How to measure home exercise adherence without overreading the record

One week, three different answers

Consider this hypothetical clinic review. A patient had four home sessions scheduled that week. They report finishing two sessions and doing part of another. They cannot remember what happened on the fourth day.

The exercise software shows two completion entries. During today's visit, the patient also demonstrates one exercise.

Those records answer different questions. Two entries describe what the software recorded. The patient's account describes two complete sessions and one partial session. Today's demonstration shows what the therapist observed today.

An owner could turn any of those into a neat dashboard number. But calling the week "50% adherent" would hide the partial session and the unknown day. Calling it "75% complete" would turn a partial session into a finished one.

The useful next step is not choosing the most flattering number. It is deciding what each number means before anyone compares it.

Start with the behavior, not the percentage

Here, adherence means following the exercise plan agreed with the patient. That still leaves several things a clinic might count:

• Sessions the patient reports finishing.
• Exercises or sets recorded during a session.
• Days with any recorded exercise activity.
• Performance a clinician directly observed.

These are not interchangeable units. A day with one recorded set is not necessarily a completed session. A completed session entry does not, by itself, show exercise technique.

Our recommendation is to write the unit beside the count. Use "two sessions reported complete out of four scheduled," rather than an unlabeled adherence score.

Also name the dates. "This week" can mean different periods when one clinician asks on Monday and another asks on Friday.

This is a recordkeeping recommendation, not a validated adherence measure or a billing rule.

What the research supports

In a 2018 measurement study, Nicolson and colleagues studied 54 adults aged 45 or older with self-reported chronic knee pain.

Participants followed a home quadriceps-strengthening program for 12 weeks. Researchers compared paper diaries and a self-report rating with measurements from an accelerometer hidden in an ankle cuff weight. An accelerometer is a sensor that measures movement.

Diary records overestimated exercise compared with the sensor measurements. Agreement between the two methods varied substantially between participants.

That supports a narrow warning: a diary and a sensor record are not interchangeable. It does not establish a correction factor for every patient's report. It also does not validate an app's completion button or show that every sensor measures exercise technique.

Nor does disagreement establish that a patient was dishonest. This study evaluated measurement, not a clinician's basis for judging an individual patient's motives.

There are structured questionnaires, too. Newman-Beinart and colleagues developed the Exercise Adherence Rating Scale, or EARS.

Their initial evaluation included 224 people with chronic low back pain. The resulting six-item scale showed good measurement properties in that study, including high consistency when repeated.

That is evidence about a particular questionnaire in a particular population. A questionnaire remains patient-reported information, not direct observation of every home session. If your clinic uses EARS, consult the instrument and its supporting research. Do not rename a homegrown percentage an EARS score.

Neither study establishes that HepBuddy improves adherence or that tracking alone improves recovery.

Label what each record can tell you

This table is an editorial guide, not a ranking of validated tools.

The distinction matters even when a system records an event automatically. Automatically recording a button press is not the same as automatically detecting an exercise.

When an entry is missing, use a neutral question. Our guide to discussing missed home exercises covers that conversation.

Keep understanding separate, too. Teach-back and demonstration can help you check what a patient understands during a visit. They do not document the following week's exercise.

Use a short record-definition card

Before comparing patients or clinicians, have your team complete these fields for the measure it plans to use:

• Behavior: What counts as complete, partial, or another recorded event?
• Unit: Are we counting sessions, exercises, sets, or days?
• Period: What are the start and end dates?
• Plan: What was scheduled during those dates?
• Source: Did the patient report it, software record it, or a clinician observe it?
• Unknowns: What information is missing or still needs clarification?

This card is our suggested documentation aid. It is not a validated questionnaire, treatment protocol, or replacement for clinical judgment.

If the exercise plan changed midweek, note which plan applied on each date. Do not judge earlier sessions against exercises added later.

For the hypothetical week above, a useful summary would be:

Four sessions scheduled. Patient reports two complete and one partial; one session remains unknown. Software contains two completion entries. One exercise demonstrated during today's visit.

That summary keeps the accounts separate. It does not pretend that the demonstration verified the home sessions.

What to standardize across the clinic

Standardize the labels before setting a clinic-wide target. Two percentages should not be compared as the same measure when their units, periods, or information sources differ.

Use the patient's report as information, with its source named. Use a software record for what it records. Let the treating clinician decide what further clarification or assessment is needed.

The goal is a record your team can read accurately, not a score that looks precise.

For a separate overview of HepBuddy's home exercise tools, see how HepBuddy works. This guide does not claim those tools directly observe exercise or replace a validated measure.