A missed appointment costs a clinic a slot it cannot refill and costs the patient a week of momentum. Most clinics treat no-shows as a front-desk problem solved with a reminder text. The evidence supports reminders, but it also shows that the patients most likely to miss are identifiable in advance, and that scheduling choices matter as much as the message.
How common missed visits are
The largest dataset comes from a 2021 study in PLoS One that analysed 444,995 patients and more than six million encounters across 697 US outpatient physical therapy clinics. Seventy-three percent of patients missed at least one appointment during their episode of care. Only 5 percent missed the very first visit; the problem builds over the course of treatment. Rates were highest among patients aged 18 to 44, those on Medicaid, and those being treated for low back, neck, or general conditions.
A smaller Canadian study of 6,162 booked visits at a single outpatient clinic in 2017 found combined no-shows and cancellations of 20.6 percent. The reasons patients gave were ordinary: forgetting, family emergencies, no transport, and a clash with another appointment. Forgetting topped the list, which is the case for reminders.
What predicts a no-show
- Prior cancellations. In the PLoS One cohort, the number of previous cancellations was the strongest predictor of missing the next visit.
- Long lead time. The further ahead a visit is booked, the more likely it is missed.
- Long gaps between visits. A patient seen fortnightly misses more than one seen weekly.
- Younger age, Medicaid coverage, smoking, and higher body mass index were each associated with more missed visits.
- Post-surgical patients and those on workers' compensation attended more reliably, likely because the stakes and the structure are clearer.
What reminders do
The 2013 Cochrane review pooled eight randomised trials with 6,615 participants across healthcare settings. Text message reminders raised attendance compared with no reminder: 78.6 percent attended with a text versus 67.8 percent without, a relative increase of 14 percent, on moderate-quality evidence. Texts performed about the same as phone-call reminders, and two of the trials found texts cost 55 to 65 percent less per attendance than calls. The review found no evidence on health outcomes or on how patients felt about receiving them, and the authors asked for more trials.
Read together, the two bodies of evidence say something specific. Reminders fix forgetting, which is the most common stated reason, and they do so cheaply. They do not fix transport, long lead times, or a patient who has already cancelled twice.
What else helps
- Book the next visit before the patient leaves, and keep lead times short. Both reduce the two scheduling predictors directly.
- Watch the cancellation count. A second cancellation is a signal to ask what is getting in the way, not to send another text.
- Offer video for the visits that do not need hands. Travel and clashing commitments disappear when the appointment is at the kitchen table.
- Keep the patient engaged between visits. Someone who did their exercises this week and saw their therapist respond to a message has a reason to turn up.
- Make cancellation easy. A patient who can reschedule in two taps frees the slot; one who has to phone during office hours often just does not come.
How KineTrue fits
In KineTrue, appointments can be set up as recurring weekly sessions, online or in person, and patients receive notifications when a session is scheduled, changed, or coming up. Each appointment carries a history of changes, so a pattern of reschedules is visible before it becomes a no-show. For the adherence side of the same problem, see why home exercise adherence is hard, and what actually helps.
The predictors above come from US insurance-based data and may not transfer to other health systems. Use them as prompts for a conversation with the patient, not as a reason to deprioritise anyone.