Is A Picture Worth A Thousand Words?  A Different Approach To Tracking Patients' Improvement
Greenhaus A

Purpose:  Keeping patients motivated to continue with their exercise program is an integral part of rehabilitating shoulder injuries.  Research studies indicate that strong predictors for compliance with exercise are perceived success, and the perception that exercises are effective in ameliorating unpleasant symptoms.  Presently, written questionnaires are used to measure improvement by assessing function.  However, those questionnaires have limitations, particularly if the non dominant arm is affected.  For the past 10 years I have taken photographs of patients' pain free active range of motion (ROM).  Over the years, I've noticed that showing patients the pictures indicating the changes in ROM seemed to make more of an impact in showing status than questionnaires.  The purpose of this study was to determine whether patients in fact, believed that photos were more effective than a written self-assessment tool (WSAT) in the tracking of their own improvement.  

Subjects: 15 non surgical patients with diagnoses of bursitis, or impingement syndrome.

Materials/Methods:  AT the IE, patients completed a WSAT.  In addition, photos were taken of their active, pain free shoulder elevation, coronal plane abduction, internal rotation and cross-body adduction.  After 2, then 4 weeks, follow up WSATs were answered and pictures were taken.  Patients were asked to assess their percentage of improvement (a) before reviewing either the WSAT or pictures, (b) after reviewing the WSAT, and (c) after reviewing the pictures.


Results: Before reviewing either pictures or written questionnaire, all patients stated they improved (estimates varied widely, from 10% to 85%).  After examining their before/after answers to the WSAT, responses changed: 4 patients said they were better, 2 said they were worse, and 9 patients assessed their improvement as the same.  However, after looking at their changes indicated by the pictures, 10 patients thought they were better, 2 thought they were worse, and 3 believed they were the same.  Patients were then asked which tool they believed more accurately showed their status.  Regardless of their assessment on level of improvement, all but two of the patients stated they perceived the pictures more accurately assessed their physical status.

Conclusion:  This study indicates that, for the patient, photos taken of changes in ROM appear to show improvement in a more dramatic manner than the WSAT.

Clinical Relevance:  Past studies have proved that when patients believe their exercise programs have fostered improvement, they are more likely to maintain their exercise programs.  This study supports the notion that a visual feedback aid (photos) should be included in the assessment armament of the clinician.