Factors influencing compliance with home exercise programs among patients with upper-extremity impairment.

OBJECTIVE: Patient cooperation and satisfaction with home exercise programs are important for successful outcomes of intervention. This study investigated factors from three models to predict increased compliance and satisfaction with home exercise programs: the Model of Human Occupation (MOHO), including the volition subsystem (interests), habituation subsystem (roles), and performance subsystem (reported physical capacity); the Health Belief Model (HBM), including perceived barriers, benefits, self-efficacy, and severity; and the Health Locus of Control (HLOC). METHOD: Sixty-two outpatients at an orthopedic upper-extremity rehabilitation facility completed a battery of questionnaires and self-report instruments, including a health belief survey to assess HBM factors, the Multidimensional Health Locus of Control Scale, the Modified Activity Profile to assess the performance subsystem of the MOHO, a demographic questionnaire (including roles), a report of home exercise, and a satisfaction scale of their therapist's treatment. Compliance was determined by comparing participants' report of exercises performed to exercises specified on their medical chart. RESULTS: Stepwise regression identified two predictors of compliance: perceived self-efficacy and internal HLOC, R2 = .16. CONCLUSION: Results supported the role of the MOHO's volition subsystem, but roles and physical capacity--representing the habituation and performance subsystems of the MOHO--did not contribute significantly to the prediction of compliance.

Defining functional limitation, disability, and societal limitations in patients with facial paresis: initial pilot questionnaire.

Experiences with patients with facial paralysis over the last 25 years and recent efforts to develop objective measures of paresis and synkinesis led us to three hypotheses: (a) dysfunction in certain regions of the face is more disturbing than that in others, (b) there are major psychosocial impacts of facial paralysis, and (c) the impact of facial paralysis is underestimated. An initial questionnaire of 10 open-ended items was submitted to 11 subjects stabilized after acoustic tumor resection. Responses were tabulated qualitatively, and frequency counts were made of responses. These results show that the region of the face that is most disturbing is the mouth; however, early in the time course of paralysis, the eye is most disturbing. Synkinesis above the eye is ultimately more disturbing than paresis in that region, and it may worsen. Major psychosocial impacts of paralysis appear common and underestimated. These pilot data qualitatively support the hypotheses.