Home exercise programs (HEP) are lauded as one of the most important tools in a physical therapist’s toolbox from the first semester of physical therapy school. For better or for worse, if you work in an outpatient setting, you will not see your patients every day. In many cases you may see them once or twice a week. One or two 45-60 minute treatments, however, do not stack up well against the over 150 hours spent on non rehab-focused activities throughout the remainder of the week. This is where the home exercise program (HEP) shines.
Whether you are a huge proponent of HEPs or aren’t sure if they are worth your time, read on to learn more about the benefits and drawbacks of HEPs and how they can be implemented into a telehealth practice.
Benefits of prescribing HEPs
Build accountability: While 1:1 treatments with a physical therapist confers a great deal of benefits when it comes to addressing injuries, pain and functional impairments, the ultimate goal of a PT plan of care is discharging the patient after they have met their goals.
In most cases, an ongoing program of strengthening, flexibility or aerobic conditioning is recommended to maintain the improvements made in therapy and establishing a home program early is a great way to help your patients build accountability when it comes to self-management. Implementing a long-term change in behavior takes time and repetition and the home program will help your patients learn that they have the tools to manage their condition after discharge.
You can’t cheat physiology: If a patient is attending one or two therapy sessions a week and not doing any rehab-focused home exercises, there is a good chance that your attempts at building muscle strength, muscle endurance, flexibility, motor control and coordination will go unfulfilled.
Don’t forget that we have a large body of research that tells us how many sets, reps and bouts per week of an exercise stimulus is needed to achieve a particular change in physiology. HEPs help you reach the dosage necessary to effect real change in the tissues you are targeting.
Intrinsic feedback and neuroplasticity: While the keen eye of a physical therapist is initially needed to ensure exercises are being performed correctly, generalizability and carryover into life and activities outside of PT is essential. HEPs give your patient the opportunities to practice what they have learned in their own environment and rely on intrinsic feedback to monitor their performance, thus enhancing learning and retention. Similarly, specificity is essential for neuroplasticity and the ability to perform these exercises or techniques within the specific context they are intended to be used, helps improve patient outcomes.
Are there any drawbacks to HEPs?
It’s easy to create a long list of how HEPs benefit your patients and your practice, but are there any downsides to prescribing an HEP? A well-thought-out and individualized HEP likely has no drawbacks, but there are some pitfalls of which you should be aware.
Don’t prescribe and forget: A home exercise program should mirror the phase of rehab your patient has reached. Failing to progress (or in some cases, regress) an HEP can hamper the patient’s progress. Be sure to keep track of the exercises they are doing at home and advance and replace those exercises as needed to support the work they are doing during their visits with you.
What are they actually doing at home? For better or for worse, you aren’t going home with your patients at the end of the day which means you can’t actually see how they are performing their exercises outside of your sessions. Many factors impact how quickly someone learns a new exercise and it is not uncommon to observe at follow up that a patient has not been performing an exercise correctly. They may be performing too many or too few repetitions or not listening to their body’s signals, increasing the risk of injury.
To help reduce the likelihood of this problem, make sure to observe the patient performing the exercise in the clinic so you can provide feedback and corrections and also review it at a later session. Additionally, ensure the exercise is safe and appropriate for the patient to perform at home, given that they may not perform it 100% correctly.
Telehealth and HEPS
Telehealth physical therapy services arose out of necessity with the onset of the COVID-19 pandemic and have stuck around in many practices due to their convenience and ability to target a larger client network. The benefits and drawbacks of prescribing HEPs does not change in the telehealth scenario but you may find there are some other advantages.
First, you can see the patient perform these exercises in their own environment with their own equipment. This allows you to tailor the program even more specifically based on their home environment. This can help improve adherence and success as you know the exercises can be performed well at home. Secondly, an individualized HEP of optimal difficulty allows you to focus on more advanced exercises during your 1:1 telehealth sessions, when you can have eyes on your patient at all times.
Cash-pay clients and insurance companies love HEPs
Home exercise programs result in better patient outcomes. In a world of decreasing insurance reimbursement rates and claim denials, showing progress and medical necessity is essential. Prescribing a great HEP and educating your patients on why it is essential that they adhere to this program, will help them to reach their goals faster. This in turn is more likely to generate payment for these services. Additionally, a home exercise program differs from a general fitness program in that it is intended to treat a medical condition so a well-crafted HEP helps show payor sources why physical therapists are a necessary part of the healthcare system.
If you are working with cash-pay clients, a HEP still has all of the great benefits listed above, but in addition it can help reduce the amount of sessions that a client has to pay out-of-pocket. You may be an excellent therapist, but if your clients cannot afford your services, they will not continue to work with you. Providing a great HEP can help reduce the frequency with which a client needs to pay for 1:1 sessions, but also helps them build self-confidence and accountability. This will keep them choosing you again in the future, if the need for PT arises again.
Put some thought into your HEP
If you haven’t been giving too much thought to the exercises you’ve been prescribing in your HEPs, now is the time to make a change. Helping to boost patient outcomes, increase patient accountability and long-term learning and retention, you can’t go wrong with a well-crafted home exercise program. Whether your clients are paying cash, using their insurance, coming to the clinic or seeing you virtually through telehealth, the HEP is a way for your patients to take a little bit of your expertise with them when they leave.
EHRs like TheraPlatform can keep common Home Exercise Programs and exercises at your finger tips and make billing a breeze. TheraPlatform offers a risk-free, 30-day trial for physical therapists with the credit card required and the ability to cancel at anytime.