Research Summary: Patients' Perspective of Home Exercise Programs and the use of healthSwapp

University of Toronto Research Summary



What was the purpose of this study?
This study explored the experiences and perspectives of physiotherapy outpatients with respect to their home exercise programs (HEPs) and how the use of healthSwapp affected the integration of HEPs into daily life.

Why was this study important?
Physiotherapists regularly prescribe home exercise programs (HEPs) to facilitate the management of musculoskeletal injuries and conditions. Adherence levels to physiotherapy HEPs are reportedly low in outpatient practice. In physiotherapy, there are novel mobile applications that are arising with the objective of enhancing patient engagement in HEPs. However, the patient perceptions of these new tools remains unexplored.

What were the methods
Ten outpatient physiotherapy patients participated in this study. All patients received treatment at the same physiotherapy clinic from two physiotherapists. A qualitative descriptive study design was used. Semi structured individual face- to face interviews were conducted with each participant.

What were the results?
Results revealed three themes that support one main finding:
The development and modification of a customized home exercise program (HEP) is a process that requires ongoing collaboration and negotiation between the patient and physiotherapist.
Collaboration and Negotiation: Therapeutic Alliance
  • Early establishment of a therapeutic alliance created a foundation for building an ongoing collaborative
    and iterative approach to the participants’ physiotherapy treatment.
  • Participants expressed appreciation for receiving education from the physiotherapist regarding the purpose of the HEP that was tailored to their individual knowledge and learning style.
  • Ongoing negotiation and two-way communication between the patient and physiotherapist helped ensure that the HEP continued to fit within the context of each individual’s life, and that any necessary modifications were made.
“I’m glad that she’s modified my exercises to what my actual experience of them is. And if it’s something I don’t like to do ... she’ll cut it out and replace it with something else instead.” – Melissa
Customization: Exploring the Mediators of Adherence
  • Consideration of unique features of participants’ daily lives and preferences was critical to co-creating a HEP.
  • Three primary contextual features that mediated whether a patient completed their exercises or not were: time, environment, and exercise complexity.
  • 1. Time: developing a routine, by setting aside specific times of day to complete exercises helped patients become more consistent with their HEP. However, unplanned interruptions to the routine was a commonly discussed barrier to adherence.
“I’m consistent [with my exercises] when my life is consistent, let’s put it that way” – Scott
  • 2. Environment: The factors that contributed to whether or not HEP were done in the workplace depended
    on the nature of the exercises, the work environment, the nature of the work, and the individual. Some participants were fearful of possible judgment from their co-workers, whereas others welcomed their co-workers to join them.
  • 3. Complexity: The need for equipment and/or a particular set-up acted as a barrier for some participants.
  • Mediators of adherence were complex in nature, and uniquely influenced individuals based on the context of their daily lives
  • To render the greatest benefit, application features should be personalized to fit each patient’s lifestyle and preferences
  • A mobile application can serve as an effective adjunct and extension of physiotherapy treatment, however it does not replace crucial elements of the in-person interaction.

healthSwapp: Patients’ Experiences of Using a Mobile Application
  • Participants were positive about their experiences with healthSwapp and noted that they preferred the application’s visual format to paper based handouts due to its accessibility and practicality.
  • healthSwapp can enhance the integration of a co-created customized HEP into a patient’s daily life. HealthSwapp acted as a valuable tool for augmenting but not replacing the patient therapist encounter.
"I do find the videos very helpful ... I’ll want a refresher on it even though it has been shown to me in person and I have done it a few times ... making sure I’m getting the proper technique ... is very valuable” – Claire
Key Analysis Findings
  • The development of a therapeutic alliance was imperative for collaboration and negotiation to occur; this approach involved the patients’ perspective in the creation and modification of a customized HEP
  • Mediators of adherence were complex in nature, and uniquely influenced individuals based on the context of their daily lives
  • To render the greatest benefit, application features should be personalized to fit each patient’s lifestyle
    and preferences
  • A mobile application can serve as an effective adjunct and extension of physiotherapy treatment, however it does not replace crucial elements of the in-person interaction.
Implications for Practice
  • From our findings we recommend physiotherapists dedicate ample time to asking patients questions and getting a detailed account of their daily lives in order to foster a collaborative approach to exercise prescription.
  • We suggest the physiotherapist frequently follows up to understand how patients are managing to incorporate their HEP within their lives, and remains open to making any necessary modifications.
Future Directions
  • Determine how to best implement technology into physiotherapy practice to enhance completion of HEPs
  • To explore the perspectives and experiences of physiotherapists implementing technology into their practice.
Authors
Hillary Abramsky, Puneet Kaur, Mikale Robitaille, Leanna Taggio, Paul Kosemetzky, Hillary Foster
Barbara E Gibson, Maggie Bergeron, Patrick Jachyra

Acknowledgments
This research was completed in partial fulfillment of the requirements for an MScPT degree at the University of Toronto.