Transcript A Comparison of Picture, Video and Written Instruction on the Proper

A Comparison of Picture, Video and
Written Instruction on the Proper
Performance and Compliance of HEP for
Patients With Rotator Cuff Disease/
Impingement Syndrome.
Cool Springs Focus Team
2008/2009
Research Question.
• What is the best method to deliver a Home Exercise
Program for patients with rotator cuff impingement? Will
the use of video, pictures or descriptions be the most
effective method to assure proper performance of exercises
at home?
• This was a pilot study where no patient identifiers were used
anytime during the process.
Background Information:
• Exercise instruction is a vital part of Physical Therapy.
Correct teaching of the home exercise program is very
important for several reasons such as:
– Improper performance may prevent patient from
improving at the expected rate and may lead to further
J. A. Reo, and V. S. Mercer
Effects of Live, Videotaped,
injury.
or Written Instruction on
Learning an Upper– Patient may lose motivation to continue program if they
Extremity Exercise
have pain with performance of a home exercise
Program. Physical
program.
Therapy, 2004 84: 622-633
• There is evidence in the literature that different formats of
teaching may be more efficient in the acquisition of a new
motor skill. Live and videotaped modeling are shown to be
more effective than a handout alone for achieving accuracy
in the performance of a basic exercise program.
Background Information:
• New technologies make it easier for patients to use other
formats of instruction such as video
• Video instruction appears to be an efficient and successful
way to instruct patients to a new Motor Skill.
Davis, M; Guadagnoli, M; Holcomb,
W. The efficacy of video feedback for
learning the golf swing. Journal of
Sports Sciences. 2002 Vol 20(8) 615-
Sewall, LP., Reeve, TG., Day, RA.,
Effect of concurrent visual feedback
on acquisition of a weightlifting skill.
Perceptual and Motor Skills. 1988
Dec; 67(3): 715-8
Procedure/Process/Methodology:
• Literature review was performed regarding styles of learning
and better learning activities to assist with assimilation of
new motor skills.
• Exercise program was developed. The program included 6
exercises to address rotator cuff impingement.
• Pictures and video of the exercises were taken and two
handouts were produced. The first handout included pictures
and descriptions of the exercises and the second included
only descriptions without pictures. A video CD was also
created with the exercises routine and audio instructions.
Exercise Selection
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Shoulder External Rotation T Band
Shoulder Extension T band
Shoulder Scapular retraction T band
Wand External Rotation
Wand Flexion
Sleeper Stretch
Shoulder T band External Rotation:
With T band secured and at navel height,
hold T band with affected arm across from
body. Rotate arm outward, with elbow
tucked in your side, until perpendicular to
your body. Let it return to the starting
position and repeat 10 times.
Shoulder Scapular retraction T band:
With T band secured and at navel height, hold T
band in both hands with thumbs pointing up.
Start with arms straight and T band pulled tight.
Pinch shoulder blades together and pull T Band
with elbows maintained at 90 degrees. Pull Arms
to chest height and maintain proper posture.
Repeat 10 times.
Shoulder Extension T band:
With T band secured and at navel height,
hold T band in both hands with thumbs
pointing up. Start with arms straight and T
band pulled tight. Pinch shoulder blades
together and bring hands slightly past hips
while keeping elbows straight. Repeat 10
times.
Sleeper Stretch:
Lie on your involved side with your arm at 90
degrees angle from your body. Keep your elbow
bent at 90 degrees angle and gently push your
forearm down toward the table with the opposite
hand. Hold for 30 seconds. Repeat 10 times
Wand External Rotation:
Lie on back with arm away from your body on a
45 degree angle and elbow bent at 90 degrees.
Place small towel roll under elbow. Place one
end of cane on palm of hand with thumb
pointing toward head. and use the other hand to
gently push your arm back until you feel a
stretch on the front of your shoulder. Hold 5
seconds. Repeat 10 times. Forearm should be
parallel with the floor.
Wand Flexion:
Lie on your back with your knee supported on a
pillow to decrease stress on your spine. Position
your hands with palms facing in and thumbs up.
Place a wand between your thumbs and index
fingers of both hands. Lift your arms over your
head until you feel a stretch in your shoulders.
Hold 5 seconds and come out of the stretch. Repeat
10 times.
Procedure/Process/Methodology: Video
Procedure/Process/Methodology:
• The group developed and assessment tool to determine
patient’s adherence to proper techniques following a preestablished criteria.
