Perhaps the most important but frequently overseen factor in recovery success is patient adherence and emotional understanding. Having a clear insight into the headspace of both the patient and the physio would be key to improving patient-physio relations. Here’s what Dr. Pallavi Variyani, a PhD candidate in community health and rehabilitation to say about patient adherence.
- Why is patient adherence important?
Dr. Pallavi explains patient adherence the best way possible i.e., a doctor’s commitment to a patient. Be it making patients feel better and confident about themselves to getting them to place their 100% trust on you, patient adherence is all about commitment from both sides.
As to why it’s important, Dr. Pallavi directly connects patient adherence to the efficiency of a treatment. Patient adherence is the most important factor in effective rehabilitation that measures the cooperation and patient-physio relationship. If patients adhere to what the physios say, their chances of full and quick recovery increase rather exponentially.
- Is patient reluctance a negative factor in recovery?
Using the example of the placebo effect, Dr. Pallavi argues that a confident and brave patient is a recovery half-done. Ensuring positive and active communication between physios and patients not only enables a better physio-patient relationship, but also increases the recovery rate and success! Since the Central Nervous System (CNS) plays an active role in the body’s active physical mechanisms, patient reluctance negatively affects response to treatment plans.
- What primary challenges do patients face when it comes to rehabilitation?
Having worked with patients with spinal cord injury, Dr. Pallavi recollects her experience with mentally-strained patients and summarizes the worst problems to be time and money. Seemingly an obvious answer, the reality of this situation is far worse.
Given that severe injuries require a longer rehabilitation period like six months to two years, the sound of that duration itself is discouraging for patients. Additionally, if patients are from rural India, the necessities for such treatment are simply out of reach for them and shifting to cities for such treatment is not feasible for their wallet. In such cases, most patients either never begin or quit midway – both being incredibly risky and counterproductive.
- How can physios prevent patients from being demotivated?
The straightforward answer would be to keep saying encouraging words to them or cherry picking positive examples or stories that may make them feel more confident and responsive. However, extreme caution must also be maintained to make sure nothing false is said (giving hope is one thing but lying is a serious offense!).
Another way to encourage patients is making their recovery plan more active. For example, vocational training for long-term impairments can massively increase mental strength alongside providing a constant source of reassurance. Such measures go a long way in addressing motivation in patient adherence.
- Where does professionalism and ethics step in during physiotherapy?
From dealing with a wide myriad of emotions to regularly making changes to existing treatment plans based on latest research and/or assessments, the burden of recovery is as much on the physios as on the patients. Therefore it goes without saying that every step taken by a physio must be met with incredible professionalism and nothing done should be legally and morally unethical.
Another aspect that tests the professionalism of a physio is his/her communication skills. Dr. Pallavi puts emphasis on the ability to control one’s emotions and frustrations and in some cases, even accept someone else’s diagnosis and treatment. The key is to make the patient comfortable and effectively communicate decisions by keeping them in the loop and giving them as much control as needed. The more the patient feels in control, the smoother the entire process goes.
- These concerns aren’t limited to physios but orthos as well. So why do orthos need to do this?
Dr. Pallavi rightfully strikes down the relevance of this aspect to physios alone by stating that patient welfare and care is the most basic part of healthcare. Communication, ethics and professionalism is part of every workplace and in healthcare, it becomes even more important because it has direct implications to rehabilitation. Therefore, saying that this is only crucial for physios is an undermining of the scope.
- How can AI contribute to adherence?
Given that adherence is based on motivation, documentation of progress is an excellent way for patients to see in real-time their rehab journey. Their progress is a massive motivating factor and that reassures them to keep continuing with their plan. Also, since AI works on statistics and data, all inferences derived are credible and eliminates subjectivity. This means physios need to spend less time on reassurance and more time on analysing data and reaching prognosis.
WHAT’S NEXT
Patient adherence is probably one part which isn’t actively part of any curriculum, especially physiotherapy. It’s almost unbelievable that there are issues that can largely be solved by a healthy mix of technology and mental resilience. Perhaps this is where the physiotherapy community and healthcare as a whole need to focus on – patient adherence through mental welfare.
