6 Keys Insights on When to Stop Physical Therapy?

What does the law say about the right to stop physiotherapy sessions?

Up to 1000 people per month, in United-States alone, wonder if physical therapy sessions can be stopped and how.

The decision to stop physiotherapy sessions can be made by patients or physical therapists.

Let’s take a closer look, first by relying on what the law, regulations, and the code of ethics for physical therapists and physiotherapists say.

Termination of sessions decided by patients

In most cases today, people go to a physical therapist because they have a medical prescription for physical therapy sessions.

Sometimes, the prescription includes:

• A number of sessions to complete: 5, 12, 15, 20, 25, etc.
• A validity period: 1 month, 2 months, 3 months.

However, you are completely free to have FEWER physical therapy sessions or a shorter rehabilitation period! Between the time your doctor wrote the prescription and the present moment, time has passed, things have happened.

Your needs may be different. Or your doctor may have indicated an arbitrary number or duration. Or perhaps the physical therapy care does not meet your expectations.

In any case, legally, you are under no obligation to complete all the physical therapy sessions indicated, even if you have started them. And if there is no specified number or duration of sessions on the prescription, it’s the same: you are legally free to stop at any time!

And you can also use the same prescription with different physical therapists and switch physiotherapists along the way. We’ll explore this further in the section “can you change physical therapists with the same prescription.

So, you don’t have to come up with an excuse not to go to the physiotherapist! Dozens of people search for information on this topic online every month!

Termination of sessions decided by physical therapists

A physical therapist has every right to stop sessions, regardless of their motivations, whether personal or professional.

They don’t have to justify themselves to anyone, not the patients, not their relatives, not the health insurance – at least, according to regulations.

What about the ethical perspective? Personally, I sometimes end sessions, but I always explain the reason to the patients.

Most of the time, it’s a joint decision, shared. I believe that continuing treatments when one is uncomfortable, uneasy, not aligned with what one is doing (or even feeling like it’s therapeutic obstinacy) has negative consequences on the quality of care provided.

Continuing treatment is not necessarily in the patient’s best interest.

It would be necessary to take concrete examples of situations to give a precise “ethical” opinion.

The only obligation for physical therapists who interrupt sessions (even when patients or their relatives would like to continue) is to: 1/ Provide the patient with the contact information of a colleague or another physiotherapist who can potentially continue the treatment. 2/ Transmit to the colleague the necessary information for the continuation of care.

This is called “ensuring continuity of care.” Here is what the regulatory texts say concretely.

Except in cases of emergency and where he or she would fail in his or her duties of humanity, the physical therapist has the right to refuse his or her care for professional or personal reasons.

Code of ethics for physical therapists, R. 4321-92

Its’ in France, but we find the same type of principles in the codes of ethics that regulate the profession in different countries.

So, there are two exceptions:

• Emergency cases: I don’t really see a situation where physiotherapists intervene urgently nowadays in private practice, except for those working in institutions. Even in the case of a patient in distress or respiratory distress, generally, if they need emergency care, their place is probably not at home or in a physiotherapy office (except in specific cases). In this case, it’s not a problem to interrupt or not the sessions, but to refer to a structure that can provide this type of emergency care.
• Failing in duties of humanity: honestly, I’m not sure how to interpret this. It seems very vague and subjective. It would really require concrete examples for it to make sense.

For example, when I, as a physical therapist, have been the one to initiate the early termination of sessions, both in private practice and as an employee, it was:

• Because people seemed to oppose the care, participated little (even if they did not verbalize it because they had cognitive impairments).
• Because the expectations of the patients were not aligned with what I could offer them. When they want massage/mobilizations/passive physiotherapy care. I can now detect this over the phone or during the first session.
• Because I reduced my scope of intervention at home (and I knew that other physical therapists could intervene).

Is it frowned upon to stop physical therapy sessions?

Some patients have told me that they hesitate to interrupt their sessions with their physical therapist or change physical therapists because they are afraid it might be frowned upon.

I have many physical therapists in my personal network, and I have NEVER heard anything like “Mrs. X stopped the sessions, that’s not acceptable!”

It can be surprising at times, especially when the treatment seemed to be going well. But after the initial moment of surprise:

• We forget about it.
• We think it’s better for other patients (it opens up a slot!).
• We think it’s better for us: it’s always more pleasant to treat people who are satisfied with the care or find it beneficial!

In short, rest assured: I believe it’s absolutely not frowned upon to stop physical therapy sessions. It’s your right as a patient, and in the medium to long term, it’s probably the best scenario for everyone 🙂.

And when it’s the physical therapist who initiates it? It’s a bit more delicate.

This will, of course, depend on the reason and how the treatment was terminated.

Perhaps these people will not contact us again and will never refer anyone to us? This is not necessarily a bad thing: maybe our way of working doesn’t suit them, and in our mutual interest, it’s better that things are this way.

Not everyone is meant to collaborate! And this is particularly applicable to physical therapists who rarely provide “vital” treatments (compared, for example, to a doctor or a firefighter who needs to resuscitate someone urgently).

Is it risky to stop physical therapy sessions?

By risky, I mean “bad for your recovery”: does stopping physical therapy sessions pose a risk of not recovering as well? Two different situations can happen if you decide to stop physical therapy sessions:

• You simply decide to change physical therapists, to continue sessions with someone else: in this case, changing will be more beneficial than risky!

