Providers of musculoskeletal services are under increasing pressure from referrers to deliver high quality, innovative services that are underpinned by evidence based practice. They will be judged on clinical outcomes (PREMs and PROMs). At the same time there is a trend towards reducing the number of treatment sessions per referral. In order to achieve more with less, greater emphasis will be placed on the patient to take responsibility for their own recovery. It is inevitable that Self-care and how it delivered will come under greater scrutiny.
Traditionally clinicians have favoured old fashioned ways of delivering home exercise programs such as stickman diagrams or line drawings. In North America, clinicians photocopy exercise cards (e.g. VHI Cards). In Europe, clinicians tend to print out line drawings from their desktop (e.g.Physiotools). The likelihood is that this is due to habit (‘that’s the way we’ve always done it’) rather than informed, reflective choice. The evidence for delivering exercises in this format isn’t great. It is thought that only 30% of patients adhere to their exercises and of these only 50% do them correctly. This simply doesn’t cut it if treatment services are to be effective.
Physiotec, the online exercise software developer cites literature that demonstrates patients are more likely to perform exercises correctly when using exercise video clips compared to static drawings . Subjects in the trial who received video clips of home exercises reported being more motivated and confident about performing their exercises. When asked which form of delivery they preferred, all participants in the trial unanimously favoured video clips over static illustrations. If we are to truly embrace a patient centred model of MSK service delivery we should ask the right questions of our patients and act upon their responses. If this is to be the case, it would seem that the days of stick man diagrams and line drawings are numbered.
In more recent times our resource, the Exercise Prescriber (www.exerciseprescriber.com) has taken the next evolutionary step for delivering better self-care. In addition to sending narrated videos of home exercises to a patient’s tablet, smartphone, laptop or PC, we have also introduced the ability for clinicians to send info pages from our database of 60 common musculoskeletal conditions. In terms of patient education and adherence to home exercises it is our belief that if a patient understands why they’ve been asked to do their exercises they will be more likely to do them.
If providers are to survive the challenges of doing more with less it is vital they embrace change. They will need to ask patients what they prefer (rather than assume) and act upon it. They will need view self-management of home exercises as the key to achieving acceptable clinical outcomes….or risk losing referrals.