Home exercise programs (HEP) are lauded as one of the most important tools in a physical therapist’s toolbox from the first semester of physical therapy school. For better or for worse, if you work in an outpatient setting, you will not see your patients every day. In many cases, you may see them once or twice a week. One or two 45-60 minute treatments, however, do not stack up well against the over 150 hours spent on non-rehab-focused activities throughout the remainder of the week. This is where the home exercise program (HEP) shines.
Whether you are a huge proponent of HEPs or aren’t sure if they are worth your time, read on to learn more about the benefits and drawbacks of HEPs and how they can be implemented into a telehealth practice.
Benefits of prescribing HEPs
Build accountability: While 1:1 treatments with a physical therapist confer a lot of benefits when it comes to addressing injuries, pain, and functional impairments, the ultimate goal of a PT plan of care is discharging the patient after they have met their goals.
In most cases, an ongoing program of strengthening, flexibility, or aerobic conditioning is recommended to maintain the improvements made in therapy, and establishing a home program early is a great way to help your patients build accountability when it comes to self-management. Implementing a long-term change in behavior takes time and repetition and the home program will help your patients learn that they have the tools to manage their condition after discharge.
You can’t cheat physiology: If a patient is attending one or two therapy sessions a week and not doing any rehab-focused home exercises, there is a good chance that your attempts at building muscle strength, muscle endurance, flexibility, motor control, and coordination will go unfulfilled.
Don’t forget that we have a large body of research that tells us how many sets, reps, and bouts per week of an exercise stimulus are needed to achieve a particular change in physiology. HEPs help you reach the dosage necessary to effect real change in the tissues you are targeting.
Intrinsic feedback and neuroplasticity: While the keen eye of a physical therapist is initially needed to ensure exercises are being performed correctly, generalizability and carryover into life and activities outside of PT are essential. HEPs give your patient the opportunities to practice what they have learned in their environment and rely on intrinsic feedback to monitor their performance, thus enhancing learning and retention. Similarly, specificity is essential for neuroplasticity, and the ability to perform these exercises or techniques within the specific context they are intended to be used helps improve patient outcomes.
Are there any drawbacks to HEPs?
It’s easy to create a long list of how HEPs benefit your patients and your practice, but are there any downsides to prescribing a HEP? A well-thought-out and individualized HEP likely has no drawbacks, but there are some pitfalls of which you should be aware.
Don’t prescribe and forget: A home exercise program should mirror the phase of rehab your patient has reached. Failing to progress (or in some cases, regress) a HEP can hamper the patient’s progress. Be sure to keep track of the exercises they are doing at home and advance and replace those exercises as needed to support the work they are doing during their visits with you.
What are they doing at home? For better or for worse, you aren’t going home with your patients at the end of the day which means you can’t see how they are performing their exercises outside of your sessions. Many factors impact how quickly someone learns a new exercise and it is not uncommon to observe at follow-up that a patient has not been performing an exercise correctly. They may be performing too many or too few repetitions or not listening to their body’s signals, increasing the risk of injury.
To help reduce the likelihood of this problem, make sure to observe the patient performing the exercise in the clinic so you can provide feedback and corrections and also review it at a later session. Additionally, ensure the exercise is safe and appropriate for the patient to perform at home, given that they may not perform it 100% correctly.
Telehealth and HEPS
Telehealth physical therapy services arose out of necessity with the onset of the COVID-19 pandemic and have stuck around in many practices due to their convenience and ability to target a larger client network. The benefits and drawbacks of prescribing HEPs do not change in the telehealth scenario but you may find there are some other advantages.
First, you can see the patient perform these exercises in their environment with their equipment. This allows you to tailor the program even more specifically based on their home environment. This can help improve adherence and success as you know the exercises can be performed well at home. Secondly, an individualized HEP of optimal difficulty allows you to focus on more advanced exercises during your 1:1 telehealth sessions when you can have eyes on your patient at all times.
Cash-pay clients and insurance companies love HEPs
Home exercise programs result in better patient outcomes. In a world of decreasing insurance reimbursement rates and claim denials, showing progress and medical necessity is essential. Prescribing a great HEP and educating your patients on why they must adhere to this program, will help them to reach their goals faster. This in turn is more likely to generate payment for these services. Additionally, a home exercise program differs from a general fitness program in that it is intended to treat a medical condition so a well-crafted HEP helps show payor sources why physical therapists are a necessary part of the healthcare system.
If you are working with cash-pay clients, a HEP still has all of the great benefits listed above, but in addition, it can help reduce the number of sessions that a client has to pay out-of-pocket. You may be an excellent therapist, but if your clients cannot afford your services, they will not continue to work with you. Providing a great HEP can help reduce the frequency with which a client needs to pay for 1:1 sessions, but also helps them build self-confidence and accountability. This will keep them choosing you again in the future if the need for PT arises again.
Put some thought into your HEP
If you haven’t been giving too much thought to the exercises you’ve been prescribing in your HEPs, now is the time to make a change. Helping to boost patient outcomes, increase patient accountability, and long-term learning and retention, you can’t go wrong with a well-crafted home exercise program. Whether your clients are paying cash, using their insurance, coming to the clinic, or seeing you virtually through telehealth, the HEP is a way for your patients to take a little bit of your expertise with them when they leave.
