Home Exercise Adherence in Physiotherapy: Why Plans Fall Apart Between Visits
By The Kitt Team
Your client leaves with a solid program. Two weeks later, the first ten minutes of their next appointment go on working out what they actually did. One exercise dropped, another done twice a day instead of three, sets shortened. The plan was fine. The problem is that nothing tells you how it is going.
That gap between visits is where home exercise adherence breaks down. The problem is not in the program. It is out in the world where the client is on their own and you have no signal.
What is home exercise adherence in physiotherapy?
Home exercise adherence is the extent to which a client does the exercises their physiotherapist prescribed, at the dose, frequency and technique set out in the plan. It is not only whether they do them, but whether they do them as prescribed over the full weeks the plan runs. One missed session is not a crisis. A pattern you cannot see until the third appointment is.
A systematic review of 30 studies notes that non-adherence to home-based physical therapy can reach 70 per cent. (Essery, Geraghty, Kirby and Yardley, Disability and Rehabilitation, 2017.)
Why home exercise plans fall apart between visits
The research on why clients struggle with their home exercise program points to four consistent causes.
The client forgets the detail
Research shows 40 to 80 per cent of medical information is forgotten immediately, and almost half of what is remembered is remembered incorrectly. (Kessels, Journal of the Royal Society of Medicine, 2003. This review covers general medical consultations, not physiotherapy specifically.) What the client remembers of the program is not the program. They go home with the best intentions, and by the next day the reps, technique and order have blurred.
Confidence and motivation fade
Essery’s review also found greater self-efficacy, self-motivation, social support, intentions and previous adherence predicted higher adherence to home-based physical therapy. Translated: a client who doubts they are doing the exercise right, or who has nobody checking in, is the client most likely to stop. Confidence at the clinic does not carry for two weeks in an empty lounge room.
Pain gets in the way
A client who feels pain during an exercise, with no way to ask whether that is expected, often just stops. Without feedback, stopping is the reasonable choice. The session is already over and the next appointment is not for another week.
Nobody sees the work
Between visits the client gets no feedback and you get no signal. By the time you learn they dropped a session a week, a good part of the block you planned has already gone. Some clients never come back to tell you. They just stop booking.
What physiotherapists can do about it
A 2024 overview of 19 systematic reviews covering 205 trials found adherence-enhancing interventions, such as booster sessions and goal setting, improved adherence to physiotherapy, with a small effect overall, and the certainty of the evidence was low. (Ley and Putz, Systematic Reviews, 2024.) The fixes that work are mostly about contact and follow-through between visits, not about writing a better handout.
Practically: keep the program short and specific. Check the client understands the exercises before they leave. Agree goals with them so the work connects to something they care about. Keep contact going between sessions so problems surface while there is still time to do something about them.
Why each cause is easier to fix when you can see it
| Cause | Plan handed over | Plan the client logs against |
|---|---|---|
| Forgets the detail | You find out at the next visit, from memory | Exercise demos travel with the plan; the client logs sets against what was prescribed |
| Confidence and motivation fade | You hear about it when they arrive, or not at all | Check-ins on how the client is feeling and logged completion against the plan |
| Pain gets in the way | You learn at the next appointment, if they come back | Pain scores per set come back to you while the block is still running |
| Nobody sees the work | Completion is invisible until the next visit | Completions land on your side in real time against the plan |
Seeing adherence while the block is still running
You build and publish a treatment plan in kitt. It goes to the client through kitt Companion with their goals, prescribed exercises and demo media, the day-by-day program and take-home instructions. The client logs per set on the companion app, including a pain score on a 0 to 10 slider. Companion sends automated check-ins on pain, completion and how they are feeling, with flags coming back to you.
On your side, completions land in real time against the plan. An adherence dashboard shows per-client completion and flags clients who look at risk. When you edit a published plan, the change pushes to the client’s copy automatically. kitt Companion is included with every subscription, not a paid add-on.
The result is a two-way record of what was prescribed and what was actually done. kitt drafts and you decide; every note, letter and plan comes back drafted for you to check and approve.
A 2025 analysis of 46 randomised trials in chronic low back pain found high exercise adherence, 80 to 100 per cent, was associated with lower pain and fewer functional limitations, while moderate adherence showed no significant association. (Jones, Hansford et al, Journal of Physiotherapy, 2025. This is an association, not proof of cause, and the certainty of the evidence was low.) Adherence is worth seeing.
An Australian randomised trial of 182 adults with knee osteoarthritis found an exercise app more than doubled complete adherence at 26 weeks, 36 per cent against 16 per cent, while function measured on the WOMAC did not differ between groups. (Hinman, Nelligan et al, Osteoarthritis and Cartilage, 2026.)
FAQ
What is a normal home exercise adherence rate in physiotherapy?
There is no single normal rate. Research finds non-adherence to home-based physical therapy can reach 70 per cent, and rates vary widely by condition, program and client. Expecting high adherence without a system for monitoring it is optimistic at best.
Why don’t clients do their home exercises?
The main causes are forgetting detail after the session, losing confidence or motivation without anyone checking in, stopping when pain appears because they have no way to know whether it is expected, and the simple fact that nobody is watching. Each of those is addressable once you know it is happening.
How can physiotherapists improve home exercise adherence?
Short, specific programs help. So does checking understanding before the client leaves and agreeing on goals they actually care about. Beyond that, keeping contact between sessions helps problems surface while there is still time to respond. Research on adherence support points the same way, though modestly: interventions such as booster sessions improved adherence with a small effect, and the evidence was low certainty.
Does my client pay extra for kitt Companion?
No. kitt Companion is included with every subscription. Your client uses it at no extra cost.
Key takeaways
- Non-adherence to home exercise programs can reach 70 per cent; the causes are known and each is addressable.
- Plans break down between visits, not in the room; that is where you need visibility.
- Contact between sessions, whether by check-in or logged data, gets problems back to you while they are still fixable.
- Seeing what the client actually does changes what you can do about it.
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