Expectation vs. Reality: Why Patients Really Drop Out of Therapy

As a rehab therapy provider, you’ve undoubtedly encountered the following scenario: a new patient comes to therapy, sets goals, and agrees to the course of treatment. Then, within the first few visits, he or she vanishes into thin air. This disappearing act is beyond disappointing, especially when you know that patients who remain in therapy are more likely to recover—and there’s a lot of research to back that up. But as Heidi Jannenga, PT, DPT, ATC/L, the president and co-founder of WebPT, explains here, "approximately 20% of PT patients drop out of treatment within the first three visits, and 70% fail to complete their full course of care." If that number frustrates you—and it should—know that you’re not alone. In fact, I’m right there with you. So, why do people go to physical therapy only to disappear later on? Here are a few reasons patients flake out, along with fixes for each.

The Reason: Results aren’t immediate.

According to this white paper from Marquette University, a lack of immediate results is one of the leading causes of high attrition rates. When patients fail to see instant gains, it can leave them feeling discouraged—and convinced that therapy isn’t helpful. As a rehab therapy provider, you know that’s not the case. But how do you prove that to your patients?

The Fix: Set expectations.

Anyone who’s ever started a fitness regimen knows how easy it is to get discouraged if you don’t set goals for yourself. It’s even more discouraging if you set your goals higher than what you can realistically achieve. The same goes for your patients. That’s why, at the initial encounter, it’s crucial to set realistic goals for every patient as well as educate those patients on the kind of results they can expect. Be sure to explain that restoring function takes time and effort. Therapy is effective—and the results tend to last longer than those derived from more instantaneous treatments (e.g., surgery or injections)—but it’s not an overnight process. So, if a patient expects a speedy road to recovery, he or she will likely end up feeling disappointed.

It’s also important to reinforce the patient’s own role in his or her recovery. For example, if the patient consistently adheres to his or her home exercise program, he or she likely will experience faster—and better—results. And don’t be afraid to go a bit Ghost of Christmas Future—that is, let the patient know what he or she can expect in the event that he or she bows out of therapy early (namely, a lot of wasted time and effort with very little improvement).

The same Marquette white paper notes that dropouts experience greater physical pain, more functional limitation, and decreased health-related quality of life compared to those who complete therapy. But patients may not be prepared take your word for it, so consider leveraging your own evidence (e.g., your practice’s outcomes data) to prove the efficacy of your treatment.

The Reason: The cost can be substantial.

Let’s face it: no matter how big or small it is, an unexpected cost can be a significant deterrent to seeking necessary treatment. According to a recent survey conducted by Bankrate, one in four Americans forego health care because of cost. And considering the commoditization problem hanging like a dark cloud over the physical therapy profession, PTs are especially vulnerable to the effects of this trend.

The Fix: Advocate for your patients.

It’s a touchy subject, but understanding how to talk to patients about the cost of treatment is a big step toward setting better financial expectations. Health insurance is complicated, and some folks have the misguided belief that if a service is covered, that equals low—or no—out-of-pocket expense. That’s why it’s important to have your front-office staff go over each patient’s insurance benefits with him or her prior to the initial visit. Some practices also craft a fee schedule discount structure for those patients who pay entirely out-of-pocket, which can help lessen the financial burden. This is especially useful for cash-based practices that strive to assist individuals from all income levels.

The Reason: Patient lifestyle doesn’t jibe with treatment.

These days, about 80% of Americans have sedentary jobs, which means most of us have to put in extra effort to maintain healthy and active lifestyles. This can be a major roadblock for those who are recovering from injury or experiencing chronic pain. If the nature of a patient’s job prevents him or her from improving, the patient might feel pressured to choose between treatment or employment.

The Fix: Seek a compromise.

This can be tricky, but it’s not impossible. It starts with researching different methods to accommodate patients’ daily activities as well as helping them make healthy lifestyle changes. This could involve suggesting that patients take sick leave in order to heal, recommending products that can improve posture and form, or teaching them simple exercises they can do at their desks. Your work as a care provider should go beyond the clinic, and that includes looking for “hacks” to help patients improve without having to derail their daily lives.

The Reason: Chronic pain impacts mental wellness.

Persistent pain is an emotional issue as much as a physical one. According to the US National Library of Medicine, those with chronic pain have elevated levels of stress and commonly suffer from depression,. The Marquette study also found that patients who dropped out of therapy had higher depression scores, which can impact patients’ ability to stay motivated.

The Fix: Focus on mental health.

The fact is, for patients to improve their physical health, they often must make major lifestyle changes. This is especially true for patients with physical conditions that cause chronic pain. The combination of dramatic change and crippling pain can seriously impact a patient’s emotional well-being, so it’s vital that you emphasize the outcomes that patient can achieve by sticking with therapy. But, even if your patients can see the light at the end of the tunnel, they are going to need a guiding hand. And even though individual outcomes rely heavily on a patient’s adherence to his or her HEP and treatment, it’s up to you—the therapist—to lead the way.

Patients drop out of therapy for any number of reasons, but savvy providers know how to address those obstacles proactively—before they turn therapy patients into therapy dropouts.  By acknowledging—and solving for—both environmental and emotional factors, you can keep patients on track to not only achieve their therapy goals, but also live happier, healthier lives.