Patient Engagement: Before, During, and After


Patient engagement occurs before, during and after care. Patients need to be engaged in their care prior to their first physical therapy appointment. Patient engagement starts when the patient goes to the doctor looking for solutions to a problem that they are having. The doctor may then recommend physical therapy and the patient may not have any prior experience with attending physical therapy. The doctor may give the patient an overview of what physical therapy is but it is up to the physical therapist to educate the patient and “set the stage” for what is going to be expected in therapy and what physical therapy will entail.  


At the initial evaluation the therapist needs to explain what the patient’s role in therapy will be. Patients must feel like they are part of the plan and also feel like they are able to take an active role in their own care. A home exercise program is an important aspect of a patient’s care. There are two parts to a home program. The first part is the choice of exercises and instructions that the therapist provides and the second part is the follow through of the patient. The patient could just be handed a piece of paper with some exercises and verbally instructed on how to do them at the initial evaluation OR could be provided with substantial patient education and instruction on a detailed home exercise program at the initial visit. The latter is likely going to improve patient outcomes. The patient will be more likely to do the home program if the patient is provided the proper education from the start. The exercises must be reviewed at follow up visits but once the patient appears independent with the initial exercises those exercises are often discontinued to focus on other interventions. Even with compliant patients, it is difficult to know if the patient is doing their home program.  
With today’s technology and patients’ constant access to social media and the internet there are new and improved ways to issue a home program. The use of technology can improve the patient experience and can improve patient engagement. Patients want to feel connected to the experience and connected to their physical therapist. One way to do this can be through a patient portal which is where information about appointments and test results can be found. Patients can also ask their healthcare providers questions through the portal and get responses usually within a few days. The other way this may be achieved is through an interactive home exercise program platform. The patient would be more engaged if the patient was able to have an overall interactive experience. If the patient had a way to connect with their therapist outside of their appointments then they may take a more active role in their care and have better outcomes. If the patient had access to videos of their exercises they may feel more confident that they are performing their exercises correctly. The patient may be more engaged if they can send their therapist questions and keep track of their progress online. Patients are generally more compliant if they have a way to track their own compliance. If the patient was able to track their progress through a website or on an app that directly sends feedback to their therapist then they may feel more engaged in their care.  


A patient may respond better if they feel like they get feedback from their therapist even when they are not at a therapy visit. This can also be true for when therapy is complete. The patient may experience may be enhanced if they have a way to connect to their therapist even after they have been discharged from care. A patient may want to ask a follow up question or continue to keep track of their exercises the way they did during therapy. If a patient gets used to using a certain website or app to track their compliance then they may want to continue to use that website or app to continue to be compliant with their program. A patient’s compliance with their home program is important even after physical therapy ends in order to continue to improve function and avoid regression. Patient compliance during and after therapy are both important. Patients often return to therapy for the same diagnosis due to non-compliance with their home program. For example, patients with chronic low back pain often return to therapy with the same complaints they had when they initially started therapy the first time. The patient is usually asked at the initial evaluation during the second round of therapy if they are compliant with their home program and usually the answer is no or not 100% of the time. The cost of health care is on the rise and if patients continue to return to physical therapy for the same condition due to non-compliance then health care costs will not improve. If a patient is truly engaged in their care then they will be compliant with their home program and if they are compliant with their home program there is a less likely chance that they will return to their doctor with the same complaints. The doctor will often refer the patient back to physical therapy because the patient will say that it worked the first time and they had symptom relief. What the patient doesn’t realize is that if they were compliant with their home program on a consistent basis then they may not have to go to multiple doctor and therapy visits for the same condition that they had previously. If the patient had a way to keep track of their compliance and a way to continue to get some encouragement or feedback from their therapist when needed they may be more likely to continue with their home program. The patient would have better outcomes and it would help to decrease the amount of patients who return to therapy for the same condition.


A patient may respond better if they feel like they get feedback from their therapist even when they are not at a therapy visit. This can also be true for when therapy is complete. The patient may experience may be enhanced if they have a way to connect to their therapist even after they have been discharged from care. A patient may want to ask a follow up question or continue to keep track of their exercises the way they did during therapy. If a patient gets used to using a certain website or app to track their compliance then they may want to continue to use that website or app to continue to be compliant with their program. A patient’s compliance with their home program is important even after physical therapy ends in order to continue to improve function and avoid regression. Patient compliance during and after therapy are both important. Patients often return to therapy for the same diagnosis due to non-compliance with their home program. For example, patients with chronic low back pain often return to therapy with the same complaints they had when they initially started therapy the first time. The patient is usually asked at the initial evaluation during the second round of therapy if they are compliant with their home program and usually the answer is no or not 100% of the time. The cost of health care is on the rise and if patients continue to return to physical therapy for the same condition due to non-compliance then health care costs will not improve. If a patient is truly engaged in their care then they will be compliant with their home program and if they are compliant with their home program there is a less likely chance that they will return to their doctor with the same complaints. The doctor will often refer the patient back to physical therapy because the patient will say that it worked the first time and they had symptom relief. What the patient doesn’t realize is that if they were compliant with their home program on a consistent basis then they may not have to go to multiple doctor and therapy visits for the same condition that they had previously. If the patient had a way to keep track of their compliance and a way to continue to get some encouragement or feedback from their therapist when needed they may be more likely to continue with their home program. The patient would have better outcomes and it would help to decrease the amount of patients who return to therapy for the same condition.


Patient engagement begins before a patient even enters your clinic. The patient goes to the doctor sometimes expecting a quick fix and then end up with a referral to physical therapy. A patient may have anxiety or be nervous about the situation if they have never been to physical therapy before. At the initial evaluation it is important for the therapist to lay out the expectations for therapy and adequately educate the patient on the importance of performing their home program. The patient needs to be completely engaged in their care in order to be successful. One way to do this is to have an interactive home program app or patient portal where information can be shared between patient and therapist. The patient may also benefit from continued education after their care has been completed in order for the patient to continue to be engaged and improve patient outcomes. Patient engagement is the key to every patient success story. Patients need to have a positive experience in order for them to be more engaged in their care.