How much physiotherapy is too much?

We are often asked to comment on the ongoing need for physiotherapy treatment. Alarm bells ring when a worker has had physio for months or even years without any objective evidence of functional improvement. Often there have been no measures made apart from patient reports of deterioration without treatment.

A paper by Sally Green and Tony Flanagan discusses this:
Link

They established a “consensus definition” of maintenance physiotherapy after consulting with a range of senior physiotherapists throughout Australasia. Although the paper is really intended to promote discussion it does outline some suggested criteria that should be met before maintenance physiotherapy can be justified.
Some of the criteria include:
All other avenues of management (including non-physiotherapy interventions) as well as the best efforts of the patient tried and exhausted
The patient is not at best outcome and demonstrably worsens without treatment
The patient exhibits decreased function and quality of life
There is a consistent clinical diagnosis throughout the post-accident course
Recognised outcome measures are being used in the monitoring and management of the patient.
There is a self-management component to the plan
My experience in reviewing these sorts of cases shows that often objective measures are lacking and that trials without treatment may not have been tried. We welcome more discussion on this topic.
If you are interested in more information we could raise this at our next QOH seminar. You can contact me for further advice: Dr David Allen 9897 7699 david allen@qoh.com.au.