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Megan Donaldson

Assistant Program Director and Associate Professor, Physical Therapy

B.S., MS D'Youville College; Ph.D., Noca Southeastern University; FAAOMPT

Walsh University
A Catholic University of Distinction
2020 East Maple Street
North Canton, Ohio44720
United States

The Fortune is the Follow-Up

PT Collaboration
The Fortune is the Follow-Up

Collaboration is the Key to Enhancing Adherence to Physical Therapy Home Exercise Programs

Frustrated by some of her experiences as an orthopedic clinician, Walsh's Assistant Professor of Physical Therapy Dr. Megan Donaldson began to question her role in developing a patient's adherence, or commitment, to physical therapy.

"So much of what we do in orthopedics is home prescription. I saw a lot of issues with home exercise programs and patients giving up before they even start to experience the benefits. As clinicians, we aren't programmed to follow-up," said Dr. Donaldson. "It was just too easy to accept that patients weren't committed to their home therapy, write them off as no-shows and move on to the next. Rarely would we ask the simple question 'Why?' That one question could make all the difference. And personally, I believe the fortune is in the follow-up."

In May 2012, Walsh University was awarded an OhioPACE (Partnership for Adherence through Collaborative Education) Grant for $20,000 that launched a cross-discipline collaborative research study led by Dr. Donaldson. The research study was created to overcome and identify the emotional barriers to a patient's recovery and increase adherence to physical therapy exercises at home. The study was designed by Dr. Donaldson in collaboration with Walsh's Assistant Professor of Counseling & Human Development Dr. Carrie Van Meter, Assistant Professor of Psychology Dr. Melisa Barden, Clinical Assistant Professor Jennifer Reneker and Walsh DPT graduate Katherine Long '13. In addition, the Walsh team partnered with both Mercy Medical Center Physical Therapy Services and Aultman Hospital Physical Therapy Services. In total, the one-year research study included over 100 patients, 40 clinicians and eight satellite locations throughout Stark, Tuscarawas and Carroll counties.

The study began in July 2012 and focused on a repeated measures design. "What makes our research project unique is that the therapists themselves were the control measures, not the patients," said Dr. Donaldson.

For the first two months of the study, the Walsh team asked that the participating PT clinicians continue to work with their patients as they normally would and provide an assessment of each patient's commitment to their home prescription. "We then provided a training session for 16 hours on the adherence strategies we had developed with our counseling and psychology experts. Working in a small group setting, we created a workshop where we conducted several role-playing exercises with each clinician so that they could have experience interacting with patients," explained Dr. Donaldson. "Before we resumed the study again, we gave the participating clinicians an opportunity to try their new skills out in their clinics. We followed with an on-site booster course and then we started the study again."

The research will be concluded in July, but the outcomes are encouraging. "We discovered that a lot of the therapists had not talked about barriers before with their patients regarding attending visits or doing exercises. As clinicians, we are trained to interview but not necessarily identify what barriers might exist to road-block therapy. Examples of patient barriers to adherence could be time restraints, finances, emotional stress to a clinical exercise setting (if they are overweight), or even a socio-economic biases on the part of the patient and/or the clinician. The therapists learned how to talk to their patients, address those personal barriers and really engage them with a home program tailored to their needs," said Dr. Donaldson. "So far, the clinician response has been strong and positive. We are trained to work in a tight half-hour consultation window, but we found that, with the right questions, time wasn't an issue. Overall, we are learning to use our time more efficiently."

This year, the team's preliminary survey study was accepted for publication by the Physical Therapy Journal of Education. The survey study focused on the question "Do therapists believe they can affect a patient's adherence and behavior change?" The article identified seven strategically significant items that prove therapists can effect positive change in their patient attitudes towards home therapy.

"What is surprising is that no one has looked at this before in Physical Therapy. I teach motivational interviewing with a collaborative spirit. When I hear a patient say 'I want to get better,' but, on the other hand, they aren't doing anything about it, I step back and let them tell me what they need. If I can get them to help identify those barriers, we can work together to find a way around them. The patient will buy-in to the therapy, and it's not just me telling them what to do. That's when we will see the results we need."

Studies have proven that adherence is a huge factor when it comes to the success of any rehabilitation program. Dr. Donaldson and her team believe it takes a holistic approach to therapy...mind, body, spirit...to get the life changing results clinicians want for their patients.

"If you take someone and cut their therapy off at the physical aliment, then their mind isn't committed to it, their spirit isn't engaged in the program. So you follow-up, encourage, and adjust as needed," said Dr. Donaldson. "We are doing some really cool grass roots things here at Walsh. It is amazing to see how Walsh is extending its reach across the miles, to help change lives for the better."

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