ADHERENCE TO HOME EXERCISE PROGRAMS ISSUED TO PATIENTS WITH SPINAL CORD INJURY: THERAPIST AND PATIENT PERSPECTIVES. Kelli Manring*; Jenny Kiratli Spinal Cord Injury Center, Department of Veteran Affairs Palo Alto Health Care System, Palo Alto, CA PURPOSE: Our purpose was to identify similarities and differences in perceptions of patients with spinal cord injury (SCI) and Veterans Administration (VA) therapists who issue home exercises programs (HEPs). Survey questions were targeted toward patterns of adherence, perceived barriers, expected outcomes, and identification of strategies for improving success with HEPs. BACKGROUNDS/SIGNIFICANCE: HEPs are prescribed by therapists to complete a rehabilitation program and prevent recurrence of an impairment or dysfunction. It is widely accepted that patients rarely adhere fully to their programs, i.e. performing all/most prescribed exercises for all/most of the length of time prescribed. Poor adherence translates into non-optimal functional gains. Little research has been done to assess the actual levels of adherence in the SCI population and identify contributing factors underlying insufficient adherence. Better understanding of the underlying causes of poor adherence should allow therapists to reverse this trend and thus achieve desired functional outcomes, prevent recurrence, and decrease the need for future utilization of services. SUBJECTS: Two groups of subjects were recruited: 1) Veterans receiving care at the SCI Center of the VA Palo Alto Health Care System and 2) Physical Therapists, Occupational Therapists, and Kinesiotherapists who issue HEPs to patients with SCI within the VA Health Care System. METHODS AND MATERIALS: Twenty-two SCI Centers within the VA Health Care System were contacted for participation in this survey. Therapists were recruited from the 19 sites that agreed to participation. Of 165 surveys distributed to SCI therapists, 105 (64%) valid surveys were returned anonymously. Patients were identified by chart review from August 2001 through August 2003 and those found to have a SCI diagnosis and documentation of a HEP issued were sent a survey. Of 206 surveys distributed, 122 (59%) valid surveys were returned. ANALYSES: Descriptive analyses were performed to generate summary statistics and Chi-square analyses were performed to determine differences between proportions. RESULTS: Level of Adherence. Although all patients surveyed were documented to have been prescribed a HEP, 27% responded that they had not been given a one. Nearly half (46%) of the patients who responded stated that they did not adhere to their HEP for the duration prescribed - 25% dropping out after 2 weeks and 70% dropping out after 3 months. In contrast, two-thirds (64%) of therapists believed that their patients were performing 50-75% of their HEP routinely. Satisfaction/Frustration with HEP. While 76% of therapists believed that their patients felt the prescribed HEP would enhance their lives, 48% of the patients reported to be moderately to severely frustrated with their HEP. Only 4% reported “no real benefit” from doing the prescribed HEP. Some differences were noted by level and completeness of injury. Those with complete tetraplegia reported highest frustration with their HEP, while patients with complete paraplegia reported the least frustration. Elderly patients (and those injured longest) reported the lowest frustration with their HEP. Patients with incomplete tetraplegia were more concerned with decreasing fatigue & pain, increasing sitting endurance, overall health, flexibility and breathing as outcomes of their HEP while those with complete paraplegia were least concerned with posture, sitting endurance and decreasing fatigue. Barriers & Attributes toward Success. Patients listed the top barriers to HEP adherence as: motivation (38%), hard to fit into daily routine (33%), lack of energy (29%), “too lazy to exercise” (23%), lack of time (23%), lack of interest & doing own activity is enough (both 17%). Therapists listed top barriers to HEP adherence as: need motivation, HEP low on priority list, unable to obtain needed assistance, pain, and lack of client patience. One third (32%) of patients reported that therapists didn’t spend enough time with them. In contrast, only 1% of therapists believed therapists’ time limitations to be a barrier to adherence, while 40% of therapists reported patient time limitations as a leading cause of reduced adherence. Therapists listed the top attributes to success as: motivation, involvement in a regular exercise program prior to injury, and ability to translate benefits into function. Patients reported that they would like increased family or friend involvement in their HEP in the form of a work-out partner (54%) as well as encouragement for participation (48%). 57% of therapists and 45% of patients responded that increased contact would help to increase adherence to HEPs. CONCLUSIONS: The finding that 27% of patients did not know that they had been given a HEP is significant. This may reflect a lack of emphasis on the importance of home exercise and how participating in the HEP translates into improved function. Therapists & patients believe similarly that increased contact would improve adherence to HEP. Different perceptions of barriers and goals were noted between therapists and patients. Increased attention to identifying and eliminating perceived and/or anticipated barriers as well as clarifying goals should improve adherence to prescribed HEP and therefore optimize functional outcomes. Follow-up contact after a plateau should be routine to optimize patient ability to self-manage/progress their HEP appropriately. FUNDING SOURCE: NIDRR Rehabilitation Engineering Research Center Grant KEYWORDS: exercise therapy, patient compliance, paralysis, survey Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.