The Importance of Patient Engagement for Private Practice

By Joseph Sullivan, PT, OCS, CSCS, and Olmer Cruz, PTA

A thriving clinical practice involves developing many aspects, yet one is often overlooked: patient engagement. During the constant bustle of daily responsibilities and ever-mounting paperwork, it can be easy to overlook the need to make patients active participants in their physical therapy. This area deserves a significant amount of attention from practice owners to help drive better results and ultimately a stronger business.

We have found that patients who are engaged in their outcomes have a strong emotional tie to the process. This leads to a tremendous level of involvement in treatment. For instance, a patient who is fully engaged will be able to realize why they are doing certain protocols and how the physical therapy will benefit them in the long run. This can not only leads to lower rates of patient cancellations, but also willingness for patients to push themselves. Rather than working against their physical therapists, they may voluntarily partner with them to achieve their goals faster and more thoroughly.

To get patients to a high level of patient engagement, physical therapists should focus on education from the beginning—explaining what will happen, why it is necessary, and how the patient can move the process along more efficiently. This can be supported by having the right technologically innovative modalities.


How Therapy Pools Increase Patient Involvement in a Physical Therapy Setting

Advanced therapy pools with underwater treadmill floors, variable water depth options, and resistance jets are not just wonderful accompaniments to any clinic’s service options, they are also an avenue to greater patient involvement. Several reasons for this exist: They offer excitement, allow for earlier interventions, and reduce risks associated with land-based physical therapy.1

How Excitement Plays a Role The “wow factor” of the pool is palpable and helps reduce patient pessimism from the first session.2 If a patient who is in pain or unable to complete exercises on land comes in and they cannot see how they can reach their desired outcome to achieve their goals, they can get caught in a more negative state. Putting patients in warm water is a tool physical therapists can use as a way to narrow that gap and help patients to see their goals as more achievable. The distance between where they are and where they want to be is narrowed.


Early Intervention and Aquatics Traditional land-based physical therapy often cannot be performed as early as aquatic therapy. 3 Patients may appreciate being well ahead of the calendar-appropriate timeline based on their injuries or expected post-operative recovery times. As they near their short- and long-term goals, they can become more inspired. For example, a patient who is able to run or jog on an underwater treadmill four weeks after an anterior cruciate ligament (ACL) tear or reconstruction may be more motivated to continue. The same may be true for neuromuscular patients who can walk with confidence without an assistive device on an underwater treadmill.

Fall Risk Reduction in Patients In terms of lowered injury risk, when a patient has a fall that results in injury, they are often afraid to even take a step.4 This can make it tough to get them to engage in traditional land-based therapy. However, in the water, the buoyancy may provide them confidence and support.


Patient Engagement in Action with Aquatic Therapy

At our practice, we have a wide range of patients who come to us after injuries and/or surgeries to their knees, hips, and shoulders. Aquatics can have a place with almost every patient. Our experience is that patients who have had joint replacements can take some steps, perform underwater squats or other exercises, and use their muscles a lot sooner than they could on land. Seeing those types of patients progress so quickly gets them—and us—excited. When a professional athlete comes in with an inflamed injury and they are trying to accelerate healing, having access to a variable speed underwater treadmill can be a plus. Elite athletes can often run underwater just days after a significant injury. 5Once they realize they are not losing ground as quickly as they thought, we have seen that they become more excited to continue their treatment.

Making Patient Engagement a Core Element of the Clinical Practice

All clinics owe it to their own successes to create an environment where patients feel comfortable. Patients should have a positive experience throughout their care; otherwise, it can be more challenging for them to obtain outstanding results. Physical therapy is a delicate balance between science and art. When patients are more involved in their care, that balance can be better realized for the benefit of everyone. And that helps patients return to their preinjury or presurgery lives as quickly as possible.

Joseph Sullivan, PT, OCS, CSCS, is the owner of Peak Performance Physical Therapy and is recognized by the American Physical Therapy Association as a Certified Specialist in Orthopedic Physical Therapy. Joe is also a Certified Strength and Conditioning Specialist, and is recognized as a Hospital for Special Surgery Credentialed Advanced Hip Clinician. He currently practices from Peak Performance’s Lynbrook office and can be reached at

Olmer Cruz, PTA, received his PTA degree from Nassau Community College and began working with Peak Performance while in school. He specializes in Aquatic Therapy Rehab and Sports Specific Rehab and can be reached at


1. 2. Accessed January 2016.

3. Accessed January 2016

4. page 64-65. Accessed January 2016

5. Accessed January 2016.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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