Patient compliance with home programs

I had a number of pts on my rural placement with chronic conditions where I had to write up care plans for them and give them home programs to try to improve their condition. I gave them the exercises and then reviewed in 2/52’s to see how they were going and if the program needed modifications, progressions etc. With these types of programs it always seems questionable whether or not the pt will be compliant with their program but self management is the only way to try to improve their condition. One of my pts had had a number of TIA’s and as a consequence had decreased mobility, was walking with a 4WW and had a few balance issues. During the initial treatment session after writing up the careplan, I went through some balance exercises and some strengthening exercises with him and wrote them out as a home program. His wife was present during the session and she was very encouraging and happy with the program. On review his wife told me that over the past 2 weeks the pt had hardly ever done his exercises and said she had tried to get him to do them but he wouldn’t. I ask him why he wasn’t doing them, if they were too hard or if it was more just him not being bothered to do them. He said it was just him being lazy, so I emphasised along with his wife the need and benefits of him doing his home program and told him it was up to him to do something about his decreased mobility and balance problems because at the end of the day he is only disadvantaging himself. I went through his exercises with him again to make sure he at least did his exercises with me and to make sure again that he would manage fine at home with them. While we were doing the exercises (I did them with him as encouragement) his wife said maybe she should do the exercises with him as well at home and that may increase compliance, I told her that was a great idea. I also referred him to the mobility group exercise class that we ran twice a week for him to also get some added exercise and which could possible add to the motivation of exercising. Two days later the pt came to our mobility class and his wife said she had done his exercises with him that morning. From these experiences I have found that most pts are noncompliant most of the time with their home programs but its still best to give them the exercises and hope they will at least do something. It has also shown me that we have to try many different things to motivate the pt to do their exercises and having family involvement is one of the best ways to do this especially in the older population. Also if there is some community based exercise program that is also a good thing to get the pts to attend because at least you know if they attend that twice a week they are getting some exercise. At the end of the day the pt has to take some ownership of their management and it is important to emphasise this to them that if they want to improve they have got to do their exercises.