Patients aren’t doing their physical therapy homework

Most patients prescribed physical therapy exercises at home fail to complete them, a trend that may slow recovery and increase the risk of complications after injuries or surgery, according to a new survey commissioned by the The Ohio State University Wexner Medical Center.

The survey of 1,006 Americans found that 76% did not complete all of their assigned at-home physical therapy exercises. Only 24% reported completing all prescribed sessions, while 28% completed 75% to 99%, 27% completed 50% to 74%, 11% completed 25% to 49%, 8% completed 1% to 25%, and 2% said they did none.

“The one to three hours per week a patient spends in physical therapy pales in comparison to the 168 hours we have in a given week,” said Kyle Smith, PT, a physical therapist at Ohio State Medical Center. “And that one to three hours patients are physically in the clinic is not enough to make big changes in the grand scheme of things.”

Smith said therapists often tailor home programs and suggest simple routine changes — such as parking farther away or doing exercises during daily activities — to help patients stay engaged.

“As physical therapists, we need to educate patients that it is going to take some work on their end to reach the goals they have to ultimately build strength and mobility and decrease the body's pain sensitivity,” Smith said.

The survey also found older adults were more likely to complete their exercises. Thirty percent of adults age 65 and older reported finishing all assignments compared with 12% of respondents younger than 30.

Reasons patients skipped therapy homework

Respondents cited multiple reasons for not completing their at-home exercises:

• Forgot or had no reminders (40%)
• Not enough time or schedule conflicts (33%)
• Boring or repetitive exercises (22%)
• Didn’t see results quickly (19%)
• Pain or fear of making the condition worse (18%)
• No accountability between visits (15%)
• Didn’t have the right space or equipment at home (13%)
• Didn’t think exercises were necessary (12%)
• Didn’t fully understand the instructions (5%)
• Other reasons (4%)
• None of the above (2%)

Additional research on adherence to physical therapy programs

Research consistently shows that nonadherence to home exercise programs is common across rehabilitation settings. Nonadherence rates can reach as high as 70%, according to a systematic review published in the journal Disability and Rehabilitation, which examined factors affecting participation in home-based physical therapy programs.

Similarly, a 2023 scoping review in Musculoskeletal Science and Practice reported that adherence to therapeutic exercise programs for musculoskeletal conditions remains “generally poor,” noting that better adherence is associated with improved functional outcomes, according to the journal’s findings.

Other research highlights patient perceptions as a key factor. A 2023 study in Musculoskeletal Science and Practice found that patients were more likely to skip home exercises if they experienced pain during the program or if symptom improvement was slow, underscoring the role of expectations and comfort in adherence decisions, according to the study authors.

Additional observational research published in the journal Archives of Physical Medicine and Rehabilitation found that only about half of patients fully adhered to prescribed home exercise programs, with adherence linked to factors such as age and whether patients felt they received clear instructions, according to the study.

Taken together, the findings suggest that while home-based exercises are a cornerstone of rehabilitation, patient engagement — influenced by reminders, education, and perceived benefit — remains a major determinant of treatment success.