Compliance with Hand Rehabilitation: Health Beliefs and Strategies

Abstract

C ompliance is the most unpredictable, least controllable variable in medical intervention. It can strongly sway the outcome of any treatment. Yet, too often we confidently provide treatment without making the issue of compliance a priority. Three years ago we retrospectively examined the clinical outcomes of patients who had had mallet finger injuries. Much to our surprise, we found compliance to be the critical factor in the final outcome.! This finding has led us to examine the issue of compliance more closely. The Clinton administration has unwittingly forced the issue of compliance into the foreground. The degree to which health care will undergo reform is unclear, but the percentage of people enrolled in managed care plans will undoubtedly increase. Managed care plans, which currently pay for an average of 6.7 treatment visits per referral,2 will not accommodate noncompliant patients. Similarly, the framework for the impending reform will be health promotion and disease prevention. 3 This will place the responsibility of compliance on patients. For the purposes of this article, compliance is defined as active engagement in the rehabilitation process. As therapists, our role in ensuring compliance is to assist our patients in their engagements, enabling them to make informed and affirmative choices. To do this, we must be aware of the external and internal factors that influence compliance and the strategies to improve compliance. Accordingly, this article broadens the therapist's awareness of the issue of compliance through exploration of external and internal factors, identification of methods of measurement, and discussion of improvement strategies that relate to specialized treatment of the hand.