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 injury. –Patient may lose motivation to continue program if they have pain with performance of a home exercise program. 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. J. A. Reo, and V. S. Mercer Effects of Live, Videotaped, or Written Instruction on Learning an Upper- Extremity Exercise Program. Physical Therapy, :

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 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 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 Shoulder External Rotation T Band Shoulder Extension T band Shoulder Scapular retraction T band Wand External Rotation Wand Flexion Sleeper Stretch

Procedure/Process/Methodology: Video

Procedure/Process/Methodology: The group developed and assessment tool to determine patient’s adherence to proper techniques following a pre- established 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.

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 /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