4 Signs Your PT Patient is About to Drop Out

We physical therapists pride ourselves on being able to truly impact our patients’ lives. There’s no better feeling than helping patients reduce their pain and reach their goals. But, as most of us know, there are always those few patients who fall off the radar, never to return before completing their plans of care (POCs). But, how do you know if your PT patient is about to drop out? 

It’s a frustrating feeling for everyone involved, but luckily, there are tell-tale signs that patients are becoming disengaged. If you spot the signs early enough, you can intervene and turn things around.

1. Failing to Comply with Their 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 felt an effective HEP had a direct link to a good PT outcome.  If your patient isn’t doing their exercises, that’s a good sign that they're not engaged in therapy. This could be an issue from the get-go, or it could develop over time as the patient becomes increasingly disengaged. 

In some cases, patients will initially do their HEP like clockwork but later will begin to avert their eyes when you ask about it. In other cases, patients never really grasp the importance of their home exercises in the first place. 

The Fix

Make a point to stress the importance of self-care during your initial evaluation as well as during follow-up visits. If you find yourself in need of guidance to get patients fully on board, follow these four tips for HEP adherence:

• Actively engage with your patient in person and digitally.
• Be ready to adjust to accommodate your patient’s needs.
• Target a few exercises instead of handing them a book’s worth.
• Be specific in selecting exercises for your patient’s needs.

If these strategies still leave your patients looking for the exit door don’t forget to sit down and discuss solutions to excuses like, “I don’t have anywhere to do these exercises,” or “I’m not sure I’m doing them right.”  

A sophisticated HEP platform that not only enables you to work with your patients to build an individualized HEP but also possesses a wealth of instructional videos to help them better understand how to do each exercise can help alleviate confusion and improve adherence. What’s more, our report found that 83% of patients who received their exercises digitally reported HEP success. And, with a dashboard that leverages remote therapeutic monitoring, you can get paid to track and monitor adherence with patients.

2. Skipping Appointments

When patients make PT a priority, they make sure they get to their appointments—no matter what. Conversely, when patients start canceling, no-showing, or arriving late, it’s a sure sign that they are not prioritizing their treatments. And if treatment is not a priority, it’s quite likely that your PT patient is about to drop out.  

The Fix

In this situation, there is more than one fix to consider. First, try sending appointment reminders via text or email in addition to providing verbal reminders at the end of each session. The last five years have seen exponential growth in digital healthcare delivery, and patients want in on this trend. According to our PT Patient Experience Report, patients are looking to simplify their pathways to care where:

• 81% prefer digital reminders, with texting as the top choice,
• 79% prefer to fill out intake paperwork at home, digitally,
• 70% prefer to pay with a digital option, and
• 61% prefer to schedule online when not scheduling in person.

Fix number two revolves around communication. Simply asking the patient if they have any questions or concerns before the end of each appointment is relatively easy. Similarly, if the patient routinely calls to cancel an appointment, do a little digging to understand the problem. All too often, patients will try to cancel for pain, but remember, you are a physical therapist! Pain is one of your many specialties, and PT is where patients need to be when they are in pain. Sometimes patients need just a bit of reminding of that.

For the last fix, you may want to think about leveraging telehealth in your clinic. Between pandemic-induced healthcare transformations to an ever faster-paced working world, being able to access health care from home can help ensure greater patient adherence for some. Of course, the PT industry still has some catching up to do in the telehealth space—namely concerning Medicare and the public health emergency—but it certainly offers a convenient solution for keeping busy patients on track with their care plans.  

3. Using Defeatist Language

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

The Fix

It’s our job to educate patients about the trajectory of healing. My own PT once said it best: treating an injury with physical therapy is like investing in the stock market. When patients invest in treatment, they’ll sometimes experience great improvements (days when the market surges), but they’ll also go through periods when they regress a bit (days when the market dips). 

But overall, things should be trending toward improvement. It’s our job to recognize when that is (and isn’t) the case—and adjust treatment plans accordingly. 

4. Undergoing Major Life Events

Life is full of curve surprises and milestones—some are good, others not so much. But major life changes often take precedence over compliance with PT, and that’s okay. It’s not our place to say whether a patient should or shouldn’t prioritize physical therapy over other life concerns.

The Fix

The important thing to do here is to communicate. Be sure to explain that if the patient needs to space out his or her appointments more, book shorter visits, or use telehealth PT services (if you offer them), you’re open to it. It’s better to know what’s going on with your patients than to simply have them vanish with no explanation. 

Something else to remember: Not every patient is appropriate for PT. Some patients might need treatment beyond our practice scope, or they might benefit from a more specialized type of physical therapy. 

Part of being a good PT is recognizing when your patients’ issues go beyond your scope of knowledge. If you suspect pelvic floor dysfunction, then look to refer out to a pelvic floor PT. Does your patient have an unusual pain pattern, unremitting fever, or night sweats? Send them back to the MD for further testing. 

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