Patient Compliance Issues

I am currently treating a patient whom has sustained a mixture of superficial and deep partial thickness burns to their UL’s following exposure to an electrical fire. The patient cannot speak or understand any English, but follows demonstrations fairly well with facilitation. Prior to last week the patient was compliant and responding well to physiotherapy. Last week the patient had a small SSG on both elbows (roughly the size of a 20c piece). Following the SSG the patient was RIB for 2/7 to allow for the SSG to ‘take’ and then was given the all clear by the surgeon to begin mobilisation. Since their SSG the patient has been non-compliant with physio. They are very tearful during the Rx session and will walk out of the gym on their own accord and go back to their room. As we mobilise their UL’s they repeatedly pull away pointing to the area where the SSG’s are and shake their head. As we do not speak their language and vise versa we were unsure of what they were trying to convey.

Rx of such burns requires fairly aggressive (within reason) stretches and mobilisations so that when the tissue heals there is enough ROM at the joints to allow for function (tissue looses its elasticity when burnt thus the patient is at a high risk of contractures). As a physio student knowing these complications it was very frustrating as we were trying to prevent the patient from losing function, but they didn’t understand this. Reflecting upon the patient’s behaviour I can understand that physio treatment is extremely painful and the patient may feel we are damaging or injuring them. In addition due to language barriers they may be confused as the surgeon (via an interpreter) had informed the patient that they must not move their arms in order for the SSG to heal (I am unsure as to whether a time frame for this immobilisation period was given to the patient). It must have been frightening and frustrating for the patient as they had no control over the situation and all our Rx appeared to do was cause them pain.

Through the week an interpreter has seen the patient with myself and the physio. The patient stated that they understand why they have to move and are now allowed to move, but added that it is very painful. To this we replied that they need to let us move their UL’s and that by moving it will infact decrease their levels of pain. By not moving we explained it will be even more painful in each subsequent physio session. By the end of the session we felt we had conveyed the message across to the patient and the interpreter assured us that the patient understood the importance of the physiotherapy and that pain did not equal damage.

Reflecting upon this situation I realised that communicating and educating the patient is vital for them to be compliant with physiotherapy and any exercises we give them to do during the day. In the future I will organise for an interpreter to see the patient prior to their surgery and them immediately after to explain the physiotherapist’s role in their Rx. In addition whilst the patient’s compliance has improved they are still not doing enough in physio and in their room to prevent contractures of the skin from forming. They currently have the maximum pain relief prior to physio, have their stretches done in their room so they can’t walk out and have had an interpreter speak to them four times in the past week explain the importance of them moving their UL’s. If anyone has any suggestions or thoughts on how to improve the patients compliance they would be much appreciated. Thanks!