Physical Therapy No-Shows: Wasted Opportunities

In order to optimize musculoskeletal care, a team of researchers acted on their curiosity about the frequency and reasons for no-shows at physical therapy (PT) appointments. Their retrospective cohort study, “Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions,” appears in the May 28, 2021, edition of PLOS ONE.

The authors used data from 444,995 physical therapy patients (aged 14-117 years old) and documented wasted clinician time, decreased revenues, inadequate therapy for current patients, and delays in care initiation for other patients.

Nrupen Bhavsar, Ph.D., an assistant professor in medicine at the Duke University School of Medicine in Durham, North Carolina, and co-author explained to OTW how novel this particular study is. “To our knowledge, this is the first study to quantify the national prevalence of no-shows in the United States for patients seeking care for physical therapy.”

“As we highlight in the manuscript, several studies have reported no-show rates for other clinical areas (e.g., cardiology, neurology, etc.). These no-show rates vary from 4-80%. A small number of studies have reported no-show rates between 57%-79% for physical therapy but these were conducted in other countries.”

“The variation in no-show rates is probably due to multiple factors, and for physical therapy the most relevant factor is that care is delivered with multiple treatment episodes, thus increasing the chances of having any no-shows. In our study we did not ‘correct’ for a no-show appointment that was rescheduled, so that issue should be taken into account when interpreting the results.”

“Using national level data, we found that 73% of patients in our study missed at least one physical therapy appointment. We developed an algorithm, that uses widely available patient information, to predict patients who may not show for their next appointment. Our colleagues at ATI Physical Therapy have been piloting the no-show predictors and have found that there is some utility in helping anticipate a missed appointment. They are investigating strategies to mitigate no-show rates, thus allowing for more efficient use of the clinical resources.”

Link to Opioid Use

“Non-pharmacological pain management, such as delivered during physical therapy care, has been recommended as a first-line option in recent clinical practice guidelines,” said Dr. Bhavsar to OTW.

“Missed physical therapy appointments highlight an inefficiency that could limit delivery of guideline-adherent care across health systems. Other studies outside this work have shown that there were decreases in short- and long-term opioid use when patients were exposed to physical therapy early in a care episode.”

“Similar findings have been found for other non-pharmacological providers including chiropractors and acupuncturists. So, this study provides proof of concept that patient no-shows represent a significant barrier to improving rates of non-pharmacological care as a first-line option. Importantly, this barrier has not been adequately addressed as best we can tell.”