Over- Enthusiastic Clients

On my current community placement im faced with the situation where rather than being uncompliant and reluctant to engage in physiotherapy most of my clients push themselves beyond their limits. I was faced with a situation in the last week where i actually had to force my client to stop.

Community pulmonary rehab and cardio respiratory classes are incorporated into my program of classes to take in the week. Recently over the last 2 weeks one of my clients from my cardio respiratory class has shown to have an increased heart rate and lower than usual saturation at rest. On initial inspection the clients sats were 90% so i continued to ask the client if they had rushed to the class from the car, if they were not feeling the best with the cold weather this week, or if they had physically exerted themselves more than usual. The client simply responded that they were fine felt slightly breathless and were keen to begin their self paced 20 minute walk. I kept watchful eye on this client who i reiterated to "take things easy" however after several laps of walking they were quite reluctant to stop. At the eighth lap i stood in the path of this client and held out the oximeter to take a reading, the client had desaturated to 78-80% so i advised them to sit down until their saturations reached 90% before they could proceed. After 3-4 mins the client had recovered and then continued to walk of which i watched them closely and made them rest. At the end of the walk the client seemed so disapointed that they had walked 7 less laps than usual. Myself and my supervising physio then went on to explain to the client that if we had not stopped them they could have desaturated to a dangerous level and that we have to intervene to ensure the client is exercising safely. The client tried to justify that despite showing signs of breathlessness they only felt very slight breathlessness and for the rest of the class the client remained distant and very unengaged in the rest of the program.I decided to reason with the client that both themself and the physio play part in deciding what are realistic goals for them in the class and if their safety is in jeopardy it is our roles as physios to intervene and modify. After some reasoning the client seemed more comfortable with modifying their workload and actually thanked me at the end of the class for giving a full explanation as to why i wanted them to stop.

This experience made a few things more apparent to me. Often we deal with uncompliant patients who refuse our services but often we will encounter clients who will work themselves to the limit just to please us. Despite subjectively a client reports they are ok, not experiencing pain etc often just by being more observant its apparent that the client is not comfortable in which we must modify what they do. In many of my classes i have had to modify my whole class plan just by observing the majority of the class not being able to cope but still allowing those who can to continue with a progression. I was wondering if anyone had some more suggestions for strategies to deal with the over enthusiastic patient......