When more treatment does not lead to better outcomes – the need for quality over quantity in physiotherapy

In both private and public physiotherapy, there is a persistent belief that more treatment leads to better results. Higher visit frequency, prolonged follow-up, and an expanding set of interventions can create a sense of thoroughness. However, research consistently shows that the relationship between treatment volume and clinical outcome is far from linear.

Treatment intensity as a false sense of security

High treatment frequency can reassure both patient and clinician. Problems arise when this intensity does not translate into measurable functional improvement.

Research in musculoskeletal care indicates that:

• Increased treatment volume does not necessarily improve long-term outcomes

• Passive interventions show limited effectiveness for non-specific conditions

• Overtreatment can undermine patient self-efficacy

Dependency and reduced self-management

Prolonged treatment without clear progression may contribute to:

• Increased dependency on the therapist

• Lower confidence in the body’s capacity to recover

• Heightened symptom focus

• Reduced physical activity between sessions

This contradicts the principles of modern, evidence-based physiotherapy, where increasing patient autonomy is a central goal.

What does the evidence say about effective care pathways?

Systematic reviews identify common characteristics of interventions associated with sustained benefit:

• Clearly defined, function-oriented goals

• Active patient participation

• Explicit progression or discharge planning

• Limited reliance on passive modalities

Shorter, targeted treatment courses combined with structured self-management often achieve outcomes comparable to—or better than—long-term care.

Quality requires clinical courage

Reducing or ending treatment when appropriate is often clinically sound, yet challenging:

• Patients may expect continued appointments

• Healthcare systems may incentivize volume over outcomes

• Clinicians may fear discharging “too early”

This is precisely where clinical judgment and professional integrity are most critical.

Implications for patients and healthcare systems

Overtreatment affects not only individuals but the broader system:

• Resources are tied up unnecessarily

• Waiting lists increase

• Access for higher-need patients is reduced

A more restrained, outcome-focused approach to treatment delivery can improve prioritization and overall quality of care.

Summary

More treatment does not automatically mean better treatment. High-quality physiotherapy is defined by clear goals, active patient involvement, and the clinical willingness to conclude care when meaningful outcomes are achieved. Future physiotherapy must reward effectiveness rather than volume.

Sources

• Foster, N. E., et al. (2018). Prevention and treatment of low back pain: Evidence, challenges, and promising directions. The Lancet, 391(10137), 2368–2383. https://doi.org/10.1016/S0140-6736(18)30489-6

• Zadro, J. R., O’Keeffe, M., & Maher, C. G. (2019). Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? BMJ Open, 9(10), e032329. https://doi.org/10.1136/bmjopen-2019-032329

• Zadro, J. R., et al. (2020). Effectiveness of implementation strategies to improve adherence to clinical practice guidelines. Physical Therapy, 100(9), 1516–1541. https://doi.org/10.1093/ptj/pzaa095