This is a post from Dr. Dustin Lee PT, DPT
A physical therapist should best be known as a master of the balancing act. There is a lot more that goes into patient care than one may expect.
From a patient perspective, speaking specifically about outpatient care, you come into the clinic for your physical therapy appointment. The physical therapist then will take you to a table, treatment room or gymnasium. Most likely, there will be some questions about life updates and your current reason for seeking treatment, and this will soon be followed by examination and treatment. You will be sent home with, or asked to perform, a certain exercise prescription that will help to maintain or further the status of your case outside of the appointment time.
From a physical therapist perspective, prior to seeing the patient, you have reviewed the pertinent history and documentation on your patient. You have made a specific plan for how to intervene and promote beneficial change in your patient’s care. You have spoken with the medical team that is involved with this patient’s care regarding factors such as medication, precautions, etc. that may impact care. You then greet the patient and begin your care. Prior to the patient leaving, you prescribe specific exercise, or important activity, that will help to maintain or further the status of the case outside of the appointment time.
Just in case you missed it: Physical therapists prescribe exercise just as physicians prescribe medication and treatment. In both cases, the intention is for the prescription to be executed by the patient because the clinician knows that the patient will benefit from said prescription.
The concept of adhering to an exercise prescription is important to understand because patients spend most hours out of direct contact with their physical therapist. For instance, my patients typically see me one to two hours per week, depending on their plan of care. That is, one to two hours out of 168 hours. A whopping .6-1.2% of their week is spent in direct contact with me. In that time, I have the privilege and responsibility to coordinate care, administer care and decide on the most effective, specific and individualized home exercise program that will provide the best opportunity for success.
So, what goes into a home exercise program you may ask? A lot. Here is a brief list:
The patient’s goal(s)– Being able to climb many flights of stairs to attend your grandchild’s graduation from high school is just as important as running your 5th marathon or learning how to safely transfer into and out of a wheelchair. The type of exercise should match the anticipated goal of the patient.
Who the patient is– A stay at home mother or father of four should be provided the best chance for success by prescribing time-focused exercises that can be fit into a busy schedule. The exercise enthusiast should not be given a restrictive exercise list without providing him or her with plenty of other beneficial activities to perform instead.
Individual and specific drivers that motive the patient to succeed– A leg lift focusing on strength of the hip may not cause lasting changes in the nerve and muscular systems of a collegiate soccer player as would a sideways, cutting or hopping drill focusing on explosive power and strength. Exercise should be fun and interactive, and it should encourage the patient to push harder toward reaching goals.
The patient’s understanding of the goal at hand– Telling someone to perform a range of motion activity without giving an explanation of why or how it will help will most likely lead to non-compliance with the exercise program.
Health status, medication and precautions– Activities and exercises need to be safe to perform to allow for progression of patient care.
Intensity and frequency of exercise– To promote impactful changes in a patient’s strength, range of motion, tissue length or extensibility, coordination, balance, etc. the therapist must be able to provide challenging-enough exercise that will allow the patient to benefit outside of regular appointments. The amount and duration of that activity or exercise is just as important, especially when the patient is learning new movement patterns.
The physical therapist’s goal– The prescribed exercise or activity should maintain or further the improvement of the patient outside of the appointment time.
The majority of my patients’ weeks are spent outside of the physical therapy clinic as they go about their daily lives and devote their time to many activities: going to work, spending quality time with loved ones, actively engaging in their health and attempting to achieve the recommended eight hours of sleep. During this time, it is imperative that the client dedicate time to the program that was collaboratively developed with the physical therapist. A comprehensive and well-structured home exercise program will promote success during physical therapy care. This unique, specifically prescribed program sets each patient up for success as it lays the ground work for subsequent appointments and establishes the framework for continued progress throughout recovery.
I would love to know your thoughts and experiences relating to physical therapy prescriptions for home exercise programs.
Thank you for reading!
Dr. Dustin Lee PT, DPT