How often do we, as physical therapists, struggle with patients following through on their written home exercise goal program?
On a typical visit, I greet the patient, ask the person how they are doing, check pain levels, perform my evaluation and then write up a plan of care complete with treatment goals. I ask my patient many discovery questions, as I evaluate him or her, but I rarely ask what his or her goals are.
I wonder why? I guess I’ve always just assumed that the patient’s goals were obvious.
- He needs to gain strength to walk upstairs to the bedroom.
- She needs to gain knee range of motion so that he can get in/out of his car.
- He needs to gain endurance so he can gain access into the community.
All of these goals meet the golden standard of FUNCTIONAL, but are they really the patient’s goals- or my goals?
Miller and Huffman of National Society of Health Coaches offer a change from the traditional caregiver driven approach of goal setting. They offer a training in Evidence-Based Health Coaching (EBHC)® that focuses on engaging the patient in their own social context to motivate them to take responsibility for their own health. Miller and Huffman offer specific “Motivational Interviewing” techniques that teach health care providers engage and empower the patient to be an equal partner in the healthcare relationship. According to Miller and Huffman, studies demonstrate that Health Coaching can “decrease hospital re-admissions, improve glucose levels, improve physical activity, diet, and medication adherence.”
As I look back over some of my experiences as physical therapist, I realize that some of the most rewarding times in my work are when I get to assist a patient in meeting a personal goal.
Goals like the following:
- Gaining strength and endurance to tolerate the physical requirements of a 10-hour car ride to attend a granddaughter’s wedding.
- Helping a CHF patient gain the strength and endurance to take his dog for a walk.
- Rehabilitating a hip fracture so that a man can return to his passion of gardening.
Sometimes the simple goals are the most rewarding.
Since the healthcare industry measures and rewards patient satisfaction, adopting a coaching framework may make a significant in impact in the rehabilitation industry. Both rehabilitation providers and patients will benefit from patients taking more ownership of their care.
Devin has worked in almost every physical therapy setting -(except pediatrics)! He’s been rotating between inpatient, outpatient, and sub acute settings since 2007. His wealth of experience comes in handy in providing advice for PT Solution’s Therapy Team Members. His favorite thing about physical therapy is helping senior citizens gain the strength they need to move back home.
