From App to Adherence:Promoting Home Rehabilitation Exercises for People with Disabilities

Increasing demand and rising costs of healthcare have driven a shift towards home rehabilitation. Physical therapists (PTs), occupational therapists (OTs), and speech language therapists (SLTs) typically implement home rehabilitation programs by prescribing exercises using exercises printed on paper. Surveys of patients using paper-based exercise programs suggest adherence is low, yet these reports are subjective and the factors influencing exercise completion are not well understood. Here, we leveraged a large data set obtained from an app-based activity management system to understand rates of exercise completion and the exercise prescription factors that influence completion. Of 766,035 exercises prescribed by a rehabilitation center in a large Southern metropolitan city in the US, 1.9% were completed. Using logistic regression with the type of therapist who prescribed the exercise and the features of the prescription order as independent variables, 9.1% of the variation in completion of exercises could be predicted. OT prescriptions had a 0.47 lower odds and SLP had 0.83 lower odds of completion, when compared to exercise prescriptions given by PTs. Prescribing an exercise multiple times per day and longer rep times increased the odds of an exercise being completed. Conversely, prescribing exercises to be completed once per day, higher number of sets, higher repetitions per set, or longer rest times decreased the odds of an exercise being completed. Although these observations are still exploratory and require future research to understand driving mechanisms, they illustrate how the transition from paper to app- based home rehabilitation management opens new possibilities for analyzing home rehabilitation exercise.