In short: Across studies, somewhere between a third and three quarters of families don't follow their child's home exercise program as prescribed. The biggest barriers are time, stress, parent confidence, and programs that don't fit real family life. Many of these are things therapists can help with.
Most of a child's therapy happens at home. A child might see their therapist for an hour a week, but the practice that builds new skills happens in the other 167 hours, usually with a parent leading it.
That's why home exercise programs are a core part of pediatric PT, OT, and speech therapy. It's also why so many therapists feel the same frustration: you build a thoughtful program, send it home, and the next visit you hear, "We didn't get to it much this week."
The good news is that researchers have studied this problem for years, although as stated below, much more research is needed. Here's what the evidence says
Why home practice is worth getting right
Home programs aren't busywork. They are one of the best supported tools we have.
A large systematic review of pediatric occupational therapy looked at 129 studies covering 52 interventions. Home programs, parent education, coaching, family centered care, and goal directed training all earned the review's strongest "do it" rating (Novak and Honan, 2019).
The same review points to evidence that parent delivered intervention, guided by a therapist, can be just as effective as therapist delivered intervention. The authors conclude that home programs and self management programs are an effective way to increase the intensity of therapy (Novak and Honan, 2019).
Intensity matters. The 2026 APTA Academy of Pediatric Physical Therapy guideline for developmental coordination disorder recommends high practice frequencies that combine direct sessions with home, school, and community practice. As a guide, it suggests building toward about 100 minutes of practice a week over roughly 9 weeks for a goal related task (Sargent et al., 2026). For most families, a weekly visit alone can't get there. Home practice is how kids reach the dose.
Speech research points the same way. In a 2024 study of 134 children ages 2 to 5 with language delay, children whose parents took an active role in a therapist led, family centered program made greater language gains than children who received therapist led sessions alone. They also made bigger gains in personal and social skills (Fan et al., 2024).
So the question isn't whether home practice matters. It's how to help families actually do it.
How often do families keep up with home programs?
Across studies, somewhere between a third and three quarters of families don't follow their child's home program as prescribed. That isn't a failure of parents. It's a sign the system around them needs more support.
A 2024 systematic review studying parents of children with cerebral palsy found non-adherence rates of 34% to 79.2%. Individual studies tell a similar story:
| Study | Who was studied | What they found |
|---|---|---|
| Niyonsenga et al., PLOS ONE, 2024 | Systematic review, parents of children with CP | Non-adherence ranged from 34% to 79.2% |
| Tanner and Schorr, Rehabil Oncol, 2024 | Systematic review, 13 studies of rehab for 318 children with cancer | Supervised session attendance ranged from 61% to 91%; unsupervised home adherence was rarely measured and ranged from under 1% to 72% |
| Williams et al., Int J Lang Commun Disord, 2024 | 199 parents of children under 5 in speech and language therapy, London | 26% did not follow home recommendations |
| Alwhaibi et al., IJERPH, 2022 | Mothers of children with CP, birth to 12 years, Saudi Arabia | 66.1% did not follow the home program |
| Holt et al., J Orthop Sports Phys Ther, 2020 | Scoping review, 41 studies of 2,020 children and teens ages 2 to 19 with musculoskeletal conditions | Only 54% of studies reported adherence; where reported, it ranged from 12% to 99% of prescribed exercises |
| Medina-Mirapeix et al., Eur J Phys Rehabil Med, 2017 | 219 parents of children with developmental disabilities, 18 early intervention centers, Spain | 61.4% met prescribed frequency; 57.2% met prescribed session length |
One pattern stands out. The systematic review on pediatric cancer rehabilitation by YourSteps founder and CEO Lynn Tanner, PT, PhD, and Erica Schorr, PhD, RN, found that studies usually measure whether kids show up to supervised sessions. Far fewer measure what happens at home, and when they do, the numbers vary widely. A scoping review of children and teens with musculoskeletal conditions found the same gap: only about half of its 41 studies reported adherence at all (Holt et al., 2020). The part of therapy that happens without a therapist in the room is the part we know least about.
Most of this research comes from cerebral palsy and early intervention, and nearly all of it is from outside the US. We need more data on US families and on OT and speech home programs. Still, the pattern is consistent: keeping up at home is hard for a lot of families.
What gets in the way
The biggest barriers aren't about motivation. They're about confidence, stress, and how well the program fits into real family life.
That same systematic review grouped what drives adherence into three buckets:
• The child. Younger children and children with stronger gross motor function tended to have better adherence.
