This Is How It Works:

Getting Started

Start with a statement and the three minute Flexibility Exam

To begin, the doctor or the CA tells patients, "We are going to put you on a monitored therapeutic exercise program." This lets them know right from the start that they are going to be watched. Then the doctor or an assistant gives the patient the easy three minute flexibility exam.

The doctor or assistant then tells the patient, "You are going to be tested again in two weeks." Psychologically, when people feel they are going to be tested, they want to prepare for the test. When the patient does see improvement upon retest, it enhances their motivation.

Let them know there is an end goal

Right from the beginning let them know there is an end goal. Just as a patient doesn't want to feel that treatment will go on forever, they don't want to feel that a more extended exercise program will go on forever. Consequently, you let them know that the goal is for them to progress from Tape A, to Tape B, to Tape C, (or A, to Neck & Upper Back, to  B or C if an upper back or neck case), (optimally three) and then when they have sufficiently learned the exercises well enough to do them on their own, you will be giving them their own personal 5 to 10 minute exercise routine that they can perform daily, after the focused program period.

Script

Start by saying something like this: "Mrs. Jones, in order to help stabilize your condition, hasten your recovery, and help you maintain a more permanent pain-free state, we are going to put you on a monitored therapeutic exercise program. This will take place over the next eight to ten weeks and will involve working through three video tapes. (could be only two - See script above) These video tapes will be used as learning tools until you are able to do them on your own. Once the exercises become relatively easy to perform, and you have worked with all three videos, we will create your own personal five to ten minute daily exercise routine which you will then make part of your maintenance program. The fee for this program will be  (When using the whole program, many doctors charge more than the basic tape price.   Billing Procedures   tells more about this.

This lets the patient know from the start what you expect from them, rather than asking them if they are willing along the way. Ultimately, their willingness is a must, but stating your expectations will greatly enhance their willingness. Also letting them know that these are just leaning tools and not something you are expecting them to do forever, takes the pressure off and makes them more willing.

Of course the patient can only be as convinced as you are, so it is essential that you have a firm belief in the importance of home exercise. It is optimal for you to be doing a few exercises each day yourself, not only to be practicing what you preach, which is a lot more convincing, but also for your own sense of well-being and vitality.

Patient Progress Report – a key feature (click here for a pdf version)

Some of the greatest motivation to keep them on the videos until complete often comes with using Patient Progress Report found in the Doctor's Manual – or in the Dr’.s Starter Kit.   The Doctor or CA gives the patient Tape A and says, "You need to do these exercises three days next week", or what ever you, the doctor, feels is appropriate. Then the doctor hands the patient a copy of the Patient Progress Report and says," I want you to check an answer to these questions as you do the exercises, and return it to me next week.  At very least check off that you have done each one. Also, please indicate which ones feel really good to you, that is, that feel like they are really doing you the most good.” These will more than likely be part of their personalized routine unless you have ideas of what you would like to see them doing.

Now, as your patients do the exercises, they feel that somebody is paying attention to what they are doing and how they are feeling. This is a process of holding them accountable, because your patients now have someone to report to. This can be the doctor or the designated CA. Patients commonly fib about what they have done and not done, but most people will not lie on paper. It all goes back to our school days when we were required to turn in our homework. There was no getting out of it!

Your Patient Returns With their Progress Report

Tailor it to your patient

When the patient brings in the report, and if there are a few check marks that suggest pain, you can now tailor the exercises shown on the tape to the patient's needs. With a few quick questions, the doctor or assistant can determine if this is real pain or just the pain of stretching. If it is true pain, then the person monitoring can alter or eliminate the exercise.

Included in the Doctor's Manual is additional information on each exercise to assist the doctor or assistant in making proper recommendations. This procedure once again solidifies to the patient, that somebody cares about what happens to them and is paying attention as they do their exercises at home.

Accountability Makes A Difference

By the patient completing their own progress report and bringing it to their next appointment, they have now become accountable for their part in the healing process

When the report shows an appropriate amount of improvement, and they indicate that they have put at least the ones they checked off” to memory, (those exercises that feel like they are doing them the most good) You can now say, "Fantastic, you are doing great! Now you are ready to move on to the next tape"  Save these reports and these checked off exercises can form the basis of their personalized routine.

Creation of Personalized Maintenance Routine

Once they have moved through as many videos as you feel necessary you are then ready to give them their 5 to 10 minute routine.  Note that each video contains entirely different exercises from which to find the best for them, except for a select few that double up. It is best to work them through at least two for maximum exposure in order to find the best exercises for their condition and ability.  Your choice can come from the progress reports with the patients sense about what was good for them or  optimally  what you know from having done the exercises yourself and reviewing the Dr.’s Manual.

Compliance is great

Compliance to their own short routine at this point is usually quite good after having done a supervised program for a few months. It takes 3 weeks to establish a new habit.  Doing only a few exercises a day after having done more will then be simple for patients to incorporate into their busy schedules. The benefits of doing their few exercises far out weighs the minimal effort. Once they are taking responsibility for their own care on a regular basis, they will love you forever for it, because you got them on it. I have found the memory of that often lasts much longer than how you made them feel better.

Program can work with little no time required of the Doctor

Doctors may feel they are just too busy to be involved at all. Patients can still benefit from the program because it is just as effective if completely handled by a designated assistant or therapist.

Your Back-care-cise program supervisor simply takes a quick look at the Progress Reports, makes a few comments or suggestions and optimally gives the flexibility exam every two weeks   Just having someone check up and acknowledge any progress or just that they did it helps keep them going. If there were problems with a specific exercise that could be run by you later, or they could have instructions to eliminate that exercise.

Additional Use for Reports

The flexibility exam and progress reports support and substantiate your treatment as well. These reports serve as excellent documentation for work comp and personal injury cases

Following The Program In It's Entirety Is Most Profitable

Go to Billing Procedures for more on this

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