Reflection: 18/11/2020 Hours: 7
Today I saw five patients in clinic, two with lower back pain, one with calf and Achilles’ pain, and two with neck pain and stiffness. The patient with calf and Achilles pain, I have previously seen and spoke to about the importance of keeping on top of home-based exercises and treatment, but she has always had poor adherence to rehabilitation. Consequently, today’s appointment was focused on managing expectations, explaining the importance of adherence and trying to work out why her adherence is poor. Research has found that rehabilitation outcomes are poor when adherence is low (Brewer et al., 2000; McKay & Verhagen, 2016; Owoeye et al., 2020). Ways in which adherence can be improved, that we are trying, is through discussion about what works best for the patient to use methods that they enjoy or are able to fit into their day. We are also implementing a diary, to record how often she performs her rehabilitation exercises and track her progress.
What I was thinking and feeling and what was good or bad:
I felt quite frustrated that I haven’t been able to improve her adherence so far, however it has been good experience to try and work with her to work out why her adherence is poor and try different techniques to improve it.
What else I could have done/areas for improvement:
Remember that all patients are different and not the same thing works for everyone, so try not to get disheartened.
Research exciting rehabilitation exercises to make rehabilitation more enjoyable for this patient.
Research other unusual methods of improving adherence.
Brewer, B., Van Raalte, J., Cornelius, A., Petitpas, A., Sklar, J., Pohlman, M., Krushell, R., & Ditmar, T. (2000). psychological factors, rehabilitation adherence and rehabilitation outcomes after anterior cruciate ligament reconstruction. Rehabiliation Psychology, 45(1), 20–37.
McKay, C. ., & Verhagen, E. (2016). “Compliance” versus “adherence” in sport injury prevention: why definition matters. British Journal of Sports Medicine, 50(7), 382–383.
Owoeye, O. B. ., Emery, C. ., Befus, K., Palacios-Derflingher, L., & Pasanen, K. (2020). How much, how often, how well? Adherence to a neuromuscular training warm-up injury prevention program in youth basketball. Journal of Sports Sciences, 38(20), 2329–2337.