If you were really uncomfortable with the way your physical therapist worked, and you made sure before changing that your future physical therapist works differently, you will probably be more satisfied with the care.

And therefore, you will potentially recover better. This is what is called contextual effects: the relationship with your therapist is one of the factors that play a role in recovery.

• You decide to completely stop physical therapy sessions. In this case, it all depends on your health, the reason for the physical therapy sessions, what you were doing during them, and, above all, what you implement on your own at home!

It’s best to discuss this with your physical therapist before stopping so that he or she can explain the potential “risks” of stopping in your situation. It’s up to you to weigh the benefit/risk balance!

Most often, stopping physical therapy sessions is not “risky.” Especially if you implement things on your own: physical activity, self-rehabilitation!

How to stop sessions with a physical therapist?

There is no specific administrative process to follow with social security/health insurance to stop physical therapy sessions. You just need to:

• Cancel upcoming scheduled sessions if there are any.
• Retrieve your prescription if your physical therapist took it, and you need it because you want to continue rehabilitation with someone else.
• Settle the remaining sessions to be paid if your physical therapist does not practice generalized third-party payment (or if he or she has billed additional fees or acts outside the fee schedule/convention).

Afraid to tell your physical therapist?

It will often be necessary to inform your physical therapist of your wish to stop sessions if you are in at least one of the three situations described earlier. I don’t see much way around that, unless you ask someone else to do it for you.

Ideally, I think it’s best to briefly explain why you want to stop, while remaining courteous. So that your physical therapist can potentially adjust his or her way of working, depending on the nature of your remarks.

However, you are not legally obligated to justify yourself.

Stuck because your physical therapist has the prescription?

If you politely ask your physical therapist to retrieve your prescription, I think he or she should give it to you without any problems. He or she must do so legally.

If he or she refuses, you can remind him or her of his or her obligations.

In case of a dispute that you cannot settle simply by discussing, you can possibly turn to the authority that regulates the physical therapy profession in your state or country. For example, in France, it’s the National Order of Physical Therapists., which can act as an intermediary.

Another option: ask your general practitioner (or another doctor) to issue a new prescription for physical therapy.

I think, however (and I hope!), it is very rare to have to go that far for a simple prescription!

Can I change physical therapists with the same prescription?

Yes, you can absolutely use the same prescription with 2 different physical therapists (or even 3, 4, etc.) at the same time as well.

However:

• If there is a maximum number of physical therapy sessions specified on the prescription (for example: 15), this number applies not per physical therapist but in total. If you’ve had 10 sessions with Physical Therapist 1, you can only have 5 sessions with Physical Therapist 2 using the same prescription.
• If there is a validity period mentioned (for example: 2 months), this validity period starts from the date of the prescription, as indicated on the document. It doesn’t matter when you started the first physical therapy session with your previous physical therapist.

I want to change physical therapists: how do I do it?

Here are the main steps to follow when changing physical therapists, assuming you have a valid prescription and remaining sessions (or no mention of validity or number of sessions):

1. Politely cancel the scheduled appointments.
2. Retrieve your prescription if your physical therapist has kept it.
3. Schedule an appointment with another physical therapist.
4. Explain during the first session that you have already started physical therapy sessions with someone else.
5. Your new physical therapist may contact your previous one if additional information is needed.

When to stop physical therapy sessions even if everything is going well?

In the last scenario, everything is going well with your physical therapist, but you’re wondering when it’s time to stop sessions!

At the initiative of the patients

You can be the one to initiate the cessation of physical therapy sessions, even if everything is going smoothly with your physical therapist.

Often, during the first session, your physical therapist assesses and co-defines objectives to achieve with you, which can evolve over time.

When these objectives are met:

• Either new objectives are redefined.
• Or you can decide to stop the rehabilitation.

Sometimes, the goals are not achieved, and you may decide to stop the sessions anyway because you don’t see improvement, you’re tired, you want a break, etc. Whatever the reason, feel free to discuss it with your physical therapist!

I inform my patients from the first session that they can be the initiators at any time, and for any reason, of stopping or interrupting the sessions. I reiterate this regularly during their care to minimize the risk that they may not dare to talk to me about it!

At the initiative of the physical therapists

For exactly the same reasons as mentioned earlier, any physical therapist can also be the initiator of a proposal to stop sessions. Ideally, in my opinion, it is to discuss together to see what is best for both parties:

• Stop the sessions?
• Space out the sessions?
• Interrupt the sessions and resume later?
• Review the course of the sessions or redefine more coherent objectives?
• Switch to in-office care (if physical therapy sessions were at home)?
• Etc.

To summarize: When and How to Stop Physical Therapy?

• Patient or physical therapist, you have the right at any time to stop physical therapy sessions, whatever your reasons.
• Physical therapists, we have certain obligations to make the continuity of care possible (provide the prescription, give the contact information of a colleague physical therapist).
• Patients, you can continue sessions with another physical therapist with the same prescription, if it is still valid (validity period or number of sessions or nothing specific written about it).
• Most often, the cessation of physical therapy sessions is co-decided between the physical therapist and the patient. Often because the set goals have been achieved or because no progress is observed.