Why We (Don’t!) Comply

After the dynamic celebration that is the International Seating Symposium in Vancouver (see coverage in this issue’s MMBeat), my immune system relaxed, and within 24 hours of getting home, I had the flu. I did the usual hopeful procrastinating, but finally staggered to my doctor, who gave me a kindly exasperated look when I said I’d run a fever for four days before coming in.

My doctor is a throwback to doctors of old. After the usual stethoscope and say-ahh routine, he sits down and chats: “How’s work? Have you been traveling? Vancouver? Business or pleasure?” I shared ISS highlights (he likes early-intervention stories), admitted I’d been on several germ-ridden planes lately, and thanked him for taking such good care of my dad, who’s also a patient of his.

Unlike me, my father religiously follows our physician’s advice on medication, lifestyle adjustments and holistic health options such as tai chi. “I know you can’t discuss him because of HIPAA,” I said to my doctor, “but my dad really does listen to you.”

“That makes him rare,” my doctor smiled. ”Most patients only follow a quarter of what I suggest.”
In this issue, we explore client compliance — in simple terms, why clients and caregivers don’t always use their seating & mobility equipment and follow your recommendations the way they’re “supposed” to.

The costs of non-compliance can be medically devastating to clients, not to mention frustrating for rehab professionals and expensive for payors. But while the question is simple — Why don’t clients comply? — the answers turned out to be anything but.

In Vancouver, Motion Concepts’ Stephanie Tanguay, OTR, ATP/ATS, presented a terrific session on applications for lateral tilt. But Steph also observed that a number of clients with posterior tilt systems don’t use the full range of tilt, and thus may not be achieving optimal pressure relief. On top of that, many clients don’t perform pressure relief as often as they’re supposed to. Why? Think about it: If you were, at this moment, presenting or listening to a presentation at the International Seating Symposium, would you tilt back and stare at the ceiling every 15 minutes because your physician or therapist had told you to?

Maybe not. Probably not.
Why? Not because you didn’t believe in tilt, your RTS or your clinician. You probably wouldn’t tilt because it’s difficult to give a presentation or optimally listen to one if every 15 minutes, you are staring at the ceiling. Yes, that kind of pressure redistribution is therapeutic, but it’s not social — and as human beings, the social factor is important to us. A lot of other factors are important to us. And sometimes they trump a known medical benefit, even if we know better.

There are other reasons for non-compliance, and we asked rehab professionals to share with us their personal observations on why specific clients did not comply — and what they as professionals learned when they found out the story behind the non-compliance.

We hope that these stories-behind-the-stories will give you new questions to ask and strategies to try with clients so they get optimal use out of the seating & mobility systems you work so hard to recommend, create and justify. Certainly these stories helped me to understand the value of patient compliance. Much to my physician’s approval, I took my antibiotics on time, got some rest and, as promised, felt better in no time.

This article originally appeared in the May 2008 issue of Mobility Management.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

In Support of Upper-Extremity Positioning