Home Exercise Adherence in an Underserved Ecuadorian Community

Purpose: Physical therapy service learning projects and volunteer experiences in foreign countries are becoming more commonplace. Patients in underserved regions are not likely to receive therapy services regularly; therefore, adherence to a home exercise program (HEP) is critical. The primary purpose of this study was to observe home exercise adherence rates between the 1st and 2nd visits in an underserved population. The secondary purpose of this study was to determine specific factors that affect HEP adherence in this population. Methods: Consecutive patients seen in Santo Domingo, Ecuador were considered for participation in this observational study. All patients were recruited from one clinic or during home visits in the surrounding community over a 5 -month period by one physical therapist. To be included in the study, patients were required to display sufficient cognitive ability by stating their name, the date, their location, and their reason for being at that location, were at least 19 years of age, and had an impairment or functional limitation that was included in the physical therapy scope of practice. Patient demographics, medical history, and answers to questionnaires were collected on the initial visit. Immediately after the initial evaluation, patients were issued 5 home exercises . On the subsequent follow-up visit, adherence was measured with the Medical Outcomes Study General Adherence Items (MOSGAI). Adherence percentage, defined by the frequency in which the patient performed all the exercises as prescribed, was calculated. In order to evaluate potential factors affecting HEP adherence, separate Kruskal-Wallis tests were performed on the categorical variables (gender, marital status, education, employment, duration of symptoms, and comorbidities) and separate Spearman correlation tests were performed on the continuous data (age, pain level, and sport injury rehabilitation adherence scale - SIRAS). Alpha was set at p ≤.05 a priori. Results and Conclusion: A total of 40 patients satisfied the eligibility criteria and agreed to participate, of which 29 (mean age 55, SD 14) were seen for a second visit. Of the patients who returned for a second visit, the median (interquartile range) MOSGAI score was 24 (21-29) and the average adherence percentage was 73%. Age was negatively correlated with the MOSGAI (p = 0.008, r = - 0.60), while the SIRAS was positively correlated with the MOSGAI (p = 0.002, r = 0.52 ). Exercise adherence in this population was similar to previously reported data, but in areas where access to health care is limited, it may be even more important to im prove adherence. It is possible that both age and the level of adherence observed by the physical therapist during the first visit helped predict HEP adherence in this population. Innovation: Volunteer physical therapists serving in this community should proactively explore strategies to increase adherence in patients with these characteristics