A physical therapy appointment gives a clinician an opportunity to assess movement, understand symptoms, provide education, prescribe exercises, and make changes to the plan of care.
Then the patient leaves.
For the next several days, that plan has to exist in everyday life.
Exercises compete with work schedules, family responsibilities, fatigue, pain, uncertainty, and everything else a patient has going on. A movement that made sense with a physical therapist standing nearby may suddenly feel less clear at home. Symptoms may change. Questions may come up. Motivation can fluctuate.
That makes the time between physical therapy visits an important part of the patient journey.
During National Physical Therapy Month, much of the recognition understandably focuses on what physical therapists do with patients in the clinic. But part of that work is also helping patients carry what they learn into the hours and days when their therapist is not standing beside them.
What happens between physical therapy visits?
Between physical therapy visits, patients may complete a home exercise program, apply movement or activity recommendations, monitor changes in symptoms and function, and adapt what they learned in the clinic to everyday life. This is also when barriers to adherence, questions, uncertainty, and changes in engagement may become apparent.
The time between visits can include much more than completing a checklist of exercises.
A patient may be:
- Working through a prescribed home exercise program
- Practicing a movement or activity discussed during the visit
- Paying attention to changes in pain, mobility, strength, or function
- Learning how their body responds to different activities
- Trying to remember instructions from the previous appointment
- Deciding whether something they are feeling is expected
- Building a new routine around their rehabilitation plan
Each of those experiences can become useful information at the next appointment.
The challenge is that they happen away from direct clinical observation.
Why does a home exercise program matter between physical therapy visits?
A home exercise program, commonly referred to as a HEP, gives patients a structured way to continue working toward goals outside scheduled appointments.
But prescribing exercises and having those exercises fit into someone's life are not the same thing.
Research on home-based physical rehabilitation has repeatedly found that adherence can be difficult. A systematic review of home-based physical therapies identified self-efficacy, self-motivation, social support, previous exercise behavior, and a patient's intention to participate among factors associated with adherence.
Other research has identified barriers such as pain, expectations about physical therapy, perceived effectiveness of the exercise, exercise burden, and how well the patient understands what they have been asked to do.
That is why HEP adherence should not be reduced to whether someone is "motivated."
A patient may fully intend to follow a program and still encounter obstacles after leaving the clinic.
Why do patients struggle with physical therapy exercises at home?
There is rarely one universal reason.
A program that works well for one person may become difficult for another because of available time, exercise complexity, symptoms, confidence, competing responsibilities, or how easily the exercises fit into an existing routine.
Sometimes the barrier is much simpler. Common examples include:
| What the patient may experience | What can help |
|---|---|
| Not remembering exactly how an exercise was performed | Clear instructions and demonstrations the patient can refer back to at home |
| Uncertainty about the number of repetitions | A written program that spells out how much to do and how often |
| Discomfort without knowing whether it is an expected response | Guidance on which responses may be expected and which changes are worth reporting |
| Not understanding why a particular exercise matters | Explaining the role each exercise plays in the larger plan of care |
| A program that becomes harder to maintain as rehabilitation continues | Watching for patterns over time and adjusting the program when clinically appropriate |
| Limited time and competing responsibilities | A realistic program that fits the patient's actual life |
Research examining adherence to home exercise has therefore increasingly treated it as a behavioral and contextual challenge rather than a simple question of compliance.
That distinction matters.
If the reason for disengagement is unknown, the response is likely to miss the actual problem.
Patient engagement is more than sending reminders
Reminders can be helpful, but patient engagement is broader than reminding someone that an exercise is due.
Engagement can include understanding the purpose of the plan, feeling confident performing it, having an opportunity to ask questions, seeing progress, receiving feedback, and knowing what to do when something changes.
A 2023 review examining behavior change techniques in musculoskeletal physiotherapy identified factors including self-efficacy and social support, while commonly mapped strategies included problem-solving and instruction on how to perform a behavior.
