If you’re reading this, you’re probably intimately familiar with a key predicament facing rehabilitation professionals: keeping patients engaged in their rehab journey and reducing their dropout rates.
Elsewhere on the blog, we’ve examined what the research says about patient dropouts and cancellations and how to combat them. We’ve reviewed the problem of treatment adherence from the provider’s perspective. However, we’ve yet to ask patients directly: what helps them stay engaged in rehab, and how can we prevent them from dropping out early?

Patient Engagement in Rehabilitation

Let’s Hear from a Patient!

In this article, we’ll address these questions directly from the perspective of a very special patient: AC Health founder Susannah Bailin. Professionally, Susannah is a business person and entrepreneur. She’s also an athlete, a mother, and a lifelong client of rehabilitation services, both for herself and her children.

Susannah’s experiences as a “frequent flyer” in physical and occupational therapy clinics have given her unique insight into the challenges facing the rehab professions, including the ever-present problem of patient engagement.

In a recent interview on the Health Me Podcast with Michael Swienton, PT, DPT, CSCS, Susannah details her views on engagement and dropouts from a patient’s point of view. You can give it a listen here. Read on for a quick synopsis of the key points.

Motivation, not Administration

In the interview, Susannah argues that many rehab practices are approaching patient engagement incorrectly. Some clinics treat contact tools like an online patient portal and emailed appointment reminders as if they are engagement strategies.

Susannah maintains that tools like these are strictly administrative. In her view, patient engagement strategies should foster a motivating environment and facilitate relationship-building between the patient and provider.

Motivation Drives Engagement

Every rehab provider has seen firsthand the difference between a highly motivated patient and one who is just going through the motions. Motivated patients are more invested, attend more visits, actually perform their home programs, and generally have better results. Often, these patients are intrinsically motivated: they want to improve for themselves, and they are willing to put effort towards the process of achieving their goal.

Other patients may be more extrinsically motivated: they are focused on the end goal itself (ex.- becoming healthy again), and they are driven towards it by outside encouragement and rewards. These patients still have the potential to do well in rehab, provided they receive the encouragement they need.

The difficulty arises in converting an unmotivated patient into a motivated one who is likely to complete their course of care. Susannah emphasizes the importance of this conversion process, and highlights how skillful goal setting can build patient motivation.

When treatment goals are relevant and important to the patient, she argues, the patient is more likely to invest in their rehabilitation journey and stay engaged. Crafting goals that are function-focused and connected to the patient’s important activities can help them buy-in.

Susannah also reminds us that goals must be time-limited. If therapists don’t provide an estimated timeframe to meet rehab goals, patients may be unclear on treatment expectations. They may become discouraged if they don’t see immediate progress towards their goal.

Relationships Encourage Commitment

Fear of pain and discouragement with slow progress are two leading causes of appointment cancellations and no-shows. In her interview, Susannah reminds therapists of the critical importance of building strong relationships with patients to counter the effects of fear and frustration.

The confines of short appointments in traditional brick-and-mortar institutions limit most therapists’ ability to continuously encourage and support their patients. Fortunately, improvements in digital communications have made it easier for providers to connect with patients between visits.

Susannah cites a recent joint report published by WebPT and Clinicient which found that inter-session communications between patients and providers were a key driver of treatment success. When providers checked on patient progress between visits, HEP adherence increased from 67% to 94%.

Inter-session communications can motivate patients to adhere to their home programs. However, it’s also important that these communications are more than just reminders: therapists should use them as an opportunity to reward compliance and congratulate patients on success.

Susannah designed AC Health to address this need for rapid, efficient, and positive communication. The app includes a broadcast messaging feature that makes it easy for therapists to send encouraging messages to all their patients simultaneously (while still protecting their privacy).

Each practice or provider can create anonymized leaderboards in the app that allow patients to track their HEP adherence rate against others – this can be hugely motivating for those with competitive personalities.

