If you survey a group of seasoned physical therapists about their top job-related frustrations, you’ll likely hear several themes on repeat: there’s too much paperwork, the productivity demands are unsustainable, and patients frequently don’t follow their PT’s recommendations.
In this feature, we’ll investigate common PT opinions on this final point of frustration. We’ll examine how current research supports some of these sentiments about why many patients don’t adhere to their therapist’s plan of care. Let’s consider four frequently cited reasons for this lack of adherence:
  1. Patients don’t understand the value of therapy for their condition
  2. The therapeutic alliance between patient and provider is insufficient
  3. Psychosocial factors like depression, stress, and previous trauma reduce patients’ agency and autonomy throughout the recovery process
  4. Patients struggle to stick with overly long or complex home programs

The Value Proposition of PT

While many physical therapists may not consider themselves to be customer service agents, the fact remains that physical therapy—and healthcare as a whole—is inextricably linked with the customer experience. As PTs, we are providing a service to the public, and our patients are our customers.

From a patient’s first day in the clinic, the PT is working to earn their trust and encourage buy-in to the proposed plan of care. Perhaps without realizing it, we are employing common sales tactics to achieve this: we are friendly and welcoming; we employ person-first language so our patients feel valued and centered in the conversation; we thoroughly educate our patients about their conditions and the pros and cons of various options to address them.

Then comes the really tricky part: selecting an initial treatment approach and demonstrating its value to the patient. Many outpatient therapists feel that if a patient does not leave the clinic with some appreciable improvement on day one, they have failed to show their value as a provider.

While some conditions lend themselves to rapid intra-session improvements, not all patients will respond so readily on the first day of treatment. In these situations, showing the value of physical therapy can be particularly daunting: how do we convince these patients that PT is worth their time and money?

While there isn’t a single clear answer in all cases, the following three steps can help persuade skeptical patients that they should come back for more:

  1. Emphasize patient-centered goal-setting from the first day
  2. Track data over time to show patients the small changes that can occur within the first few sessions
  3. Measure the patient experience and patient satisfaction from the get-go, and keep reassessing them throughout the course of care to ensure you’re still on track

For more details on how to use these techniques to improve your patients’ experience and adherence, download our free guide to measuring and improving the delivery of patient care.

Therapeutic Alliance: Building Patient Trust

From the first day of our clinical training as PT students, we are taught the importance of the therapeutic alliance between patient and provider, and with good reason: the research demonstrates a connection between a strong therapeutic alliance and improved clinical outcomes.

Without the firm foundation of a trusting, respectful relationship between us and our patients, it can be difficult to convince them to adhere to our treatment recommendations. After all, we are often asking our patients to engage in exercises and interventions that can be painful, fatiguing, confusing, boring, or a combination of all four!

By taking the time to really understand our patients’ goals and motivations, and by investing in the human relationship we are forging with them, we can help them commit to our plans of care. After all, we design these plans to help our patients: it’s our job to guide patients through them with compassion and understanding.

Psychosocial Barriers to Adherence

Elsewhere on the blog, we’ve discussed the key reasons that patients discontinue physical therapy altogether (link to Five Key Reasons Patients Drop Out article – aug 2021), and psychosocial issues like depression, anxiety, and traumatic stress rank high on that list.

If our patients are depressed and hopeless prior to beginning their physical therapy journey, it may be difficult for them to have faith that PT can help them. Uncontrolled stress, anxiety, and prior trauma can all interfere with our patients’ best efforts to adhere to their home programs and our recommendations.

If we fail to address these underlying concerns, we are failing to provide our patients the tools they need to succeed in their rehabilitation journeys. While physical therapists are not mental health providers, we arehealthcare professionals with a duty to help our patients gain access to the resources that can help them manage their mental health.

Endless Exercises: When HEPs become Unsustainable

A few months ago, I was working with a longtime patient who had seen multiple outpatient physical therapists for a variety of issues over the years. He asked me to help him condense his PT exercise list down to just the key exercises he should be continuing long-term. I agreed, and he arrived to his next visit toting a 3-inch binder filled with laminated copies of all the exercises he’d been assigned over the last two decades.

While not all patients will save exercise printouts from 20 years prior, most PTs have encountered similar situations, in which a patient is attempting to perform upwards of 15-20 exercises on a regular basis, and often becoming discouraged and burnt out on PT in the process.

Home programs that last 30+ minutes and require frequent consultation of crumpled paper print-outs are simply unsustainable for the vast majority of our patients. Even in high-functioning and motivated populations, adherence to an HEP decreases significantly when the program contains more than three exercises.

We’ve discussed the value of concise and customized HEPs elsewhere on the blog, (link to Create Custom HEPs article – Jul 2021) but the value of short, modest home programs simply cannot be overstated. By employing technology like the AC Health app to streamline your HEP prescription, you’ll be taking a key step towards encouraging engagement with your plan of care: start your 30 day free trial of the app, and starting boosting patient adherence today!