Tips for Home Exercise Program Compliance
Now that we’ve identified some barriers to HEPs, how do we overcome them, and what other methods can we utilize for better HEP compliance?
Overcome Perceived Barriers
Let’s examine some practical ways you can encourage your patient to move past their hesitancy to HEPs:
- Pain: Start by dispelling the myth that exercises should be painful. Patients will be more inclined to comply when they know their HEP shouldn’t cause them pain. Be sure to explain that performing their HEP should reduce their pain. As the patient progresses in therapy, it’s important to check in with the patient on their pain level during their HEP.
- Depression: Lend an empathetic ear to your patient’s struggles. If possible, work to eliminate barriers that are causing your patient to feel demotivated. Even if you can’t fix the problem, you gain your patient’s trust by listening well.
- Present Low Physical Activity: Take time to help the patient find a specific time in their day to perform their HEP. This will help with habit formation. Explain some hurdles the patient may experience, such as weakness and soreness, and encourage them to continue despite discomfort.
- Lack of Social Support: Brainstorm with your patient how they can successfully perform their HEP. If they don’t have time to do it, they won’t, so don’t rush past this step! If they lack social support, explain that their HEP enables them to be better spouses, employees, and friends.
- Unanswered Questions: Therapists often hand their patients a printout at the end of their session with a few home exercises and save very little time for instruction or answering questions. Give every patient an explanation of their HEP and allow patients time to ask questions. Some patients need more help than others; some may benefit from performing every exercise the way they would at home. This is time-consuming but worth the reward of better HEP compliance!
Every patient has unique strengths, fears, and circumstances. Stay creative in your patient care because a personalized approach pays off in the end! For more on overcoming perceived barriers, you can check out our article on how to motivate your patients.
Less Is More
Don’t overwhelm your patient with dozens of exercises or a long exercise session. One study found that patients were most compliant with their HEP when they were given only two exercises. Choosing the most important two or three exercises will be better in the long run than assigning half a dozen exercises that will rarely be performed.
If it’s not possible to limit the HEP to a few exercises, try two sets of exercises. The patient can perform each set once a day (if they have time) or on alternate days. Aim for exercise sessions to be 15 minutes or less.
The goal is for the patient to not be overwhelmed by the number of exercises or the time it takes to perform them. When patients feel confident in performing a few exercises and know they don’t have to block off a large chunk of time for their exercise session, they are more inclined to comply.
Patient Education After the First Session
Most therapists give a general rundown of the benefits of a HEP in the first treatment but neglect patient education in subsequent sessions. However, patients need reinforcement and encouragement to continue their HEP, especially as they begin to recover and it’s easier to slack off. Instead of giving an educational lecture, try asking your patient questions such as:
- How do you feel after performing your HEP?
- Are you able to do more everyday activities?
- Have you noticed the exercises becoming easier?
- Are you having better endurance?
- Are you having less pain?
Questions along these lines give you an easy opportunity to boast about the benefits of HEPs and extend patient education. Using their answers, guide your patient to see how their HEP is helping them achieve their goals. When patients realize how HEPs improve their everyday life, there is an automatic motivation for compliance!
Provide a Highly-Personalized HEP
Patients are more likely to perform their HEP when they know it has been personalized specifically for them. Instead of simply handing your patient a printout with a standard HEP for back pain, use Exercise.com’s physical therapy software to give that personalized touch patients want.
With our software, you get a HEP creator with a library of professionally-made demonstration videos providing clear instructions on all your HEP exercises. (You can also upload your videos to increase personalization and promote your business!) Simply select the exercises for your patient’s HEP and enter reps, weights, sets, and more. These are automatically sent to your patient via your custom-branded HEP app for them to log in anytime, anywhere.
Provide Accountability
Accountability is an important tool for breaking or starting any habit. It’s also one of the best motivational methods to encourage better HEP adherence. When patients know they are accountable to their therapist for performing their HEP, they are more inclined to comply.
However, sometimes verbal accountability still isn’t enough. Not wanting to discourage their patient, many therapists are quick to downplay noncompliance. While the therapist’s intentions may have been good, in the long run, this reinforces to the patient that their HEP is optional.
This is where Exercise.com’s physical therapy software comes in! Patients have a higher level of accountability with their therapist by using the HEP logger because their therapist sees all their logged exercises and sessions. If your patient lacks good social support, this accountability can be the difference between compliance and noncompliance.
Studies show that patients are more likely to comply when HEPs are attractively presented. Our HEP logger does just that! Far from a paper handout that’s been copied one too many times, our logger is fun and easy for patients to use. Because HEPs are sent the app, their HEP is always at their fingertips! This convenience enables patients to complete their HEP just about anywhere.
Additionally, patients can communicate with their therapists inside the app. This further encourages compliance because it removes the excuse of not understanding the exercise. If the patient has questions after watching the video, they can message their therapist for clarification and stay on track.
Utilizing these tips increases the chances of your patients adhering to their HEP. When patients complete their HEP, they have better recovery outcomes and higher satisfaction, which makes your business more profitable.
