Supervised vs Home Exercise Alone  – Is it Worth the Money?

I have changed my mind. I must admit, I have struggled with how much in office exercise to do with patients. Am I just babysitting patients if I do multiple sessions? Sometimes patients do not want to spend the money or take time to do multiple exercise sessions in the office. Read on to find out how a new study has helped me answer this question.

My general practice has been to instruct each patient on exercises, watch them perform them to make sure they are doing them correctly, and then spot check them on occasion.  I now believe I need to do more. 

The Study

In the January 2021 publication Clinical Rehabilitation, a study looked at 86 patients with lumbar stenosis who were treated in a spine care center. One group received physical therapy twice a week for 6 weeks (12 visits) and given a home exercise program. The second group was given a 6-week home exercise program only.  

Results

1 year later they did a follow-up. The supervised group had greater improvements in the severity of their symptoms and in their physical function. There was also a much lower likelihood of surgery (7% vs 23.3%) in the supervised group. 

My Thoughts

We must be careful to not overstep the conclusions of this study. Lumbar spinal stenosis can be one of the most challenging spinal conditions I treat. These patients appear to do significantly better with more supervised exercise. Does this apply to all back conditions? We can’t say for sure from this study alone, but I suspect it will hold true for many conditions. I think patients sometimes do an exercise properly in the office and then forget exactly how they did it once they get home. They can inadvertently be doing them incorrectly. Compliance with exercise is often an issue. It may be that working with a patient over a 6-week period of time helps them to establish a habit. Admit it, we all have good intensions but most of us need accountability. 

Reference:

Masakazu Minetama, Mamoru Kawakami, Masatoshi Teraguchi, Ryohei Kagotani, Yoshimasa

Mera, Tadashi Sumiya, Masafumi Nakagawa, Yoshio Yamamoto, Sachika Matsuo, Nana Sakon,

Tomohiro Nakatani, Tomoko Kitano, Yukihiro Nakagawa: Supervised Physical Therapy Versus

Unsupervised Exercise For Patients With Lumbar Spinal Stenosis: 1‐Year Follow‐Up Of A

Randomized Controlled Trial. Clin Rehabil 2021 Jan 10;269215520986688