What To Do When Your Patient Is Making Slow Progress

There are a few common contributors to slow patient progress, and you can prevent them. With careful investigation, you can get the patient back on track for a full recovery.

What should you say and do when patient progress slows or stops?

Throughout your therapy career, you’ve likely helped dozens of people achieve life-changing outcomes. Whether treating a sports injury or preparing for surgery, patients and therapists alike strive to hit certain treatment milestones.

But what happens when the patient doesn’t meet those milestones? Or if they aren’t progressing as fast as they expected? Patients, and sometimes the therapist, can get discouraged and frustrated. Some patients may stop scheduling treatment sessions altogether.

While these are disappointing outcomes, they don’t always mean the end of therapy. There are a few common contributors to slow patient progress, and you can prevent them. With careful investigation, you can get the patient back on track for a full recovery.

Common reasons patients make slow progress

All medical providers have biases, whether they are aware of them or not. Before you assume that your patient is non-compliant or has received a misdiagnosis, ask yourself if your bias is getting in the way. Do you tend to use your favorite treatment modalities, rather than exploring different approaches?

The following are some common reasons for slow patient progress in rehabilitation:

• The clinician does not address lifestyle issues that could contribute to the physical condition such as prolonged sitting, smoking, or sleep quality.
• Too much stretching aggravates symptoms, rather than helping
• The clinician fails to consider coordination or vestibular problems
• Over-dependence on passive modalities
• Too much or too little manual therapy depending on the presenting condition
• Not consulting or referring to other medical providers when the situation calls for it

While these problems focus on the therapist, the patients themselves or their doctor can also contribute to the problem. Patients not being forthcoming about their symptoms or lifestyle can present a huge problem. After all, you cannot treat a problem you don’t know exists.

Other patients may do little to no exercises at home, which can lead to losing newly developed skills between sessions. Finally, referring providers may have missed several things during their examination of the patient and could have made the wrong diagnosis altogether.

For example, if a patient comes in with diagnosed muscular atrophy and you notice it affects a certain group of muscles, you might consider the possibility of nerve damage. If you suspect a patient has nerve damage, or need to verify innervation and anatomy, use the Muscle Joint Action Guide (MJAG). It’s a quick and easy reference tool for joint movements, muscle groups, and innervation.

If patient progress slows or stops

Patients who make slow progress may quickly become discouraged and stop coming to your clinic. Taking the steps outlined below may be all you need to keep the patient in treatment and preserve clinic revenue.

Start at the beginning

Complete another assessment on the patient. If you suspect the patient’s referring doctor misdiagnosed the condition or you missed something during your initial examination, it’s always a good idea to repeat it.

As much as you want to help your patients, you’re also pressed for time. That means you could have missed an issue contributing to the impairment when initially creating the patient’s objective measures.

It is possible that something contributing to your patient’s additional symptoms is interdependent but not adjacent to the problematic tissues. Don’t hesitate to consult another clinician if you have any concerns about completing a second assessment.

Check the HEP progress

Speak to patients about their home exercise program. You see your patients for a few hours a week at the most. This means that most of their progress must take place outside of the clinic.

You’ll begin to see significant patient progress during the first two to four weeks of starting therapy. If this does not occur, now is the time to ask patients about their compliance with home exercises.

Unfortunately, patients commonly complain they do not have enough time to complete HEPs between sessions. If you feel certain that this is the only issue, you can suggest rescheduling for a later time. This suggestion is often all it takes to send a clear message to patients that their progress depends largely on their commitment to therapy.

Consider other options

While your rehabilitation clinic is in business to help people, not everyone responds well to all types of therapy. Consider the possibility that Physicians and Physical Therapists often see patient problems quite differently. One month is certainly long enough to determine if a patient should remain in your care or visit elsewhere to receive the most appropriate treatment.

If the patient isn’t a good fit for your services at this time, be sure to schedule a one-on-one meeting to explain this. It’s important that patients know you are acting in their best interest if you refer out to another provider. This communication allows them to pursue the care they need without harboring potentially negative opinions and sharing those with others.

While you naturally want to help all patients, this isn’t always a realistic possibility. Part of being a good healthcare provider is always doing what is best for the patient regardless of your personal motivations. Remember that referring some patients to other providers gives you a better opportunity to focus on patients that you are better equipped to help.

 

Sara M., DPT