We physical therapists pride ourselves on being able to make a real difference in the lives of our patients. There is no better feeling than helping a patient alleviate their pain and achieve their goals. But, as most of us know, there is always a small minority of patients who get ignored and never come back until they complete their Plan of Care (POC). But how do you know if your PT patient is about to drop out?

It’s a frustrating feeling for all involved, but fortunately, there are signs that patients are disengaging. If you spot the signs early enough, you can intervene and turn things around.

1. Failure to follow a Home Exercise Program (HEP)

As any therapist knows, home exercise is one of the most important (if not the most important) components of PT, and patients agree. In our PT patient experience report, 77% of patients believed that an effective HEP was directly related to good PT outcomes. If your patient is not exercising, it is a good sign that they are not participating in treatment. This can be a problem in the beginning, or it can develop over time as the patient becomes more and more alienated.

In some cases, patients initially do HEP like clockwork, but then start looking away when you ask. In other cases, patients never really appreciate the importance of home exercise.

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Emphasize the importance of self-care during your initial assessment and follow-up visits. If you find yourself needing guidance for full patient acceptance, follow these four HEP compliance tips:

• Actively engage with your patients both in-person and digitally.
• Be ready to adjust to your patient’s needs.
• Aim for some practice instead of handing them a book’s worth.
• Exercises are chosen specifically according to the needs of the patient.

If these strategies still leave your patient looking for an outlet, don’t forget to sit down and discuss solutions such as “I don’t have a place to do these exercises” or “I’m not sure what I’m doing” and they’re right.

A sophisticated HEP platform that not only enables you to work with your patients to build a personalized HEP, but also has a wealth of instructional videos to help them better understand how to perform each exercise, which helps reduce confusion and improve compliance sex. Additionally, our report found that 83% of patients who underwent digital exercise reported HEP success. And, with a dashboard that leverages remote therapy monitoring, you can get paid to track and monitor patient adherence.

2. Skip dating

When patients make PT a priority, they make sure they show up—no matter what.Conversely, when patients start canceling, no-showing or showing up late, it is a sure sign that they are no Prioritize their treatment. If treatment is not a priority, your PT patient will likely drop out.

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In this case, there is more than one fix to consider. First, in addition to providing verbal reminders at the end of each meeting, try sending appointment reminders via text message or email. Digital health services have grown exponentially over the past five years, and patients want to ride the trend. According to our PT Patient Experience Report, patients want to simplify their care pathways where:

• 81% prefer digital reminders, SMS is the first choice,
• 79% prefer to fill out admissions documents digitally at home,
• 70% prefer to pay using digital options, and
• 61% prefer to arrange online rather than in person.

The second fix revolves around communication. It is relatively easy to simply ask the patient if they have any questions or concerns at the end of each appointment. Likewise, if patients are constantly calling to cancel appointments, dig deeper to understand what is wrong. Many times patients will try to cancel because of the pain, but remember, you are a physical therapist! Pain is one of your many specialties, and PTs are where patients need to go when they are in pain. Sometimes patients just need a little reminder.

For the last solution, you may want to consider utilizing telemedicine in your practice. Between the healthcare transformation triggered by the pandemic and the increasingly fast-paced world of work, being able to access healthcare at home can help ensure better compliance for some patients. Of course, the PT industry still has some work to do in the telemedicine space – namely regarding Medicare and public health emergencies – but it does offer a convenient solution for keeping busy patients on track with their care plans .

3. Use defeatist language

Be aware when patients start saying things like “I guess I’ll just have to live with this” and “I don’t know why I expected physical therapy to be any different.” These are strong signals that they are losing faith in the efficacy of physical therapy, and could mean that they may drop out of treatment soon.

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Our job is to educate patients on the trajectory of healing. My own PT once said the best thing: Treating an injury with physical therapy is like investing in the stock market. When patients invest in treatment, they sometimes experience big improvements (days when the market soars), but they also experience some periods of regression (days when the market falls).

But overall, things should tend to improve. Our job is to recognize when this is (and when it is not) and adjust the treatment plan accordingly.

4. Experience a major life event

Life is full of surprises and milestones – some good, some not so good. But major life changes often take precedence over compliance with PT, and that’s okay. We do not have the authority to decide whether a patient should prioritize physical therapy over other life issues.

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The important thing to do here is communication. Be sure to explain that if the patient needs to schedule his or her appointments more often, book a shorter visit, or use telehealth PT services (if you offer them), that is acceptable to you. It’s better to know what’s going on with your patients than to let them disappear without explanation.

One more thing to keep in mind: Not every patient is a candidate for PT. Some patients may require treatment outside the scope of our practice, or they may benefit from more specialized physical therapy.

Part of being a good PT is recognizing when a patient’s problem is beyond your knowledge. If you suspect pelvic floor dysfunction, see a pelvic floor PT. Does your patient have unusual pain, persistent fever or night sweats? Send them back to MD for further testing.

At the end of the day, one of the best things you can do before you determine that a PT patient is about to drop out is to keep them engaged and interested in their treatment. That way, they have the best chance of achieving their goals. If you’re looking for more ideas to prevent patient dropouts and maximize patient success, check out our guide to patient retention.