You are the one right person who might make a difference for me

Background:The ability to engage in upper extremity rehabilitation exercise is shaped as much by a patient's identity, values, beliefs and daily realities as it is by their physical impairments and diagnosis.Purpose and Design: Written by a person living with chronic neck, shoulder and hand pain, this message to clinicians paper describes how psychological and social factors influence patients' engagement in upper extremity rehabilitation exercises.Key messages: The narrative explains that a patient's trust in their therapist supports engagement in exercises, but that trust is not automatic and grows only after feeling seen, heard, and treated with dignity and respect.It considers how therapists' own assumptions, viewpoints, and power positions can shape the rehabilitation goals that are prioritized, how exercise adherence is interpreted and how "success" in rehabilitation is defined.Factors such as pain, fear, exhaustion, motivation, time, finances, and available support are not barriers to overcome, but real-life circumstances to work with because they shape a patient's ability to engage in prescribed exercises.Conclusions: Tailoring exercise therefore requires reflection, partnership, creativity, and an understanding of the context patients live in.