Horizon Physiotherapy cut post-op rehab no-shows by 61% with private goal tracking

Dr. Sarah Blackwell runs a four-clinic physiotherapy group in Leeds. Her post-op rehab patients were given home exercise programmes on paper and had forgotten them by day three. Bitir's goals and assignments turned that around over one quarter.

The paper sheet that disappeared

Every physio in the country knows the rehab adherence problem. You assess the patient, agree a programme, print the exercise sheet, hand it over, watch them walk out of the door, and then — statistically — watch them do about a third of the exercises you agreed.

Horizon's four-clinic group had tried several fixes over the years. A branded printed booklet. A video library on YouTube. A referral to an exercise-specific app that was decent but cost per-patient and required its own account setup. None of them moved the adherence number very far.

The problem, Sarah eventually concluded, was not the content. The content was fine. The problem was that patients were being asked to run their own adherence programme, in their own heads, with no structure and no visible check-in. A paper sheet cannot ask "did you do it today" and a YouTube video cannot send a Monday morning nudge.

What she was looking for

Sarah had three constraints that ruled out most of the dedicated physio apps she had looked at:

1. It had to work for patients who did not have or want a new account. Elderly patients in particular were not going to create yet another login.
2. It had to be private between the patient and the clinic. No open community feed, no advertising, no cross-clinic data sharing.
3. It had to be cheap enough that she could roll it out across all four clinics without a capital request.

She had seen Bitir being used by a running-group friend of hers and had initially dismissed it as "not a clinical tool". Then she looked at the feature list again and realised it had exactly the three things she needed: phone-number invites (no new account), private groups, and a free tier that worked for a small practice.

How she structured it

Sarah did something most of our customers do not do. Instead of one big Bitir group, she created a separate Bitir group per patient cohort — where a "cohort" is a month of post-op starts. So "Knees — April 2025" is one group, "Knees — May 2025" is another, and so on.

Why cohorts? Because post-op rehab has a week-by-week protocol — week one looks different from week eight — and putting ten people who are all at week three of their recovery in the same group means she can give the whole group the same weekly assignment and they are all at the relevant stage.

Inside each cohort, she set up:

• One group-wide goal: "complete 12 weeks of the agreed rehab programme".
• Per-member individual goals for range of motion, pain, and function, reviewed at weeks 4 and 8.
• A daily exercise check-in poll (single question: "did you do today's exercises?").
• A weekly free-text assignment asking patients to note any pain, any set they could not complete, and any questions for the next session.
• Celebrations posted for each patient who hit a milestone: first pain-free day, first full range of motion, first jog, first return to sport.

The daily poll changed the adherence curve

The daily check-in poll was, in her words, "the stupidest, smallest, most effective thing". One question, one tap, every evening. Patients who answered yes felt a small win. Patients who answered no were reminded — gently — that today's exercises existed.

The clinical team did not chase the "no" answers. Sarah was explicit about this with her physios. A patient who was asked to feel guilty about a missed day stopped answering the poll at all. A patient who was quietly acknowledged and invited to try again the next day kept answering.

The numbers after one quarter

The follow-up no-show number was the one that caught the attention of Horizon's practice administrator. No-shows are expensive — they cost roughly £45 in unused clinician time each, and across four clinics the weekly total used to run into the low hundreds of pounds. Reducing no-shows by 61% recovered that cost almost immediately, and paid for the internal time Sarah had put into the Bitir rollout several times over.

The unexpected benefit for physios

Sarah had expected the benefit to land with patients. It also landed, differently, with her physiotherapists. Before each follow-up session, the treating physio could open the patient's Bitir group and see — at a glance — what the patient had reported in the past week. A patient who had logged pain on two days, missed three exercise days, and posted a short note about a difficult Tuesday walked into the room with context already attached.

Her physios say the pre-session preparation used to take five minutes of paper-shuffling per patient. It is now about thirty seconds.

What she would tell another clinic director

• Use cohorts, not one big group. Cohort-based post-op rehab is a natural match for Bitir's structure.
• Use the daily poll as a nudge, not a compliance tool. The moment patients feel judged by their answers, the answers stop.
• Give your physios 10 minutes of training on how to read a patient's Bitir group before a follow-up. The prep payoff is immediate.
• Celebrate the first pain-free day. It matters more to patients than any other clinical milestone.