For patients who are less motivated by competition, therapists may take a more direct approach. A quick text or video message through the AC Health app allows the therapist to recognize their patient’s hard work and encourage them to stick with it between visits.

Habit Stacking and Trigger Events

Throughout the interview, Susannah and Dr. Swienton discuss the importance—and the challenge—of building consistent habits in rehabilitation. Adherence to rehab recommendations is critical for treatment success, but it can be difficult for patients to establish an adherence habit.

Susannah cites the book Tiny Habits: The Small Changes That Change Everything by author BJ Fogg as an inspiration. Dr. Fogg recommends tying a new habit you’re trying to develop to another, pre-existing habit or routine. The pre-existing routine acts as a “trigger” to remind you that it’s time to complete the other, newer activity.

Susannah explains how the AC Health app was designed with this concept in mind: the app helps “trigger” patients to perform their home programs.

  • Inter-session messages between therapist and patient act as a helpful reminder for patients who’ve forgotten to perform their HEP. Since most patients look at their phone frequently throughout the day, a push notification from the app can be a helpful reminder to make time for self-care.
  • Patients can set their own reminders within the app. Susannah recommends setting a reminder at the end of a session for the next time it should be performed. She and her team have found that patients who set consistent, recurring reminders often start ignoring the notification. However, those who scheduled only their next session reminder are more likely to engage.

By consistently triggering patients to perform their HEPs, AC Health helps make rehab-related habit creation smooth and easy for both patient and provider.

Find It, Trust It, Ask About It

Susannah’s experience as both patient and entrepreneur in the rehab space have helped her develop a keen sense of what patients need to stay engaged with their home programs. In the interview, she breaks this down into three components. To adhere to their HEP, each patient must be able to:

  1. Find it
  2. Trust it
  3. Ask about it

Find It

Like many patients, Susannah was frustrated by the paper printouts of

instructions from the therapists she and her children saw. The stick figure pictures of exercises were difficult to understand and the papers were too easy to lose.

When a discerning PT finally grabbed Susannah’s cell phone and started filming her performing exercises in the clinic, something clicked in her mind. The audiovisual format was easier to follow, and digitized exercises were harder to lose.

What if there was a way to make finding these exercise videos effortless by eliminating the need to scroll through her camera roll? Soon after, AC Health was born.

Trust It

In the process of building AC Health, Susannah saw firsthand how critical the patient-provider relationship is to the success of treatment. What patients really wanted, she learned, was to take a version of their therapist home in their pocket.

Patients trusted the advice and instructions of their therapist, but doubted their ability to recall and follow their provider’s instructions at home. They didn’t trust print-outs and written instructions to provide the detail they needed to perform their home programs correctly. If patients can’t trust their home programs, Susannah argues, they’ll lack the confidence and motivation to perform them.

By allowing therapists to customize every activity precisely for each patient, and to provide real-time audio and written instructions to that effect, AC Health bridges the trust gap. Patients can take the words and instructions of their therapist home, ensuring that they can confidently perform their home programs correctly.

Ask About It

Although AC Health solves the problems that cause patients to lose and distrust their HEPs, they may still have questions. Their body’s response to an assigned activity may be different at home than it was in clinic. They may wonder if they can make an exercise harder before their next in-person visit with their therapist.

Susannah knew that allowing patients to ask questions about their home programs between in-person visits was critical to treatment success. She and her team designed AC Health’s in-app messaging to fulfill this need: patients can send their therapists text, photo, or video-based questions, and therapists can respond in kind.

Quick inter-session clarifications can help patients build more confidence in the effectiveness and appropriateness of their home programs and plan of care, encouraging them to stay the course at home and in clinic.

AC Health was built by patients, for patients.  It keeps the needs and desires of rehab patients front and center, and it helps therapists bridge the gaps left by traditional patient engagement platforms.

By allowing patients to find, trust, and ask about their home program, AC Health lays the foundation necessary to keep patients engaged and motivated throughout their rehab journey. What are you waiting for? Sign up for your 30-day free trial today, and watch patient engagement soar!