Patient Compliance with At-Home Hand and Wrist Exercises: A Randomized Controlled Trial of Video Versus Handout Format
Gregory R Toci, BS1, Anna H Green, MD2, Nailah Mubin, DO3, Casey Imbergamo, MD3, Francis Sirch, BS1, Bobby Varghese, MD3, Daren Aita, MD4, Daniel Fletcher, MD4 and Brian M Katt, MD1, (1)Rothman Orthopaedic Institute, Philadelphia, PA, (2)Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, (3)Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, (4)Rothman Institute, philadelphia, PA
Patient compliance to physician recommendations has remained a topic of investigation and area of improvement for all medical specialties. Home therapy programs are of particular interest due to their convenience for patients, but also due to their escalated implementation during the COVID-19 pandemic. Limited research has examined the use of technology-based distribution of home therapy exercise regimens recommended for the distal forearm and hand. The purpose of this randomized controlled trial was to evaluate patient compliance rates with handout versus video formats of instruction for home-based exercises.
MATERIALS & METHODS:
Patients were prospectively enrolled in outpatient orthopaedic clinics and were randomized to either the handout or video group. All patients were asked to complete the same exercise set 3 times a day for 28 consecutive days. Exclusion criteria included patients less than 18 years of age or those without access to technology to view the video. Questionnaires were distributed electronically at 1-week, 2-week, 3-week, and 4-week timepoints following enrollment. Questionnaires assessed the amount of times per week patients performed their home therapy exercises, which percentage of home therapy exercises they utilized, and their confidence in performing the exercises correctly. The handout group and video group were compared via two-sample t-tests for continuous data and chi-square tests for categorical data. Alpha was 0.05.
Of the 89 patients enrolled, 71 patients responded to the initial follow-up survey (80% response rate), and 54 of these patients (76%) completed all surveys at each timepoint. The handout group (37 patients) and the video group (34 patients) had no differences in response rate, age, or sex. There were no differences in times per week, exercise utilization rate, or confidence in performing exercises between groups at week 1. However, the video group reported higher exercise utilization rates and confidence in performing exercises correctly than the handout group at subsequent timepoints (Table 1). Compliance decreased over time for both study groups (Figure 1).
Video-format distribution of home therapy exercises is superior to that of paper handout distribution for rehabilitation of the distal upper extremity. Patients in the video group utilized more exercises and had higher confidence in completing them correctly at multiple timepoints following their clinic visit.
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