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If in-clinic care is the meat and potatoes of rehabilitative therapy, then home exercise programs (HEPs, for short) are its bread and butter. In other words, as important as it is for physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) to provide excellent in-clinic care to their patients, that care is not complete until it’s paired with an equally excellent home exercise program.
What is a home exercise program (HEP)?
An HEP is a set of physical exercises curated by a PT, OT, or SLP to help a therapy patient maintain or improve upon their functional movement goals. HEPs are typically assigned in conjunction with an active PT, OT, or SLP plan of care (POC), and are unique to each and every patient. This is because the treating therapist selects exercises that target individual patients’ movement or therapeutic goals in a way that keeps their current and highest potential strength in mind.
Why are HEPs important in physical, occupational, or speech therapy?
When HEPs are crafted with care—and patients adhere to them—they can help patients regain function, as they supplement the care that is provided in the clinic. But that’s just the tip of the HEP iceberg! Per thesethreesources, HEPs can also:
Help patients reduce, manage, or sometimes even eliminate their pain;
Increase patients’ endurance and range of motion;
Lower patients’ chances of reinjury; and
Encourage patients to adopt long-term movement routines.
At the end of the day, HEPs are important in rehabilitative therapy because they help patients heal faster and improve their overall quality of life. As many PTs have told their patients before, “the patients who respond best to PT are the ones who do their HEP.”
What’s the difference between an HEP and a workout plan or a home fitness program?
The main difference between an HEP and a workout plan or a home fitness program boils down to intent. In other words, their differences lie in who prescribed the exercises—and what those exercises are supposed to help a person achieve.
An HEP is a set of exercises specially prescribed by a PT, OT, or SLP (or sometimes even an athletic trainer) that will help a patient progress through their medical treatment plan. This exercise therapy targets specific areas of the body in an effort to strengthen them and, most often, reduce overall pain. HEPs—and the exercises therein—are always crafted and customized with regard to a patient’s individual strength level and musculoskeletal status.
In comparison, a workout plan or home fitness program is curated by someone who may be familiar with exercise science, but who isn’t prescribing exercises with a medical goal in mind. These workout plans and home fitness programs are intended to strengthen muscle groups and improve endurance, often to achieve an athletic goal (e.g., a couch to 5K program, or deadlift 400 pounds). And while these plans and programs may be tailored to target specific parts of the body, they’re not designed for specific people—which means their generalized advice is not always suited to everyone who follows it. There are hundreds, if not thousands, of general exercise plans that have been uploaded across the net.
How do you create a successful HEP?
Creating a successful HEP involves more than simply evaluating a patient’s musculoskeletal condition, picking exercises, and sending them on their way. The best HEPs get patient buy-in because they are:
Simple (i.e., patients are more likely to remember and adhere to them),
Meaningful for the patient (i.e., they know why you picked those specific exercises),
Flexible (i.e., they change as the patient’s condition changes), and
Easily completed within the patient’s day (i.e., think 15 minutes or less).
Beyond that, HEPs are usually explained in detail via comprehensive resources (e.g., print-outs or apps) that patients can review at home. But not all HEP materials are created equal, and the best therapeutic plans (and therefore the ones that patients are most likely to adhere to) follow the below advice.
Include photos of the exercises.
Remember that patients are not musculoskeletal or exercise therapy experts—at least not usually. If you simply provide them with a list of exercise names, they’ll be hard pressed to remember exactly what those exercises are—or their correct form. That’s where including photos comes in handy. Ideally, the HEP materials that you send home with your patients will include high-resolution photos that clearly demonstrate what the exercise should look like.
Here are two example photos that demonstrate a bridge exercise. Notice how they show patients the proper form when at rest and also at the peak of the movement. They are also professional-looking: The image quality is crisp, the shot is well lit, and the frame is angled to help patients easily see the exercise’s entire range of movement.
Here’s another example. The next two high-quality pictures demonstrate the proper form of a prone press up—from rest to peak.
Include videos of the exercises (if possible).
If you’re using a digital HEP solution—like an app or a website—consider sending patients videos of their assigned exercises. Videos are a slight upgrade from exercise photos, as patients can see the nuances of a motion that would normally get lost between one or two stills. These videos should also demonstrate the full range of movement in an exercise (i.e., from rest to peak) and should look just as professional, if not more.
Take a look at the previous two stills offered in a video format.
