Occasionally in the clinic, I am asked by doctors or nurses if a patient has been compliant with their physical therapy program. Or a patient may come to me and say that he or she was compliant with their home exercise program.
I never liked the term "compliance" when working with patients. It implies a relationship where one person tells another person what to do. The person being told is then expected to comply. In any caregiver-patient relationship, an uneven balance of power exists, and expecting patients to comply without questioning or providing input just perpetuates this uneven balance.
A term that I use in the clinic to replace "compliance" is "therapeutic alliance." It implies that the patient is an active participant in the physical therapy program. He or she has a say in what is to be done. Questions are encouraged, and discussion about the diagnosis, course of treatment, and prognosis can occur. A therapeutic alliance is a patient-caregiver relationship where the balance of power is a little more equal.
If you have been to physical therapy, how did your relationship with your P.T. feel? Were you simply told what to do to get better? Did you comply? Or was your experience a therapeutic alliance, where you provided input and worked closely with your therapist to develop a plan of care that was right for you?
A friend of mine had back surgery this past february and she required physical therapy for a month or so afterwards. I talked to her about her therapist and she said it was one of the best physical therapy experiences that she has ever had. It was more of an alliance than just compliance. I think its really important to find the program that works for you, and compliance isn’t the best way to do that.
I had rotator cuff surgery a few years ago and went within 3 days to a PT center that “specialized” in shoulder therapy. The person I was assigned to followed the “compliant” description you mentioned. At a specific point in therapy (about midway) I was suddenly thrust into “getting to this position” which was extremely painful for me…more so than ever before in the therapy. I even broke down into tears. I left this group and joined another PT group that, seemingly, now uses the “alliance” philosophy you describe, Dr. Sears. My success with this was phenomenal! I reached my 18th week of therapy with minimal pain and success and in spite of the previous threats that I’d have “frozen shoulder if I didn’t comply” I have well over 95% mobility and that’s from a patient who had a 100% tear and impingement. So in simpler terms, alliance is the key to success!