Soft Skills for the Physical Therapist and Patient
Physical therapy treatment is a collaboration between the patient and therapist. A recent blog “How to Get the Most out of Physical Therapy” from Outside Magazine Online presents great advice for the patient, provided by Nicole Haas PT, DPT, OCS. In the article, Nicole discusses how to choose the right PT. More importantly, she also introduces the need for the patient to overcommunicate and to be a good historian to provide the necessary information that the therapist needs to create a treatment plan. She also recommends using physical therapy as an educational opportunity for the patient and to actively participate.
It’s not surprising to expect that the readers of Outside Magazine Online to be an active community and only need a single sentence of “Do your exercises, of course…” to motivate them to return to their preferred activities and lifestyle. However, it is fairly common to find physical therapy patients unmotivated to do their home exercises with studies suggesting that non-adherence with treatment regiment and exercise performance as high as 70% (Sluijs et al., 1993). In “Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review” by Jack, McLean, Moffett and Gardiner, the authors identify strong barriers to adherence of which some are listed below:
- Low level of physical activity or aerobic capacity at baseline
- Low in-treatment adherence with exercise
- Low self-efficacy (for exercise, tasks and coping)
- High level of depression at baseline
- Anxiety/stress at baseline
- Poor social or family support for activity
In “Interventions for enhancing adherence with physiotherapy: a systematic review” by McLean, Burton, Bradley and Littlewood, the authors aim to identify strategies to improve adherence with musculoskeletal outpatient treatment. In their summary, they identify one high quality study that cognitive-behavioural (CB) interventions may be effective at increasing short-term adherence with home exercise.
Laura McKenzie, MHK, RCC in the blog “The Soft Skills – Part 3 of 3: Motivational Interviewing” reports that “Patients receiving MI (motivational interviewing) enjoyed statistically significantly better outcomes on physical strength and disability-related behaviours targeted by PT compared to those without MI.“ McKenzie provides recommendations on how to use motivational interviewing:
- Let the patients speak and ask open questions
- Provide information
- Explore their concern
- Skillfully use scaling questions
- Help with decision making
Another potential method to improve patient home exercise compliance is to use sports psychology. Dr. Justin Ross in “How to Implement Sport Psychology in Your Training Plans” recommends three skills coaches can use to improve performance in their athletes:
- Priming: introduce a set of beliefs that will subsequently influence what to follow. WHAT the workout entails, WHY the workout is important.
- Cognitive Appraisal: athletes spend 5-10 minutes of each workout paying attention to their thoughts about what they are experiencing.
- Mindfulness: a meditation platform to help athletes in a number of ways such as improved pain tolerance or willingness to do an exercise.
For the best results in physical therapy, the PT and patient need to work together to ensure that patient compliance is high by identifying barriers and motivating patients to overcome these hurdles.