Page 27 - Mobility Management, March/April 2021
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factors that are going to impact someone’s use of their equipment. It’s all relevant to whether someone is then able to use the equip- ment as we intended. Everyone’s an important stakeholder.”
Managing Adherence & Supporting Clients
“Managing adherence requires monitoring and measurement,” Friesen added. “One of the things that strikes me as I read published papers about this is that we actually don’t define what the recom- mended behavior is. If you think about medication, you’re told about what dose to take, how many times a day, until the packet runs out. You’re given very clear instructions. In a written prescrip- tion, it usually is also printed in some way on the packaging. It’s put in multiple places so you’re informed of the recommended use.
“In seating and mobility, I don’t think we give that level of information to people and their circle of support. We say this is what we’re recommending and have that discussion, but I don’t know that we communicate that always in a very clear way, that this is what the recommendation actually is. So there’s a lot of potential for it to be misunderstood, and it also means it’s almost impossible to measure because we’re not using any objective standard to measure it.”
In the end, factors such as client/caregiver education are crit- ical to adherence, because how consumers and families feel about
their seating and wheelchairs has a domino effect.
“In terms of psychology, there is a big body of evidence around how a person’s beliefs about their treatment, be it a medication or an intervention, affect what they do,” Friesen said. “Also, people’s
beliefs about their illness or condition impacts what they choose to do. But in terms of adherence-related sciences, we’ve defined adherence to medication as a process of taking the medication as recommended, understanding that there’s been conversation, and the person has had agency in the decision-making process. There’s also management of adherence, and that’s the piece of the puzzle that talks about monitoring of adherence and also supporting people with adherence-related behaviors.”
While compliance is rather a one-way street — healthcare professionals give instructions, which clients and caregivers obey or ignore — adherence suggests much more active involvement and responsibility on everyone’s part.
“If a person and their circle of support is unable to use the equipment as intended, then it possibly wasn’t the optimal solution to begin with,” Friesen said. “This is why I get concerned when we say ‘Oh, they were non-compliant.’ Was that piece of equipment truly matched to that person’s life, environment, care regimes, all the other issues that come into play? If it wasn’t, was it the optimal solution?” m
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