patients who dont improve

Over the past few placements I’ve noticed that there are several patients that I see in each placement that do not seem to improve in their condition. It can be quite a frustrating and confusing thing to encounter. I think there are a few reasons for this happening.
Firstly, there are patients whose conditions are of the deteriorating type (it’s not really these that I’m talking about though). For example, multiple sclerosis patients tend to steadily decline, as with patients who have motor neuron disease.
Secondly, patient compliance with HEP’s is a very large issue. One lady in particular springs to mind when I think of this. It was on my musculoskeletal outpatients practicum that I treated her, and it was a long-term (like 2 years) injury. The unfortunate thing is that she had a stack of notes the size of gray’s anatomy, and it would’ve taken a long time to go through them. As such, I decided to do a full assessment, and treat her based on my assessment rather than what the last student had done. My treatment basically consisted of shoulder muscle strengthening exercise and scapula retraining, most of which was to be done at home, daily. Unfortunately, the patient had a very set idea about what worked for her (pretty much just massage) and did not comply with the HEP that I gave her. This is probably a reason why she did not improve. And there are several other patients that I have seen with this same problem.
A third reason that patients sometimes do not improve, is that sometimes they just don’t want to get better. I encountered this mainly on my international prac. Over there (Malaysia) the family network is very strong, and younger members of the family really look after the older members. This is good in a way, but not so good in other ways. While its always good to have the support, it can lead to the patient becoming very dependent and even relying solely on the family. Some patients are perfectly happy to be waited on hand and foot by their families and not have to do a thing for themselves, and as a result do not comply with their rehab, and so don’t get better. These are just some the reasons why patients often don’t improve, im sure there are probably more. Does anyone else know of any?