That gives physical therapists a more useful question to ask than simply:
"Did the patient do the exercises?"
The better questions may be:
Do they understand what they are doing?
Do they know why they are doing it?
Does the program feel manageable?
Has anything changed since the last appointment?
Is there a barrier preventing them from following the plan?
Those questions turn adherence from a score into a conversation.
Questions do not wait for the next appointment
Patients experience rehabilitation in real time.
Questions do too.
An exercise may feel different on Tuesday even though the next appointment is Friday. A patient may notice that stairs are becoming easier. Someone else may notice a movement has become more uncomfortable. Another patient may simply wonder whether they are performing an exercise correctly.
Traditionally, many of those observations have to be remembered until the next appointment.
By then, several days of experiences can become:
"It was mostly okay."
That does not mean every question requires immediate clinical intervention. It does mean that the period between appointments contains information that can help provide context for the next conversation.
Creating appropriate ways for patients to communicate questions, report meaningful changes, or document their experience can help preserve some of that context.
Better between-visit information can make the next visit more useful
The purpose of paying attention to what happens between physical therapy appointments is not to create constant monitoring.
More data is not automatically better care.
What matters is having useful information that can inform a clinical conversation.
Consider the difference between starting a follow-up appointment with each of these:
The second question has context.
The patient's answer might reveal increasing symptoms, confusion about an exercise, a scheduling problem, or nothing clinically significant at all.
Either way, the conversation starts closer to the actual experience.
How can physical therapists support patients between visits?
Supporting the period between appointments does not necessarily require adding more work or more technology.
It starts with the plan itself.
Make the home program understandable
Patients should know what they are being asked to do, how they should do it, and what role the activity plays in the larger plan of care. Clear instructions reduce the amount patients have to reconstruct from memory once they get home.
Make the program realistic
More is not always better. Recent research examining home-based exercise for people with nonspecific low back pain found that higher prescribed exercise frequency and dosage were associated with lower adherence. A program still has to work in the patient's actual life.
Explain what patients should pay attention to
Patients can benefit from knowing which changes are worth noting and which responses may be expected as part of the plan established by their clinician. The goal is not to encourage patients to interpret clinical information independently. It is to help them know what information may be useful to bring back to their physical therapist.
Create an appropriate feedback loop
Some patients may need little support between appointments. Others may benefit from additional education, digital exercise instructions, messaging, scheduled follow-up, or another structured way to communicate what is happening. The level of support should reflect the individual patient and plan of care.
Look for patterns instead of isolated moments
One missed exercise session does not necessarily mean a patient is disengaging. Patterns are more informative. A program that becomes progressively harder to maintain, recurring uncertainty around one movement, increasing symptoms, or a sustained change in participation may provide more useful information than any single data point.
Can technology improve engagement between physical therapy visits?
Technology can support between-visit care, but technology itself is not the intervention.
Digital home exercise programs can make instructions easier to access. Video demonstrations can give patients another reference after they leave the clinic. Messaging can provide a communication channel. Patient-reported information can help preserve details that might otherwise be forgotten.
Research has also explored whether digital delivery changes HEP adherence.
In a randomized trial involving people with musculoskeletal conditions, participants who received their home exercise program through an app combined with remote support demonstrated better adherence than those who received paper-based programs.
More recent research has also examined how physical therapists use digital HEP platforms and identified efficiency, individualization, platform knowledge, and perceived patient engagement as factors affecting adoption.
The lesson is not that every patient needs an app.
It is that technology is most useful when it solves a real problem for either the patient or the clinician.
A complicated digital workflow can create another barrier just as easily as a thoughtful one can remove one.
Where does Remote Therapeutic Monitoring fit?
Remote Therapeutic Monitoring, or RTM, is one way eligible care teams can establish a more structured connection with patients between visits.
Depending on the clinical program and technology being used, RTM may give clinicians insight into information such as adherence, symptoms, activity, function, or a patient's response to therapy.