• Patients were identically instructed on the performance of
the 6 exercises after their initial evaluation. They randomly
received one of the handouts or the video CD. During their
first follow up visit, the performance of the exercises was
evaluated using the assessment tool specially developed for
the study and a score was determined
• The results of each group were compared for determination
of best performance of exercise program.
Exercise Program Performance
Worksheet
Patient ID #
Wand Flexion:
1. Lying on back
( )
2. Elbows straight ( )
3. Hold Cane Using thumbs ( )
4. Thumbs pointing up ( )
5. Raise arm until feel a stretch in the front of your shoulder. ( )
6. Hold 10 seconds/ relax ( )
7. Repeat ( )
(_______/7)
Wand External Rotation:
1. Lying on back ( )
2. Elbows away from body at 45 degrees angle ( )
3. Elbow bent at 90 degree angle, ( )
4. Small towel roll under elbow. ( )
5. Cane in palm of hand with thumb pointing toward head ( )
6. Use hand to gently push arm back until you feel a stretch in the front of your shoulder. ( )
7. Hold 10 seconds/ Relax ( )
8. Repeat ( )
(______/8)
Sleeper Stretch:
1. Lie on your involved side ( )
2. Shoulder at a 90 degree angle from your body. ( )
3. Elbow at a 90 degree angle ( )
4. Gently push your forearm down toward the table with your opposite hand Until you feel a stretch. ( )
5. Hold this stretch for 30 seconds ( )
6. Repeat 10 times ( )
(_______/6)
Scapular Retraction:
1. Theraband positioned at naval height wrapped around secure post ( )
2. Hold theraband in both hands with thumbs pointing up. ( )
3. Start with arms straight and theraband pulled tight. ( )
4. Keeping shoulder blades pinched pull theraband with elbows at 90 degrees and kept into side.
5. Relax and Repeat 10 times ( )
(_____/5)
( )
Scapular retraction/ Shoulder Extension:
1. Theraband positioned at naval height wrapped around secure post ( )
2. Hold theraband in both hands with palms facing down. ( )
3. Start with elbows straight and theraband pulled tight. ( )
4. Pinch shoulder blades together ( )
5. Extend Shoulders bringing hands positioned slightly past hips keeping elbows straight. ( )
6. Relax and Repeat 10 times ( )
(_____/6)
External Rotation:
1. Theraband positioned at naval height wrapped around secure post ( )
2. Elbow bent at 90 degrees ( )
3. Hold theraband in hand with thumb pointing up. ( )
4. Rotate arm outward with elbow maintained at 90 degrees ( )
5. Keep elbow against your body. ( )
6. Keeping shoulder blades pinched pull theraband with elbows at 90 degrees and kept into side. ( )
7. Relax and Repeat 10 times ( )
(_____/7)
Results
• The group produced 2 handouts and a CD with videos with
identical exercises commonly used for the treatment of
rotator cuff impingement. We also developed an exercise
assessment tool to be used for evaluation of proper
performance of exercises instructed.
• 8 patients received the Home Exercise Program divided in 3
formats: 2 patients received written descriptions, 4 patients
received pictures and descriptions and 2 patients received
the video format.
Results
• The patients that received the written format performed the
worse. They only scored 24 points out of 39 points possible
in average on the exercise performance assessment tool.
• The patients that received video and pictures/descriptions
scored similarly. The picture and description group scored
36. 25/39 and the video group scored 36/39.
Assessment of results
• Video and picture/ descriptions format were more successful
than simple descriptions in addressing learning needs of
patients with rotator cuff impingement.
• Results were affected and could be because of the small
sample of patients and the fact that some of the patients
were not reviewing exercises at home.
Assessment of results
• New interview tool and guidelines will have to be developed
to address patient’s compliance and if they reviewed the
exercises to assure proper adherence to protocol.
• The small sample of patients shows promising data in favor
of video and picture/descriptions format.
Recommendations
• A new assessment tool will be developed along with
guidelines to address patient’s compliance and if patient’s
reviewed the exercises at home to assure proper adherence
to protocol.
• We will continue to collect data regarding learning styles for
another year. The purpose is to collect more significant
numbers to determine what format for home exercise
program is more efficient.
Recommendations
• We will determine if patients are reviewing the exercises at
home prior to reassessment. Patients that do not meet the
criteria will be eliminated from the study.
• The results of this study may be used to modify and/or
enhance existing outpatient rehabilitation guidelines
regarding HEP.
• New handouts and videos will be produced to address
shoulder and other different diagnosis.
Questions ?
Thank you