The number of physiotherapy treatments that people who need them can get from their health fund is limited, along with the effort for reaching the clinic, and the patients often lack persistence in carrying out exercises at home that they have been taught.
It is especially evident in vestibular rehabilitation – exercises to treat dizziness and balance problems. The condition affects more than a third of adults. Researchers from Ben-Gurion University of the Negev (BGU) in Beersheba analyzed the barriers to conducting consistent home exercises.
They have just published their recommendations to overcome the obstacles in the leading journal of physical therapy, the Journal of Neurologic Physical Therapy, under the title “Barriers and facilitators of vestibular rehabilitation: patients and physiotherapists’ perspectives.”
Vestibular rehabilitation copes with dizziness and balance problems, gait instability, sensitivity to movement, and blurred vision. Treatment is especially effective when consistently practiced at home.
To find a solution to the lack of consistent practice at home, BGU physiotherapists asked 39 patients doing vestibular rehabilitation and experienced physiotherapists to identify the barriers to at-home therapy.
Team identified six problems
The team conducted three single-session focus groups per population group, and each focus group discussion included five to eight participants. Patients were recruited from the otolaryngology department of Sheba Medical Center in Tel Hashomer and via advertisements emailed to physiotherapists. Focus groups were conducted online using the Zoom video-conferencing platform; sessions lasted 60 to 90 minutes, were video-taped, and transcribed verbatim.
They found six problems: motivation (lack of confidence in the effectiveness of the practice, boredom, and lack of internal drive); increased symptoms during the practice (temporary worsening of dizziness, during or after the exercises); difficulties in time management (difficulty integrating practice into daily routine); lack of feedback and guidance (patients’ limited understanding of how exercises should be done and their effect); psychosocial factors (what will the environment think?); and related medical deficiencies (such as neck pain and migraines).
The research team formulated recommendations for physiotherapists who want to significantly improve treatment outcomes and patients’ quality of life. To increase motivation, For example, personal interaction and follow-up by a clinician would allow for greater attention to the exercises – availability and feedback conversations on the performance of the exercises, including initiated phone calls, text messages to patients in between visits to the clinic – and nurture motivation for practicing them. Investing time and money should also increase motivation.
In terms of time management, the clinicians could personalize the exercises to fit into the patient’s daily routine, for example, to practice a little bit at a time throughout the day and/or write in a daily diary.
The exercise instructions should include an explanation of the importance of the exercises, the expected symptoms, and the expected recovery time, the researchers wrote. Documenting improvement by providing quantitative and visual feedback, such as charts and graphs, should encourage continued practice.
“Our study provided a broad perspective for data analysis by both patients and treating physicians,” lead researcher Prof. Shelly Levy-Tzedek said. “Identifying the common barriers to practice allowed us to build strategies that could improve adherence to home practices and, as a result, the effectiveness of treatment. This is a study that can be applied in any clinic and to any patient and, therefore, is an important guide for therapists.”
This research was carried out as part of Liran Kalderon’s doctoral dissertation in BGU’s physiotherapy department under the joint supervision of Levy-Tzedek and Dr. Yoav Gimmon, together with Azriel Kaplan and Dr. Amit Wolfovitz.