The importance of exercise as therapy

The demand for rehabilitation and physiotherapy services is increasing, as the population ages and chronic, degenerative problems and other factors arising from current living conditions increase. This growth in demand generates saturation of services, since waiting lists increase, and as a consequence so does the delay in receiving treatment.

Therapeutic exercise is the most effective treatment for treating any musculoskeletal injury, keeping in mind the long-term results. It is a fundamental clinical practice for the treatment and prevention of a large number of pathologies. Despite this, the problem with these treatments where the patient is an active agent of his recovery, is the lack of involvement he has when completing the prescribed exercises.

Much of the evidence of recent years takes as a reference the study conducted by Meichenbaum and Turk (1991), in which they proclaimed that one of the biggest problems in the therapeutic prescription of active treatments is the lack of adherence by the patient. The study looked at failure rates in follow-up to therapeutic prescriptions, with short-term curative treatments having 30% adherence.

Taking into account the latter and in order to combat this lack of widespread adherence to treatments, one of the most recent reviews published on the subject, that carried out by Collado-Mateo D et al (2021), established a series of guidelines to increase adherence. From this study, we have drawn the following conclusions:

1. Protocolization and coordination

When establishing a therapeutic exercise treatment we must ensure that the exercises are based on recent and quality scientific evidence. In addition, we must individualize them, so that they adapt to the patient in terms of intensity, duration or frequency.

With respect to weekly frequency, it has been observed that exercise programs of 1 session/week result in worse results in commitment to therapy.

In the last blog post we talked about the prescription of exercises for shoulder pain based on the typology of the patient. The treatment cycle that is recommended to offer the highest quality service to the patient is based on three main processes: Personalization, measurement and monitoring and progression. It is essential to be able to offer individualized treatments using simple scales such as the DASH scale, composed of 30 items. In this way we can guarantee safety to patients being able to prescribe treatments that adapt to them.

Bei P et al, stated in 2018 recently that any exercise protocol increases its adherence if the patient is supervised and monitored while performing it in front of uncontrolled groups.

On the other hand, Sasan A et al recommended in 2020 the use of web applications that did not involve the presence of the patient. That is why the main letter of introduction of TRAK is the supervision of remote exercise programs, granting flexibility to the patient to perform their protocol.

2. Initial evaluation and monitoring.

We must always make an objective assessment of the patient’s own characteristics. Each person who comes to our clinic is different, so we must analyze not only the pathology they bring with them, but their general health and lifestyle in order to find out how to increase their adherence to the protocol we have prescribed.

There are numerous negative factors associated with the lack of adherence to treatment of patients such as sedentary lifestyle or smoking and the presence of chronic diseases, which are often related to situations of fragility or depression.

With regard to monitoring, the follow-up of the patient’s progression must be carried out with objective data that support their evolution. For this, there are some indicators that we can use different mechanisms that we can use as a reference. On the one hand, through clinically validated scales and questionnaires, we can make periodic assessments of the patient’s functional status. On the other hand, we can resort to objective metrics of the patient’s sessions and compare them how they progress over time.

Trak’s tracking system allows you to record the maximum range of motion per exercise, the number of repetitions performed, the execution time and many more indicators. These data allow us to know the functional improvement that the patient is obtaining in the different variants: pain, mobility, resistance …

3. Education and integration

Explaining the benefits of exercise to the patient, as well as making them see the benefits of any treatment, will provide them with confidence in the treatment and also in the professional who is prescribing it. We must understand that either out of habit (because of prescribing rest) or simply because he adopts an anti-algesic attitude, the patient continues to see exercise as something that can worsen his clinical situation.

It is not about giving him a symposium on the benefits of exercise in the long or short term or about physiology, but to make him understand that therapeutic exercise is his new medicine, in this case. For this reason, we must accustom them to working in a framework of low pain and make them understand their pain so that it does not limit them. This will be key in ensuring their adherence to the program we have delivered.

There are many scientific articles that relate a high adherence to an exercise program with a correct inclusion of physical exercise in the daily life of the patient. Carrying out her protocols in an environment known to the patient, such as her home and knowing that she is being monitored by a healthcare professional, reinforces this fact.

In-person attendance involves certain difficulties that arise as adherence problems, such as having to travel or the weather. In addition, membership will be higher if it offers time flexibility and does not require attendance at a previously arranged session.

4. Fluid communication and information between professional-patient

We have already seen that monitoring and supervision of treatment, as well as constant communication with the patient, is essential for them to feel motivated and adhere to the exercise program.

At TRAK we are aware of these concerns and for this reason we offer the possibility of establishing direct communication with the patient with whom we can generate an active interaction that helps them comply with the prescribed treatment. It is important to convey positive messages and even feedback on how to perform the prescribed exercise sessions.

It is also essential that, after several weeks of home work, face-to-face reinforcement sessions are included to carry out a more exhaustive assessment to observe their progression, keep their motivation high and be able to make modifications in the execution of the exercises or in the program itself.

TRAK offers both, the health professional and the patient, the data of the progression of the treatment in a system of graphs of the evolution. It presents joint ranges, pain scale or the adherence data itself to guarantee that the professional obtains the greatest amount of information possible and the patient is motivated to continue observing his progression.

In addition, TRAK uses gamification mechanics that involve the patient in the treatment, being able to report the progress that he is making in a fun and attractive way. As can be seen in the image, we visualize the evolution you are making 📈, you can get Trak 💯 points and have a streak of the sessions carried out ⚡.

5. Patient participation and objectives selection

Digital health is becoming more and more a reality, and one of its maxims is the empowerment of the patient and the assessment of it as an active part of their own treatment. This is established by the WHO in the Draft Global Strategy on Digital Health 2020–2025 and in the REHAB 2030 Project.

The patient must know, understand and get involved in his own treatment and for this he must be informed, educated and offered self-treatment strategies that allow him to control part of it. Likewise, it is important as professionals that we organize our treatment and our protocols based on a series of objectives that are real and that adapt to each patient.

Currently, there are tools available to offer telerehabilitation services with assistance in real time and that allow objective monitoring of the patient’s evolution remotely.

If you want to know more about the advantages that TRAK could give you, do not hesitate to request a trial!

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