Page 24 - Mobility Management, March/April 2021

ATP Series
THE PROBLEM WITH COMPLIANCE
UNDERSTANDING WHY CLIENTS & CAREGIVERS DON’T FOLLOW RECOMMENDATIONS
BY LAURIE WATANABE
COMPLIANCE is key to optimal outcomes. It is also one of Complex Rehab’s greatest challenges, because who likes fingers being pointed at them? Every clinician, ATP supplier, and funding specialist has stories of a seating system or wheelchair that was perfectly dialed in, custom built or fitted, fought for via funding channels, delivered... and then rarely used, perhaps brought out only for clinic appoint- ments. Or the wheelchair is used, but the tilt and recline remain idle.
It’s a complex issue that starts, perhaps, with the term itself.
Why Words Matter
Emma Friesen, Ph.D., Clinical Director for Raz Design Inc., has closely studied the concept of compliance.
“A lot of my reading and understanding on this is as a result of being exposed to the adherence-related sciences, which I would say are dominated by medication-related adherence, because that is a global issue of concern,” Friesen said. “There’s a whole lot, at least 40 years of worldwide research, on these topics. I got exposed to that when I was working at a pharmaceutical company.”
And compliance, she noted, is a term on its way out. 22 MARCH-APRIL 2021 | MOBILITY MANAGEMENT
“The term compliance has largely been deprecated,” Friesen explained. “It’s not a consensus term anymore, and that started in the early 2000s. The reason was the common definition of compliance: the extent to which the patient’s or person’s behavior matches the prescribed recommendations. Back in 2000, there was a report written by the World Health Organization, and the concern is that the term implies a lack of involvement by the patient or person in decision making about their treatments.”
Compliance’s passivity, Friesen said, reflects “a very medical model of healthcare: You had a healthcare practitioner doing
an assessment, deciding what the patient needed, and then expecting the person would go away and comply. There was no sense that the person was agreeing with the recommendation or that there had been any real discussion or ownership or agency.”
A Good Fit for Complex Rehab
Patients who don’t cooperate or comply are hit with another label: non-compliant. “Even in the early 2000s, that had become a very negative term, a judgmental term, one that was placing blame on
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