Challenge: The client with the frozen shoulder presents with the same stiffness as the last two visits. You ask her about her home program. She does not even remember what exercises you taught her. Apparently, she is not complying with the home program. What do you say or do to encourage compliance?
This is one of my favorite issues. We are in business to be successful, achieve goals and hopefully to make a difference in the life of someone with a rehabilitative health issue. When no difference is being made, one must question as to why? We expect results when we instruct clients in self-care, home programs, and therapy interventions. We may be confounded by a client’s lack of cooperation or reticence when it comes to taking responsibility for his/her health. Some people believe the doctor fixes them. Others feel that if they paid for a service, it should be up to the provider to make change happen. Others are negotiating for some kind of gain, either disability benefits, attention, liability awards, or a way out of a situation they do not like. (such as an undesirable job). A few clients may be fearful of failure, of re-injury or pain, or they just do not trust you. Some clients have informed me of just how long they must exaggerate their injury to gain in a lawsuit. (“I must be out of work at least four months or I will not win this case.” or “If I return to work too soon my wife will kill me. I take home more on disability than I do when I am working.”) Whatever the reason, you must discuss the problem with them and identify a realistic solution. Give them the benefit of the doubt. Maybe you missed something. Examine again. Repeat objective measures. Review your records. Refer to another practitioner or to their physician for assessment. Ask them directly about how they feel about their home program, without being confrontational.
Be honest but fair. The client may surprise you with his/her answer. Be open and supportive, but firm. Perhaps something you did caused them pain, or did not meet their preconceived expectations, or what their neighbor said about his PT experience. Be sure you provided good reasons for compliance, perhaps some stats on the value of home programs. Educate the client about how important it is for them to understand why you prescribed such a program, what your expectations are, and the list of goals. If you are on the same page as he/she is, you have a greater chance for success. If not, you might decide to “show them the door” after explaining why you cannot help them, you will not take their money for nothing. Be sure to refer them back to the physician, and document the interaction.
