We designed YourSteps® to put the research on home exercise adherence into practice. In our first article, we looked at why families struggle with home programs, and in our second, at seven evidence-based ways to help. This article explains how that research shaped YourSteps.
What we know about digital tools
Digital home programs show real promise. The pediatric studies are still small, though, so we should be honest about what we know and what we don't.
Here's what we know so far:
• Digital support can boost adherence, at least in the short term. A 2022 systematic review pulled together 10 randomized trials with 1,117 participants across many rehab populations. In 7 of the 10 trials, adding a digital tool to a home exercise program led to better adherence than the program alone. The three trials that found no difference followed people longer, so long term effects are less certain (Lang et al., 2022). Most of these studies were not in children.
• Too few apps are built with the people who use them. A review of 69 randomized trials of health apps for chronic conditions found that only about one third reported involving patients or health care professionals in development (Cucciniello et al., 2021).
The lesson: technology doesn't replace the therapist. The best use of digital tools is to extend what the research says works. That means keeping the therapist connected to the family between visits, making progress visible, explaining the why, and making practice something kids want to do.
How we built YourSteps® with families
We didn't want to build another app nobody used. So YourSteps® was developed and tested with children and their parents, along with pediatric physical, occupational, and speech therapists. We shared how we built and tested it at the 2025 Pediatric Healthcare Innovation Summit in Atlanta (Tanner, 2025).
When we asked families about home programs before YourSteps, we heard the same things over and over. They were confused about what to do at home. They forgot details from the visit. They didn't know which handouts were for this week and which were from weeks ago. The apps weren’t made for kids and parents. Those are exactly the barriers the research describes, and our patient advisory board helped us design around them.
We built YourSteps around two approaches with strong research behind them: family-centered care and self-determination theory.
Family-centered care treats parents as partners and as the experts on their own child. It earned the strongest "do it" rating in a large review of pediatric occupational therapy for children with brain injury or CP (Novak and Honan, 2019), and the 2026 APTA guideline builds shared decision making into both goal setting and home programs (Sargent et al., 2026). That's why YourSteps keeps therapists and caregivers communicating and deciding together, and why so many activities include a family member or friend.
Self-determination theory is one of the best-known frameworks for understanding what keeps people motivated over time. It says motivation lasts when three basic needs are met: autonomy (having a say), competence (feeling capable), and relatedness (feeling connected) (Ryan and Deci, 2000). Each one shaped how we designed YourSteps®:
• Autonomy. Families choose how the program fits into their day, and kids get more say and ownership as they grow.
• Competence. Kids see their progress, earn points, and build confidence with every challenge they complete.
• Relatedness. Messaging keeps families connected to their therapist between visits, and many activities bring in a family member or friend.
How YourSteps® is designed to help families keep up at home
Every feature in YourSteps® maps back to a barrier or helper the research describes.
• Fun, interactive exercises and challenges. Boredom and a lack of enjoyment are among the most common reasons kids stop practicing, and exercise that feels fun helps (Holt et al., 2020). Activities like Side to Side Hot Lava, Hospital Animal Yoga, and Arm Strengthening at the Playground turn home practice into play.
• Smartphone sensor challenges. Games and friendly competition came up again and again as ways to keep kids engaged, especially older kids (Holt et al., 2020). YourSteps uses the phone's built in motion sensors to turn exercises into interactive challenges kids can play.
• Points, rewards, and customized gamification. Rewards and feedback are among the strategies clinicians use most (Holt et al., 2020). In YourSteps, kids earn points and rewards for every exercise and challenge they complete, and the game elements can be customized to what motivates each child.
• A personalized experience for parent and child. Programs work best when they fit a family's real routines (Gmmash et al., 2021), and kids need more ownership as they grow. YourSteps lets parents and children use the app in ways that fit their family, so a younger child can practice alongside a parent while an older child takes the lead.
• Goals at the center. Clinical guidelines call for home programs built around the child's own goals, set together with the family (Sargent et al., 2026). In YourSteps, each home program connects to the child's goals, and families can see what they've completed today and what they're working toward next.
• Progress front and center. In an early intervention survey, parents whose therapists shared information about their child's progress were 3.75 times more likely to follow the prescribed frequency (Medina-Mirapeix et al., 2017). In YourSteps, the child and family can track their progress in the app, and the therapist can see it remotely, so progress is easy to share and talk about between visits.
• Messaging with therapists. Checking in, sharing progress, and a strong relationship with the therapist are some of the best-supported ways to help families keep going (Medina-Mirapeix et al., 2017; Niyonsenga et al., 2024). Messaging lets families ask questions between visits and lets therapists check in, encourage, and adjust the program.
None of this replaces the therapist. It's there to support the therapist and family relationship that the research keeps pointing back to.
Making family support sustainable
Checking in and sharing progress are linked to better adherence, but that support takes time. If you lead a pediatric therapy team, learn about remote therapeutic monitoring (RTM) to support sustainability and outcomes for more children. Where payers cover it, RTM lets clinics bill for monitoring and supporting home programs between visits, which can help make that support sustainable.
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. Lang S, et al. Do digital interventions increase adherence to home exercise rehabilitation? A systematic review of randomised controlled trials. Arch Physiother. 2022;12(1):24. doi:10.1186/s40945-022-00148-z
2. Del Lucchese B, et al. The wide world of technological telerehabilitation for pediatric neurologic and neurodevelopmental disorders: a systematic review. Front Public Health. 2024;12:1295273. doi:10.3389/fpubh.2024.1295273
3. Cucciniello M, et al. Development features and study characteristics of mobile health apps in the management of chronic conditions: a systematic review of randomised trials. NPJ Digit Med. 2021;4(1):144. doi:10.1038/s41746-021-00517-1
4. 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
5. Tanner L. User-centered development and usability outcomes of YourSteps: a digital solution for pediatric remote therapeutic monitoring. Presented at: 2025 Pediatric Healthcare Innovation Summit; 2025; Atlanta, Georgia.
6. 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
7. 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
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. Gmmash AS, Effgen SK, Skubik-Peplaski C, Lane JD. Parental adherence to home activities in early intervention for young children with delayed motor development. Phys Ther. 2021;101(4). doi:10.1093/ptj/pzab023
10. 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
11. 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
12. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68-78. doi:10.1037/0003-066X.55.1.68