Why don’t we stick to home physiotherapy exercises?

The lack of persistence in home physiotherapy exercises is a well-known problem hindering the effectiveness of treatment. It is especially evident in vestibular rehabilitation (exercises to treat dizziness and balance problems). Researchers from Ben-Gurion University of the Negev analyzed the barriers to conducting consistent home exercises and have published recommendations to overcome them in the leading physical therapy journal, The Journal of Neurologic Physical Therapy (JNPT).

Vestibular rehabilitation addresses abnormalities in the vestibular system, such as dizziness, gait instability, sensitivity to movement and blurred vision. Treatment is especially effective when consistently practiced at home.

To find a solution to the lack of consistent practice at home, a research group from the Department of Physiotherapy at Ben-Gurion University approached 39 patients doing vestibular rehabilitation and experienced physiotherapists to identify barriers.

They found six barriers: motivation (lack of confidence in the effectiveness of the practice, boredom and lack of internal drive); increased symptoms during the practice (temporary worsening of dizziness, during or after the exercises); difficulties in time management (difficulty integrating practice into daily routine); lack of feedback and guidance (patients’ limited understanding of how exercises should be done and their effect); psychosocial factors (what will the environment think?); and related medical deficiencies (such as neck pain and migraines).

The research team formulated recommendations for clinicians, which can significantly improve treatment outcomes and patients’ quality of life. Thus, for example, to increase motivation – personal interaction and follow-up by a clinician would allow for greater attention to the exercises, availability and feedback conversations on the performance of the exercises – including initiated phone calls, text messages to patients in between visits to the clinic, would nurture motivation for the practice. Investing time and money should also increase motivation. In terms of time management – personalizing the exercises to fit into the patient’s daily routine. For example, to practice a little bit at a time throughout the day and/or write in a daily diary. Patient guidance – the exercise instructions should include an explanation of the importance of the exercises, the expected symptoms, and the expected recovery time. Documenting improvement by providing quantitative and visual feedback, such as charts and graphs, should encourage continued practice.

“Our study provided a broad perspective for data analysis by both patients and treating physicians,” explained Prof. Shelly Levy-Tzedek who led the research. “Identifying the common barriers to practice allowed us to build strategies that could improve adherence to home practices and, as a result, the effectiveness of treatment. This is a study that can be applied in any clinic and to any patient, and therefore an important guide for therapists.”

This research was carried out as part of Liran Kalderon’s doctoral dissertation in the Department of Physiotherapy at Ben-Gurion University of the Negev, under the joint supervision of Prof. Shelly Levy-Tzedek and Dr. Yoav Gimmon, and together with Azriel Kaplan and Dr. Amit Wolfovitz.