Implementation of Home Exercise Programs in a Pro-bono Clinic: An Exploratory Study

Purpose: Because the number of return visits in a pro-bono setting is low and distributed over a longer timeframe, home exercise programs (HEP) adherence is crucial for patient success. The purpose of this study is to describe a process for HEP delivery and to collect measures of HEP adherence on patients at a pro- bono physical therapy clinic. Methods: Thirteen participants were instructed to perform at least four exercises at home. Exercises were chosen based on best available practice. Exercise images, instructions, and daily logs were populated using PHYSIOTEC® software. A follow up phone call was conducted approximately 4 days after the initial visit to answer questions regarding the exercises. Adherence outcomes were collected on the patient’s first follow-up visit and when possible adherence data was repeatedly collected until discharge. The first performance outcome, scored by the treating therapist, was an observational evaluation of the patient performing the exercises exactly as instructed on the first visit. Second, the patient was asked to complete the Medical Outcomes Study General Adherence Items (MOSGAI) while the therapist reviewed and calculated a score for the exercise log. Measures of central tendency and variability of the demographic data and measures of exercise adherence were calculated using Statistical Package for the Social Sciences 23.0 (Chicago, Illinois). Results: Participants included 7 females and 6 males with an average age of 56.73 (SD ± 12.78) years and body mass index of 27.3kg/m2. Self-reported HEP adherence was general good. The MOSGAI average was 85.3% (SD ± 24.3%), the HEP log average was 84% (SD ± 20.2%), and the therapist rated HEP accuracy scores was 79.16% (SD ± 29.84%). Trends in the data shown an improvement in self-reported HEP adherence overtime up to the third follow up visit. Conclusion: Initially our approach to HEP delivery in this pro-bono setting appears successful as reported measures of adherence and accuracy of performance were generally good compared to the existing literature. Clinicians could consider using a similar HEP delivery model to a population of patients with limited access to health care.