PT on the Net Research

Utilizing Corrective Re-assessments to Enhance Program Success


Learning Objectives:

  1. To highlight the mental and physical benefits of performing musculoskeletal re-assessments
  2. To provide the reader with two re-assessment examples and describe how the results can be interpreted to increase client confidence and adherence to their corrective exercise program
  3. To teach the reader the importance of assigning and reviewing exercise homework

One of the most overlooked skills of a successful corrective exercise specialist is the ability to conduct simple and effective re-assessments with their clients. When incorporated into a well-structured exercise program, the re-assessment process can increase client adherence and greatly improve chances of long-term success.

Re-assessing Is Beneficial for You and Your Client

Incorporating re-assessment procedures into your exercise programs, regardless of whether the goal of such programs is pain-reduction or performance enhancement, is useful for both you and your client for a variety of reasons. Firstly, re-assessments provide you with the opportunity to ensure that your client understands what they are supposed to be doing with respect to their program variables, including if they are indeed doing those things correctly. Secondly, incorporating re-assessment protocols helps to shape clients’ expectations about the overall plan and requirements of the program. Shaping these expectations enables you both to have a clear vision for how to accomplish the desired outcomes. Most importantly, re-assessment procedures allow you to create a pattern of dialogue with clients that will shift the ultimate responsibility for the success of the program, from you to the client (Whitworth, et al., 2007).

How to Formulate Effective Re-assessment Procedures

The key to utilizing re-assessments to help clients achieve long-term success is to use your practical assessment and communication skills to build a working relationship, that fosters an equitable partnership, between you and your clients. This is very important because clients will view you as the expert when you first begin working together (which means that they will ultimately view you as responsible for the success or failure of their program) (Milgram, 1974). Although it will be necessary for you at times to demonstrate your expertise, the eventual goal is to help your clients feel confident in making decisions that will help them progress and succeed on their own. You can achieve this by facilitating an alternation between the roles of "leader" and "supporter" during the re-assessment process. The following explanation provides an illustration of how to do this.

Once you have conducted your initial assessments and the first exercise session with your client, you will schedule your next appointment with them. In between those first and second sessions, it is highly recommended that you provide the client with "corrective exercise homework" to perform in order to help facilitate their goals of eliminating pain and improving their function (Price, 2010). When the time for the second session arrives, you can begin by establishing the framework for the re-assessment process that will eventually become a permanent feature of the client’s program.

Starting Off: You Take the Lead

When your client comes in for their second session, repeat some of the musculoskeletal assessments you performed on them during their initial evaluation. Choose simple assessments you know will reveal change or progress, but make sure that your client understands them too and can easily evaluate any changes for themselves. Conducting these repeat assessments (or re-assessments) at the beginning of the session puts you in the role of "leader" and establishes that you are the person whose job it is to investigate change and interpret results for your client. Leading the direction of the session is very important during this initial stage. This is because your client may have anxiety and/or negative thoughts surrounding the program and establishing yourself as the expert allows the client an opportunity to temporarily relinquish feelings of responsibility for the program. This will enable the client to relax and let down their guard. It also gives you a chance to redirect the focus of the program by pointing out progress and achievements the client has made (no matter how small). You can use the objective feedback obtained from the assessments to help your clients see the progress they are making. This will help your client see the obvious benefits of the program and increase their trust in both you and the recommendations you make. You can also use the results to steer the discussion so that the client moves away from any subjective negative emotions they may be feeling from having pain or limited function. Once the client is less anxious, you can start to facilitate the change in your role from "leader" to "supporter" and put the client into the leader position.

Let’s first look at two simple musculoskeletal assessments you can use to reassess your clients’ posture. We will then discuss how you can use the results of these re-assessments to influence a positive client mindset and increase their adherence to the program.

Height On Wall Dowel Rod On Hips

Making Successful Transitions

Although you will initially be leading the discussion about the re-assessment findings, the key is to do so in such a way that the client begins to see that the positive results they have achieved is because of the direct effort they are putting into doing their exercise program and their homework. Alternatively, if they have not made much progress, you can use the re-assessment results to help reinforce the behaviors they need to adapt to increase their adherence to doing their homework and ensure success of the program.

Let's look at how you can use the two re-assessment strategies discussed previously to transition your client into the leader role.

Regardless of the responses a client gives to your question about the assessment finding, the trick is to use the results to coach your client about the behaviors they are in control of that are helping them see positive results. This will improve their self-confidence and adherence to the program.

Support the Client as they Lead the Way

Following your discussion about what the client thinks they have done to help their situation, ask them to perform their homework exercises so you can evaluate their progress in this area and make any helpful adjustments, progressions and/or regressions.

Communicating with your client about their homework in this way and devising strategies together to remove any barriers to them completing their homework, ultimately puts them in control of the success of their program (Whitworth, et al., 2007). Additionally, reviewing homework with clients and explaining how the exercises they have been doing (or not been doing as the case may be) influenced their re-assessment results also helps you praise appropriate behaviors, reshape undesired actions, and adjust program variables (i.e., progress or regress) as necessary so that clients feel emboldened to achieve their goals.

Conclusion: Putting It All Together

The key to providing outstanding exercise services lies not only in your ability to assess and design effective programs, but also in your skill to be able to engage your clients verbally in ways that will make them feel confident in taking the steps needed to reach their desired goals. Incorporating re-assessments in your session protocols will enable you to provide objective feedback about the progress of a client’s program and highlight those behaviors the client has made that are influencing their success (Bandura, 1986). Furthermore, utilizing homework review as an additional re-assessment tool enables you to further encourage your client’s participation in the program, increase their confidence and provides you with the valuable information you need for successful program design.

References:

  1. American Council on Exercise. 2010. ACE Personal Trainer Manual (Fourth Edition). American Council on Exercise.
  2. Bandura, Albert. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall, 1986.
  3. Kendall, F.P. et al. 2005. Muscles Testing and Function with Posture and Pain (5th ed.). Baltimore, MD.: Lippincott Williams & Wilkins.
  4. Milgram, Stanley. 1974. Obedience to Authority. New York: Harper and Row.
  5. Price, J. 2010. Corrective Exercise Program Design. Module 4 Reference Manual of The BioMechanics Method Educational Program. www.thebiomechanicsmethod.com.
  6. Whitworth, L., et al. 2007. Co-Active Coaching: New Skills for Coaching People Toward Success in Work and Life (2nd ed). Palo Alto, CA: Davies-Black Publishing.