiotherapist at Sheffield Hallam University in the United Kingdom, has studied barriers to treatment adherence in PT clinics. She notes,
The important thing that a physical therapist can do at this stage is not to blame the patients and to understand that all exercise behavior change is difficult.
PTs alone are not going to make their patients better, but physical therapists have the opportunity to teach patients how to make themselves better (Miller, 2015).
In my experience, patients who are not only compliant, but also adherent, to their prescribed home exercise program tend to progress and recover much more quickly than patients who don’t do anything outside the clinic. This reduces the time and money spent attending supervised physical therapy sessions (“Importance of home exercise program”, 2008). Patient compliance is of considerable importance in physical therapy because treatment effects partly depend on it. The efficacy of therapeutic exercises can only be established when patients comply with the exercise regimen.
There are indications that noncompliance with exercise regimens is as great as noncompliance with other medical regimens. The development of methods for improving patients’ compliance requires insight into factors that are related to noncompliance in physical therapy (Sluijs et al., 1993). According to Slujis et al. (1993), when health care providers give unclear instructions and fail to explain the rationale for the instructions, unintended noncompliance can arise from forgetting or misinterpretation.
From my experience, physical therapists typically provide HEP programs in the form of written instructions with diagrams and/or verbal instructions with demonstrations. Many HEP software programs are antiquated and/or incomplete, as clinics have to balance the financial costs of upgrading software with declining reimbursement rates and other challenges. Furthermore, different learning styles require that a therapist select the ideal method to deliver HEPs. Clear descriptions of how to perform exercises correctly is critical to the success of any exercise program. Perfecting this skill will make you a better physical therapist and is often a tough lesson to learn. The goal of this article is to provide a list of software applications that allow physical therapists to create specific exercise programs for their patients.
Below is a list of online databases and software applications to help the New Grad PT most effectively create HEPs for their patients:
HEP 2 Go is a home exercise database accessible through any online search engine. There are two plans available. The first plan is free and includes access to all content. You can access this content in the form of print or email, and you can create unlimited exercises. The limitation is that you can only save two routines. The second plan costs $4.95/month and includes everything above, as well as the ability to save unlimited routines, share HEP through SMS texting, and other benefits. Exercises are sorted by joint region, education (body mechanics), and special populations such as vestibular, aquatics, and neurologic patients.
BPMRx is a physical therapy home exercise software program that includes access to all modules (cardio, barbell, kettlebells, stretches, etc.). PTs can build unique exercise handouts from a library of hundreds of beautifully rendered black and white illustrations. PTs can create up to 100 different exercise handouts per day on a single account. A PT can email a PDF to a patient’s computer or smart phone at no extra cost. The plan costs $10.00/month.
This is an online HEP database that ranges from $20/month plan (0-50 new patients/month) to $55/month (301+ new patients/month). The database contains nearly 1,000 exercise, activity, and education options. Stretching, mobilizations, range of motion, strengthening, education, equipment and device demonstrations, and more are included. A PT can expect to increase patient compliance and provide better customer service and communication by utilizing the secure, private messaging feature. Each individual patient has secure access to their own portal, where they can access their own HEP, which also includes HD videos.
Patient Care HEP is an online software program that was developed by MEDBRIDGE as a way for rehab professionals to better connect with their patients. This program includes smart search, custom filter views, fast sorting, and intuitive categories. There is a collection of over 3,000+ exercises in the database. Included is a condition-based 3D animated videos in each program to help your patients better understand their rehabilitation. Each exercise is filmed in HD on a pure white background with multiple camera angles to provide your patients with easy-to-follow instructions. Patients have access to their own portal, where the videos, exercise programs, and condition based videos are easily accessible. Patient Care HEP is part of MEDBRIDGE’s yearly subscription of $300/year.
Physiotec is a web-based home exercise program that covers a wide range of specialized exercises for all types of rehabilitation programs. There are video home exercise programs that are produced in-house. With Physiotec, patients have access to their home exercise programs online through their smart phones, electronic tablets or computers. It’s easy for them to play the video of each exercise, see the number of sets and repetitions, as well as access written instructions in Spanish, English and French. Clinicians can print home exercise programs by choosing from 8 different print formats to accommodate patients’ needs. The handouts can be printed in color, black and white, or vector (line) formats.
PacPacs + is an online rehabilitation exercise and client management software. The online system consists of video exercises that consist of multiple angles and a voice over to explain and talk the patient through the exercises. Software consists of an ever-expanding exercise library which can be augmented if you want to add a novel exercise of your choice. PTs can prescribe exercises and send them to email or smart phones. Print source is still available for those clients who don’t have internet access. Pricing varies depending on number of users, but base price for one user is 20 pounds per month/user. Client histories, contacts and consultation sheets all stored on the site, the speed and ease at which you can organize your patients and prepare for revisiting clients is really important. An added benefit is that the software even lets therapists know when their patients have viewed their exercises.
PTX is a free web-based exercise database that currently contains over 1,000 physiotherapy exercises appropriate for people with injuries and disabilities. The website primarily consists of exercises aimed at improving strength, flexibility, function, and fitness. Emphasis has been placed on providing exercises that are independent of different philosophical approaches to rehab. Exercises can be searched via different categories, such as condition, exercise type, body part, equipment available, exercise difficulty, age category, and image orientation. Each exercise has an accompanying illustration and photograph. Each exercise has instructions, aims, and precautions written in two formats: one for the patient and one for the practitioner.
WebExercises® gives clinicians the ability to quickly and easily create concise and personalized exercise programs, selecting from over 3,000 clinically accepted exercises and stretches from all body regions. Instruction sheets can be printed or delivered by email, customized with a specific clinic’s name and logo. With WebExercises®, patients gain a clear understanding of their home exercise programs, promoting more frequent and proper form of all prescribed rehabilitation. A database of exercises is also provided in video form. This program gives clinicians the ability to track and improve compliance, and has the added flexibility of allowing PTs to add their own photos and videos.