But RTM should not be confused with simply collecting data.
The clinical value comes from what the care team does with relevant information.
That may mean asking a question, providing additional education, adjusting a plan when clinically appropriate, or determining that no change is necessary.
For a deeper look specifically at RTM and adherence, see our guide to Remote Therapeutic Monitoring and Patient Adherence: How Between-Visit Care Supports Better Outcomes.
Physical therapy continues after the patient walks out the door
National Physical Therapy Month is an opportunity to recognize the skill, education, problem-solving, and relationships physical therapists bring to patient care.
Some of that work is easy to see.
It happens during an evaluation, while teaching a movement, measuring progress, answering a patient's questions, or adapting a treatment plan.
Some of its impact becomes visible later.
It shows up when a patient remembers how to approach an activity differently at home.
When an exercise becomes part of a routine.
When a patient recognizes progress that once felt impossible.
When a question from earlier in the week leads to a more productive conversation at the next appointment.
The appointment matters. So does what the patient carries with them when it ends.
Frequently Asked Questions
What should patients do between physical therapy visits?
Patients should follow the individualized plan provided by their physical therapist. Depending on the plan of care, that may include completing a home exercise program, practicing specific movements, following activity recommendations, and paying attention to meaningful changes in symptoms or function.
What is a physical therapy home exercise program?
A physical therapy home exercise program, or HEP, is a set of exercises or activities prescribed by a physical therapist for a patient to complete outside scheduled appointments. The program is typically designed around the patient's condition, goals, current abilities, and overall plan of care.
Why is home exercise adherence important in physical therapy?
Home exercise allows patients to continue working on parts of their rehabilitation plan outside scheduled visits. Research suggests adherence is influenced by multiple factors, including confidence, motivation, social support, exercise burden, understanding, symptoms, and how the program is delivered.
How can physical therapists improve patient engagement between visits?
Physical therapists can support engagement by providing clear instructions, explaining why activities matter, prescribing realistic programs, creating appropriate opportunities for feedback, personalizing the plan, and addressing barriers when they emerge.
Does Remote Therapeutic Monitoring replace in-person physical therapy?
No. Remote Therapeutic Monitoring is designed to support care between visits for appropriate patients. It can provide clinicians with additional information about a patient's experience outside the clinic, but clinical interpretation and treatment decisions remain with the care team.
Research cited in this article
| Study | Type and source | Relevant finding |
|---|---|---|
| Predictors of adherence to home-based physical therapies | Systematic review, Disability and Rehabilitation (2017) | Self-efficacy, self-motivation, social support, previous exercise behavior, and intention were among the factors associated with adherence. |
| Behaviour change techniques for home exercise adherence | Scoping review and mapping exercise, Musculoskeletal Science and Practice (2023) | Self-efficacy and social support were identified as factors. Problem-solving and instruction on how to perform a behavior were among the commonly mapped techniques. |
| Barriers to home exercise in musculoskeletal neck pain | Clinical study, Musculoskeletal Science and Practice (2023) | Pain during exercise, delayed symptom improvement, and unmet expectations were among the barriers identified. |
| Home exercise frequency and dosage in nonspecific low back pain | Prospective cohort analysis, Musculoskeletal Science and Practice (2025) | Higher prescribed frequency and dosage were associated with lower adherence. The authors noted the effect sizes were small. |
| App with remote support vs. paper handouts | Randomized trial, Journal of Physiotherapy (2017) | Participants who received an app with remote support showed better home exercise adherence than those who received paper handouts. |
| Physical therapist engagement with a HEP platform | Mixed methods study, Archives of Physical Medicine and Rehabilitation (2025) | Platform knowledge, efficiency, individualization, and perceived patient engagement were among the factors affecting how therapists used the platform. |
A note on this article
This article provides general educational information about physical therapy, patient engagement, home exercise programs, and between-visit care. It is not medical advice and is not intended to replace an individualized plan of care or the clinical judgment of a licensed healthcare professional.
