Patient activation in rehab: Using the time between therapy sessions

In rehabilitation facilities and clinics, longer gaps often open up between individual therapy sessions. For suitable patients, these periods can be used to continue agreed movement and training content independently. This does require clear structures, though: who is allowed to train on their own? Which exercises are suitable? Which safety rules apply? And how are these training activities fed back into the ongoing course of therapy?

Make the gaps in the daily schedule visible first

Before you create a new offering, it is worth taking stock. The first thing that matters is when suitable time windows actually occur and how they can be integrated into the existing ward and therapy routine.

Over a limited period, you could record the following points, for example:

• the length and timing of therapy-free windows for different patient groups
• weekdays or times of day with a lower therapy density
• the proportion of patients who are already active on their own between sessions
• available rooms and training areas
• overlaps with nursing, medical and diagnostic appointments
• staff responsibilities and availability during possible training times

This overview tells you at which times supplementary self-training can sensibly be offered from an organisational point of view at all.

Three possible formats for guided self-training

Depending on the patient group, the available space and the level of support needed, different formats come into question. They can be used individually or in combination.

Room-based self-exercise programmes offer a low-threshold entry point. The therapist puts together a small number of clearly defined exercises that the patient can perform independently after an initial briefing. The advantage lies in the low organisational hurdle. At the same time, there is no immediate feedback on movement quality while the exercises are being carried out.

Self-training in a defined training area allows patients to perform previously practised training content in a dedicated space. What form of supervision or availability is required depends on the patient, on the training content and on the rules of the individual facility.

Scheduled self-training slots are built into the daily routine like any other appointment. This gives training a fixed place in the therapy plan and makes it easier to coordinate with nursing, diagnostics and other treatments.

Which format is appropriate should not be decided purely on the basis of organisational availability, but above all according to the individual patient's need for support and safety.

Approval criteria: Who can train independently

Self-training is not a blanket option for every patient. Whether independent or partly independent training is suitable should be assessed individually by the treating team.

A written set of criteria can help to make decisions transparent. Relevant points might include:

• sufficient orientation and the ability to understand the agreed training and safety rules
• sufficient physical and cognitive prerequisites for the intended exercises
• defined load limits and known relevant medical restrictions
• safe handling of any aids that may be required
• no current restrictions that argue against the planned form of training
• correct understanding and safe performance of the exercises in a previously supervised session
• the ability to notice symptoms and to stop training if necessary

A staged approach can also make sense. At the start, the patient performs the exercises under direct guidance. In the next step, familiar exercises can be carried out with less support. Only once safe performance is demonstrably assured does more independently organised training become an option.

If the patient's state of health changes, the approval must be reviewed again. That may be necessary after an infection, a worsening of symptoms, a change of medication or another relevant event, for example.

Set out supervision, safety and responsibilities clearly

When introducing a self-training offering, it should be unambiguously clear who is responsible for organisation, approval and safety. The requirements can differ depending on the facility, the patient group and the form of training, and should be agreed with the therapeutic and medical leadership as well as with internal rules.

Before you start, the following questions in particular should be settled:

• Who is responsible during the respective training times and how can that person be reached?
• Which patients may use the offering and who grants approval?
• Which safety and stop criteria apply?
• What emergency procedures are in place in the training area?
• How are patients briefed on the exercises and on any equipment used?
• How are relevant incidents or discontinued sessions documented?
• When does the patient need to be reassessed therapeutically or medically?

A short, easy-to-understand standard operating procedure can help to apply these points consistently in day-to-day ward life. The decisive factor is that all staff involved know the rules and that they are genuinely built into daily routines.

Patient activation in rehab with digital training support

One challenge with more independent training is that a therapist is not permanently standing right beside the patient while the exercises are performed. Digital training systems can support certain recurring tasks such as exercise prescription, movement feedback and training documentation.

The Pixformance Station is a digital training and therapy unit with an integrated camera system and a virtual trainer. Exercises are demonstrated on the display while the system captures the movement and provides immediate visual and written feedback.

