Today I saw 3 patients in clinic, two with neck pain and one with ankle pain.
The lady with ankle pain, is training for a ultramarathon and is suffering from pain in her achilles which is presenting as a reactive Achilles Tendinopathy. I have educated her on the continuum theory and explained the importance of reducing load to allow the tendon time to recover and have prescribed her some home based exercises. However, her adherence is really poor, including adherence to HBE, appointments and following advice. The patient often cancels appointments and then returns to clinic after a few months with worsening symptoms.
What I was thinking and feeling and what was good or bad:
I often feel really disheartened and frustrated which I have to hide when dealing with the patient. I feel like I am unable to help her as I she does not listen to my advice which I think is because she doesn’t want to accept that she might need to reduce her training intensity and is worried this will affect her ultra marathon preparation.
What else I could have done/areas for improvement:
I need to work out ways to improve her adherence, communicate with her and assess her barriers to adherence in order to overcome them.
Plan the next session to overcome the barriers to adherence and focus on appropriately communicating in order to help the patient improve their adherence and get the most from the sessions.
It is important to work with the patient to improve their adherence (Brewer et al., 2000; Scherzer et al., 2001) as lack of adherence is an issue and was found to be influenced by social, contextual, personal and sociodemographic factors (Engel, 1996). Research on injury rehabilitation adherence has found that individuals are more likely to adhere when they are self-motivated, experience social support, believe their health is within their control, understand the effectiveness of rehabilitation and believe that they have the ability to complete the rehabilitation (Brewer et al., 2000).
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.
Engel, G. . (1996). From biomedical to biopsychosocial: Being scientific in the human domain. Families, Systems & Health, 14, 425–433.
Scherzer, C. ., Brewer, B. ., Cornelius, A. ., Van Raalte, J. ., Petitpas, A. ., Sklar, J. ., & Ditmar, T. . (2001). Psychological skills and adherence to rehabilitation after reconstruction of the anterior cruciate ligament. Journal of Sport Rehabilitation, 10(3), 165–172.