• The caregiver. Parents who felt confident and knowledgeable, had strong social support, and had lower stress, anxiety, and depression kept up better. So did parents who saw fewer barriers to fitting exercises into the day.
• The therapist relationship. A parent's sense of a supportive, collaborative relationship with the therapist was one of the strongest positive factors.
Other studies echo this. In a study of 219 parents, those who saw few barriers to building exercises into their daily routine were 2.6 to 4.8 times more likely to adhere (Medina-Mirapeix F, et al. 2017). In speech therapy, how important a parent felt a recommendation was, and how confident they felt doing it, predicted whether it happened at home.
The same patterns show up beyond cerebral palsy. In the scoping review of 41 studies of kids with musculoskeletal conditions, the most common barriers were time, where the exercise had to happen, and negative experiences like pain or boredom. The most common helpers were social: family involvement, group exercise, peer support, and a strong relationship with the clinician. Exercise that felt fun helped too (Holt et al., 2020).
Children going through cancer treatment face extra hurdles. In the pediatric cancer review, the most common barriers were fatigue, illness, time, and motivation. What helped was support from peers or caregivers, and supervision (Tanner and Schorr, 2024). A small UK study of parents of children with CP heard similar themes. Parents described the time and effort home programs take, frustration when therapists changed often, and goals or routines that felt unrealistic. What helped was involving siblings and friends, making exercises fun and part of everyday activities, and setting realistic goals with manageable routines (Peplow and Carpenter, 2013).
The takeaway for us as clinicians: many of these factors are hard to change, like a child's diagnosis or a family's circumstances. But a parent's confidence, their understanding of why each activity matters, and their relationship with the therapist are things we can strengthen.
Read next: 7 Evidence Based Ways to Help Families Keep Up With Home Exercise Programs. It covers the therapist habits most linked to keeping families on track.
Every child deserves the chance to make the most of their therapy, and so much of that happens at home. If you'd like to see how YourSteps® helps therapists support families between visits, request a demo.
References
1. Novak I, Honan I. Effectiveness of paediatric occupational therapy for children with disabilities: a systematic review. Aust Occup Ther J. 2019;66(3):258-273. doi:10.1111/1440-1630.12573
2. Sargent B, Mueller M, Iverson E, Frazier M, Kaplan SL. Physical therapy management of children with developmental coordination disorder: a 2026 evidence-based clinical practice guideline from the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatr Phys Ther. 2026;38:296-333. doi:10.1097/PEP.0000000000001284
3. Fan Q, et al. The effectiveness of therapist-led family-centered language intervention for children with language delay. Transl Pediatr. 2024;13(10):1720-1736. doi:10.21037/tp-24-225
4. Niyonsenga J, et al. The psychosocial determinants of adherence to home-based rehabilitation strategies in parents of children with cerebral palsy: a systematic review. PLOS ONE. 2024;19(6):e0305432. doi:10.1371/journal.pone.0305432
5. Tanner L, Schorr E. Factors related to rehabilitation adherence in pediatric cancer: a systematic review. Rehabil Oncol. 2024;42(4):149-163. doi:10.1097/01.REO.0000000000000372
6. Williams P, Slonims V, Weinman J. Turning up and tuning in: factors associated with parental non-attendance and non-adherence in intervention for young children with speech, language communication needs. Int J Lang Commun Disord. 2024;59(2):762-778. doi:10.1111/1460-6984.12961
7. Alwhaibi RM, Omer AB, Khan R. Factors affecting mothers' adherence to home exercise programs designed for their children with cerebral palsy. Int J Environ Res Public Health. 2022;19(17):10792. doi:10.3390/ijerph191710792
8. Holt CJ, McKay CD, Truong LK, Le CY, Gross DP, Whittaker JL. Sticking to it: a scoping review of adherence to exercise therapy interventions in children and adolescents with musculoskeletal conditions. J Orthop Sports Phys Ther. 2020;50(9):503-515. doi:10.2519/jospt.2020.9715
9. Medina-Mirapeix F, et al. Predictors of parents' adherence to home exercise programs for children with developmental disabilities, regarding both exercise frequency and duration: a survey design. Eur J Phys Rehabil Med. 2017;53(4):545-555. doi:10.23736/S1973-9087.17.04464-1
10. Peplow UC, Carpenter C. Perceptions of parents of children with cerebral palsy about the relevance of, and adherence to, exercise programs: a qualitative study. Phys Occup Ther Pediatr. 2013;33(3):285-299. doi:10.3109/01942638.2013.773954