We physical therapists pride ourselves on being able to truly impact our patients’ lives. There’s really no better feeling than helping a patient reduce his or her pain and increase his or her independence. But, as most of us know, there are always those few patients who fall off the radar, bailing on therapy for good before they meet their goals. 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.

Here are some of the top signs that patients are losing interest in physical therapy—and thus, are likely to stop short of meeting their goals—along with ways to remedy each problem.

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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. If your patient isn’t doing his or her exercises, that’s a good sign that he or she is 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 it a point to stress the importance of self-care during your initial evaluation as well as during follow-up visits. Review the HEP thoroughly and regularly with your patients. Ensure that they understand the importance of the exercises, but don’t overwhelm them with homework. Regularly check in and eliminate exercises that aren’t helping or are frustrating to the patient. Discuss solutions to excuses like, “I don’t have anywhere to do these exercises,” or “I’m not sure I’m doing them right.” (Hint: An interactive, mobile-friendly HEP software can help alleviate confusion over exercise technique and ensure that patients are able to complete their exercises virtually anywhere. Bonus points if your HEP solution allows patients to track their progress and message their therapists with any questions that come up.)

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 this, in turn, is a sign that they are not engaged in therapy.  

The Fix

Try sending appointment reminders via text or email in addition to providing verbal reminders at the end of each session. Another simple fix is to simply ask the patient if he or she has any questions or concerns before the end of each appointment. If appointment times or lack of progress are weighing on the patient’s mind, this opens the door for him or her to discuss those concerns.

You may also want to think about leveraging telehealth in your clinic. Americans are getting busier and busier each year, and convenient solutions are starting to dominate many markets—health care included. Of course, the PT industry still has some catching up to do in the telehealth space—namely with respect to payment for telehealth services—but it certainly offers a convenient solution for keeping busy patients on track with their care plans. Alternatively, you could look into adopting a PT-specific patient relationship management (PRM) solution that allows you to connect with patients between appointments with automated check-in messages and personalized content.  

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 that means 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

Is your patient getting married? Divorced? Expecting a baby? Dealing with a devastating medical diagnosis or family emergency? 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 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 keep in mind: 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. Do you suspect a pelvic floor dysfunction? Refer out to a pelvic floor PT. Does your patient have an unusual pain pattern, unremitting fever, or night sweats? Send him or her back to the MD for further testing.


At the end of the day, one of the best things you can do for your patients is to keep them engaged and interested in their treatments. That way, they have the best possible chance of achieving their goals. Looking for more ideas on how to prevent patient dropout? Check out our new patient retention guide.

Meredith Castin, PT, DPT, is the founder of The Non-Clinical PT, a career development resource designed to help physical, occupational, and speech therapy professionals leverage their degrees in non-clinical ways. Meredith is also the co-founder of NewGradPhysicalTherapy and works as a freelance writer and editor for a variety of publications.

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