By Meagan Aponas, OTR/L
Occupational Therapist, Massachusetts

Have you ever had a patient who refuses to perform an exercise, or a patient who isn’t motivated to complete a specific activity during your intervention? Or how about a patient who displays little to no home carryover of the home exercise or activity program you spent time creating for them? 

As clinicians, we’ve all dealt with these patients at some point or another. Yes, it is part of the job, but there are ways to reduce these tendencies among your current and future patients. Here are a few things you can do to help your patients complete their exercises and stay motivated.

Tie Exercises to Your Patient’s Routine

This is a simple way to increase a patient’s willingness and motivation to engage in the exercise or activity you’ve chosen as part of their intervention plan.  Don’t stop at simply explaining the purpose behind the movement, but try to directly relate it to a functional task the person may be struggling with. 

By relating the exercise or activity to a functional task, you provide the patient with a concrete step (the exercise or activity) to assist them in being able to resume the functional task they’re currently struggling with. For example, I found that many of my patients scoff when I first introduce them to Theraputty. I’m sure we’ve all had a patient refer to Theraputty as “Play-Doh” at one point or another. However, by directly relating different Theraputty activities to daily tasks, a patient’s motivation to participate tends to increase. Some examples I use frequently include relating putty squeezes to opening jars or turning a door knob, or relating key pinch with putty to managing clothing fasteners or opening food packages.

To make the connection between the exercise and the task, it can be beneficial to demonstrate the movement of the activity and then that same movement while performing whatever task you’re relating the activity to. 

This connection doesn’t just relate to Theraputty activities. It can be true for nearly all exercises and activities we ask our patients to perform. Some additional exercise examples I use frequently include: 

• Relating triceps exercises to pushing oneself to the edge of the bed or using their arm to get up from a chair. 
• Relating shoulder flexion to reaching into cabinets to get the ingredients for whatever recipe your patient enjoys making.
• Relating elbow flexion to having to lift pots and pans when your patient cooks their favorite meal

Educating Patients on the Importance of Exercise in Home Programs

Relating the exercises and activities chosen for a patient’s intervention plan to functional tasks is particularly important when introducing a patient to a home program. When creating a patient’s home exercise program we, as clinicians, use our clinical reasoning. Based on a qualitative study focused on clinical reasoning, “clinical reasoning is a context-dependent process that guides occupational therapists to plan, direct, perform and reflect upon patient care. Clinical reasoning needs to be considered within authentic relationships, such as those held with clients and colleagues”. By sharing our clinical reasoning with patients, we hopefully increase their understanding of the Home Exercise Plan’s purpose and their motivation to carry it over at home.

If you were handed a paper with a list of exercises matched with a confusing photo demonstration, what are the odds you would carry over the program 3-5 times per week? I’m sure some would, but many will add that to the pile of papers on their countertop and won’t glance at it again until you, the clinician, return. 

On the other hand, what if you educated patients on the purpose behind a home program? You can do this through concrete information about how each exercise or activity within the program could increase their independence or safety during your day-to-day tasks. The majority of our patients want to return to doing the daily tasks that compromise their routine, allow them their independence, and bring them a sense of joy. Taking the time to sit with your patient and ensure they have an understanding of the reasoning behind their home program will increase the likelihood of your patient following through on their end. 

Relating Exercise to Daily Routines Builds Trust Between Clinicians and Patients

Relating the chosen exercises and activities to functional tasks ultimately makes us better clinicians. By forcing ourselves to stop and relate an exercise or activity, it ensures there truly is a reason behind why we’re instructing a patient to perform a specific task. According to Mosey (1986), communication between patient and clinician regarding the aim of therapy is of vital importance for successful intervention. Mosey suggests that to successfully deliver a message means that one person (that is, the occupational therapist) is the messenger and another person (that is, the patient) is the one who shall receive the same message at an equal level of understanding.

If we search for reasoning and an activity to relate the exercise to and come up short, it’s an indication that maybe that intervention of choice isn’t appropriate or as beneficial as an alternate choice. This is true for all practices whether you’re an OT, PT, or SLP. It is easy to fall into a pattern of using the same home program for patient after patient, but remember the real role you play as a clinician. It’s our job to create individualized treatment programs that are meaningful to each unique individual you treat. Furthermore, we need to ensure each patient understands the purpose of each exercise and activity and how it relates to the daily tasks they struggle with. 

Relating Exercise is Only Part of Your Overall Care

This isn’t to say that if you relate your interventions to daily tasks you’ll never have a non-compliant patient again. This is just one additional step to incorporate into your daily practice that may increase a stubborn patient’s participation during sessions or during home carryover. 

Overall, there are numerous benefits for your patients and you as a clinician when you put time and effort into educating them on the relationship between your intervention and their daily lives.