Patient Retention in Physical Therapy: Why It Matters and How to Improve It

Patient retention in physical therapy is more than a clinical concern—it’s a strategic priority for healthcare organizations looking to improve outcomes, reduce costs, and sustain practice growth. Yet, it remains a widespread challenge. Studies show that a significant percentage of patients discontinue therapy before completing their treatment plans, often without notifying their provider.¹

This article outlines the scope of the patient retention problem, examines the underlying factors that contribute to attrition, and provides practical strategies healthcare organizations can implement to strengthen retention efforts. From care delivery models to patient education and digital engagement, each section highlights actionable opportunities to support continuity of care.

The Scope of the Challenge

High dropout rates in physical therapy have been documented across diverse care settings—and they remain one of the most pressing challenges for outpatient therapy providers. Industry data suggest that 7 out of 10 patients do not complete all authorized visits, often leaving clinics with thousands of dollars in lost revenue annually due to no-shows, poor engagement, and communication barriers.² These premature drop-offs can lead to worsened clinical outcomes, decreased functional recovery, and avoidable increases in downstream healthcare utilization. 

One study of patients with chronic knee and low back pain found similarly concerning trends: 55 percent of patients self-discharged from therapy before completing their care plan, with higher no-show rates significantly increasing the likelihood of premature dropout.³

For healthcare organizations participating in value-based care models, poor patient retention can also directly impact performance metrics tied to reimbursement, including episode completion rates, patient satisfaction, and readmission prevention. Beyond financial repercussions, attrition can negatively affect staff morale and skew quality improvement data, making it harder to track program effectiveness over time.

Common Drivers of Attrition

Understanding why patients discontinue therapy is the first step to reversing the trend. Several well-documented factors contribute to patient drop-off:¹

1. Lack of Perceived Progress

When patients don’t feel they’re improving, they’re more likely to disengage. This perception may not always align with clinical measurements, but it still influences behavior. Communicating small wins and reinforcing the purpose of each exercise or visit can support long-term engagement.

2. Inconvenient Scheduling or Location

Transportation challenges, scheduling conflicts, and limited appointment availability often discourage continued participation. Practices that lack flexible hours or telehealth options may unintentionally create barriers for patients balancing therapy with work, caregiving, or other responsibilities.

3. Financial Barriers

High out-of-pocket costs, uncertainty around insurance coverage, and billing confusion can all lead patients to cut therapy short. Transparent cost discussions and supportive billing practices are key to minimizing this friction.

4. Low Health Literacy

Patients who don’t understand their condition or the value of therapy may struggle to follow through with their care plans. Without consistent education and reinforcement, dropout becomes more likely—particularly among patients with limited medical knowledge or language barriers.

5. Limited Social Support

Limited social support can also contribute to attrition, as patients may be less likely to stay engaged without encouragement from family or peers. This is especially true when therapy requires long-term behavior change or consistent participation outside clinic visits

Strategies to Improve Patient Retention in Physical Therapy

Improving patient retention requires a combination of operational alignment, patient-centered communication, and supportive technology. Here are four strategies healthcare organizations can adopt:

1. Set Clear Expectations and Milestones

Retention begins with the first interaction. During the initial evaluation, therapists should outline the expected length of treatment, the frequency of visits, and what progress might look like at different stages. Providing a printed or digital care plan with milestones can help keep patients aligned and motivated throughout the process.

2. Use Outcome Tracking to Show Progress

Objective data can reinforce perceived improvement. By using outcome measurement tools—such as the Oswestry Disability Index or DASH—therapists can visually demonstrate progress to patients. Digital platforms that allow patients to track their outcomes over time provide ongoing validation that therapy is worth continuing.

3. Offer Digital Engagement Tools

Mobile apps, patient portals, and virtual check-ins can make physical therapy feel more accessible and relevant. These tools can be used to deliver home exercise programs, share educational content, send reminders, and collect feedback. When combined with in-person care, they help maintain a consistent line of communication that supports adherence.

Connected health technologies have been shown to improve adherence by supporting patients' self-efficacy, engagement, and sense of progress, especially in home exercise contexts where nonadherence can reach as high as 50 percent.⁴

4. Provide Consistent Patient Education

Educational interventions have been shown to improve adherence to physical therapy programs. Clinicians should consistently review goals, explain the purpose of each exercise, and tailor language to the patient’s comprehension level. Videos and interactive tools can reinforce learning outside of appointments.

5. Tailor Interventions to Individual Barriers

Retention improves when care plans are personalized to the unique challenges each patient faces—whether that's low self-efficacy, psychological symptoms, or scheduling limitations. Clinicians can improve adherence by identifying these factors early and adjusting their approach accordingly. This may include more flexible scheduling, additional support, or targeted education delivered through the most effective mix of in-person and digital channels.

The Organizational Payoff

Improving patient retention in physical therapy is a strategic investment. Higher retention supports stronger clinical outcomes, better patient satisfaction scores, and improved operational efficiency. It also contributes to higher staff productivity and more predictable revenue streams by reducing no-shows and missed appointments.

For organizations operating under bundled payments or alternative payment models, better retention supports stronger performance against quality metrics and outcome-based incentives. This positions therapy services as a value driver—not just a cost center—within larger integrated care strategies.

A Broader Reflection of Care

Patient retention in physical therapy reflects the broader experience patients have with your organization—how accessible, responsive, and aligned it feels with their goals. When patients drop off, it’s often a sign that expectations were unclear, barriers went unaddressed, or value wasn’t communicated effectively.

Organizations that prioritize communication, leverage technology, and build systems around patient needs are more likely to retain patients through the full course of therapy. And in doing so, they don’t just improve outcomes—they build trust and long-term engagement across the continuum of care.

References

1. Jack, K., McLean, S. M., Moffett, J. K., & Gardiner, E. (2010). Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Manual therapy, 15(3), 220–228. https://doi.org/10.1016/j.math.2009.12.004

2. Prompt Staff. (2019, May 16). The patient retention problem in physical therapy. Prompt EMR. https://blog.promptemr.com/blog/the-patient-retention-problem-in-physical-therapy/

3. Balinski, M., Blanchard, L., Mendoza, R., Zaranec, M., Duncombe, A., & Madhavan, S. (2024). Factors associated with physical therapy attendance rate and self-discharge in people with chronic pain. JOSPT Open, 2(4), 332–339. https://doi.org/10.2519/josptopen.2024.1136

4. Argent, R., Daly, A., & Caulfield, B. (2018). Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence?. JMIR mHealth and uHealth, 6(3), e47. https://doi.org/10.2196/mhealth.8518