Understanding and improving treatment adherence in physical therapy

Abstract

For decades researchers have been searching for ways to improve the level at which a patient follows a prescribed regimen. After all these years there has been little improvement as patients only follow through with approximately fifty percent of the prescribed regimen, be it prescription medicine or exercise programs. There have been several attempts to improve this level by using approaches such as reminders, pill counters, simplification of regimen, reducing the cost of medications, etc. However, these approaches, as good as they might be, do not typically address why a patient would not follow their assigned regimen in the first place. If the regimen is good for the patient and will lead to a speedy recovery, why are the adherence levels still so low? The objective of this thesis is to distill existing literature related to the understanding of why patients do not adhere to treatments and how to motivate patients to adhere. Literature related to the psychological factors of adherence, motivation and patient beliefs will be reviewed. This understanding will then provide a foundation on which to build a framework for adherence. Concepts from persuasive technology will be explored as to how they can be used to help motivate patients carry out their exercises through the use of computers and other digital technology. Finally, an opportunity of offering a service based on this framework that physical therapists can use will be evaluated with future applications in other medical fields. Throughout this thesis the research, application and feasibility has been in the context of rehabilitative services and physical therapy as these are medical fields where patients are typically asked to carry out some regimen at home. This thesis has shown that by simply evaluating a patient's beliefs in their ability to carry out a regimen and the threat posed by the illness, health care personnel can be provided with a picture of how a patient will adhere. This information can be used to better educate and motivate the patient for adherence. Further trials and testing are needed in order to prove the accuracy of the adherence prediction.