Include brief overviews of each exercise.
One of the most important pieces of information you can include for patients in an HEP is a brief description of the exercises in the plan. These descriptions are important for accessibility reasons (especially if a patient is using a piece of technology to access their HEP)—and they also can give patients specific reminders addressing their personal habits. For instance, if a therapist asks a patient to complete bridges, and that patient has a tendency to lift their toes at the peak of movement, the therapist can address this in the exercise description. Simply adding a short reminder that says something along the lines of “Be sure to keep your feet flat on the floor” is enough to continue directing the patient long after they’ve left the clinic.
Additionally, these short descriptions should provide quantitative instructions, including the number of repetitions and sets the patients should perform, as well as the frequency per day (or per week) they should perform them.
How much should you customize an HEP?
Ideally, an HEP should be customized as much as possible—from its medical contents to its distribution method. Customize every description that you provide a patient, offering suggestions and tips that address the unique needs of each patient. And if you have the option to do so, try to choose pictures or video demonstrations that patients can relate to. For instance, a geriatric patient may respond better to an HEP when they see an older person perform or demonstrate an exercise. It shows them the movement is both reasonable and accomplishable!
What are some modern HEP best practices?
One of the most fundamental HEP best practices is providing high-quality media. We touched on this above, but ultimately, it boils down to this. Use photos and videos that are:
High-resolution (i.e., they’re not fuzzy),
Well-lit (i.e., it’s easy to see the exercises), and
Angled to show the entire range of movement.
When photos and videos meet all three of these criteria, they look incredibly professional—and most importantly, they are easy for patients to reference and understand.
Although they are still in wide circulation, the standard printout for issuing an HEP is no longer acceptable for best practice standards. Sure, you can print out exercises and hand them to patients as they walk out the door, but there’s always a chance that the patient will damage or misplace the paper, subsequently forgetting about their exercises. That’s why we highly recommend opting for high-quality HEP software that is accessible anywhere—rendering these issues moot.
Using tech-centric HEP platforms is not only the way of the future, it is what patients want. Take for instance our Patient Experience Report. Of the 550 PT patients polled, 50% of those aged 45 and older preferred digital HEPs and for patients aged 60 and older, 41% preferred a digital HEP while only 19% received one. Simply put, digital HEP software enables patients to ask questions, interact with their therapist, and log their progress, as well as it allows providers to better track adherence and tolerance to therapy while utilizing remote therapeutic monitoring (RTM) codes. The end result? An engaged patient who is on track to achieve optimal outcomes.
How can therapists improve HEP patient adherence?
Therapists are always looking for ways to encourage patients to stick to their HEPs. While there isn’t a one-size-fits all solution for this problem, these following tips may help you improve patient adherence.
Get patient buy-in. Educate your patients about the home exercises you prescribe so they know exactly how and why completing them is critical to meeting their functional goals.
When tweaking your exercise descriptions, don’t go overboard with text! Sometimes less is more.
Keep your HEP as short as possible. The longer it takes to complete an HEP, the less likely a patient is to complete it.
Use a technology platform to provide your HEP exercises and/or videos. Studies show that patients better adhere to their therapy plans when an app is involved.
Respond to patient questions in a timely manner. Whether patients leave questions in your voicemail or in your HEP software, it’s critical to answer them as soon as possible—though you don’t have to answer them off the clock.
Ensure the patient’s HEP is accessible to them. If a patient doesn’t have stable Internet access, for instance, provide them with a hard copy of their HEP.
What is the best rehab therapy HEP software?
There isn’t one single “best” software that meets the needs of every single practicing clinic. Some clinics may need to opt for a low-cost option until they expand their patient base, while others may be searching for all the bells and whistles that come with a high-tech solution. That said, here are some of the more popular HEP softwares on the market:
WebPT’s HEP software comes with a massive library of professional-quality videos (think in the thousands!), each of which are packaged with pre-written instructions. Every description and set of exercise instructions is totally customizable—ensuring that patients can easily perform these exercises from their homes. Therapists can also create plan templates with multiple phases, allowing them to easily transition patients from phase to phase as they progress in their care. Additionally, patients can:
communicate with providers via chat within the HEP software itself,
access HEP from any internet-enabled device, or
download an app (Strivehub) from the Apple App Store or Google Play.
Want to help your patients adhere to their care plan and get better—faster?
Learn how WebPT HEP improves the patient care experience.