Training plans can be prescribed therapeutically and adapted to the patient's individual goals. Training parameters are documented automatically and can then be viewed via the online platform.

For rehabilitation facilities and clinics, this kind of digital support can be particularly interesting wherever suitable patients are meant to repeat familiar exercises in a structured way. The decision as to whether a patient may train independently, which exercises are suitable and when therapeutic intervention is needed remains with the treating team.

Pixformance has also been studied in various clinical and scientific contexts. When assessing such results, the patient group studied, the specific study design and the particular field of application are always decisive.

Criterion	Digital training station (Pixformance)	Exercise sheets	Home exercise apps	Supervised training
Guidance	via virtual trainer and stored training plan	via text and images	depends on the app, often via videos	directly from the therapist or trainer
Feedback during performance	automated visual and written feedback	no immediate feedback	depends on the particular application	individual feedback from the supervising professional
Training documentation	training data captured automatically	depends on manual documentation	depends on the application and data capture	therapeutic or organisational documentation required
Individual adaptation	training plan can be adapted therapeutically	only by adapting the programme	depends on the application and support	possible immediately
Manual and tactile support	not provided	not possible	not possible	possible immediately
Independent performance	supported by digital guidance and feedback	possible	a core element	depends on the support concept
Continuation outside the facility	possible via supplementary digital offerings	possible	often a core element	depends on a follow-on offering being available

The different formats serve different purposes. For patients who need close therapeutic assessment, manual support or short-term adjustments to their daily form, personal supervision remains central.

A self-training offering should therefore not be seen as a replacement for therapy. It can complement therapy sessions by allowing suitable patients to repeat familiar, approved training content in a structured way between treatments.

Linking up with progress documentation

Self-training is most useful for the further course of therapy when the relevant information from it is available to the team. What matters is not the largest possible volume of data, but a small number of comprehensible pieces of information that are actually used for therapeutic decisions.

The article Digital exercise therapy: Which metrics really hold up describes which measurements are fundamentally suitable for this.

The facility should define:

• which information from self-training is documented
• which data is transferred into the patient record
• who checks or transfers this information
• at which points it is taken into account in the therapeutic process
• which abnormalities trigger a new therapeutic assessment

Depending on the training concept, training frequency, completed exercises, load parameters and relevant symptoms or discontinued sessions can be taken into account, for example.

Not every automatically captured value has to be transferred into the patient record. What is important is that the selected information has a clear link to therapeutic decision-making.

You will find guidance on distinguishing between necessary treatment documentation and supplementary training data in the article Training documentation in physiotherapy: What really counts?.

Implementation: From pilot project to established routine

For the roll-out, it makes sense to start with a clearly defined area or a suitable patient group. That way, processes can be tested and adjusted before the offering is extended to other areas.

One possible approach:

1. Identify time windows: Check when suitable training times arise between existing therapy, nursing and diagnostic appointments.
2. Define the approval process: Determine which criteria a patient has to meet, who grants approval and when it is reviewed again.
3. Standardise the briefing: Every patient should first get to know the intended exercises under supervision. That includes stop criteria and the applicable safety rules.
4. Assign responsibilities: Set out who is available during training, who checks up on any irregularities and how relevant events are documented.
5. Evaluate the results: After a defined test phase, review uptake, discontinued sessions, organisational problems and feedback from patients and staff, among other things.

For the economic and organisational assessment of capacity, staffing and digital training offerings, the Therapy Efficiency Report 2026 can also be consulted.

Conclusion: Free time only becomes training time through structure

Therapy-free windows alone do not create additional activity. For patients to use these periods meaningfully for movement and training, you need clear approval criteria, suitable exercises, defined responsibilities and a link to the ongoing course of therapy.

Digital support can help to guide familiar training content, give feedback on movement quality and capture training data in a comprehensible way. The therapeutic decision about who can train independently and how training is adapted, however, remains with the treating team.

That way, self-training does not become a detached add-on, but a structured part of everyday rehab.