What is physiotherapy?

Physiotherapy is the use of therapeutic exercises, hands-on treatment (e.g., manual therapy, electrotherapy, etc.), and appropriate patient education to treat a wide variety of musculoskeletal disorders. A combination of all three aspects yields the best result while non-compliance with even one of them leads to injury reoccurrence and/or non-recovery.

While compliance with hands-on treatment and patient education is guaranteed as long as the patient shows up for the sessions, compliance with therapeutic exercises is known to be a challenge. This, along with drop out from treatment, accounts for most non-recoveries after physiotherapy treatment. Thus, the reason my treatment approach emphasizes following the prescribed exercises diligently. 

What physiotherapy is NOT:

  • General medical practice – I know the limits of my expertise and knowledge, thus I will refer you back to your GP or a specialist if I see “red flags” or feel you need some other form of medical help.
  • Massage therapy – I have treatment methods that work better on orthopaedic conditions. For this reason, massage is not part of my treatment protocols.
  • Psychotherapy – I will not tell you the pain is in your head!

My Treatment approach

I treat my patients hands-on with a combination of various techniques [see How I treat]. I also educate patients on the actual root cause of their problem(s) based on my findings confirming their medical diagnosis from the prescribing physician or imaging result. I use 3D computer models, live skeletal models, or picture illustrations to explain the root cause. The same method of explanation is employed when describing the effects of both hands-on treatment and therapeutic exercises.

From the second session onwards, reassessment is a vital part of the treatment protocol. This includes re-checking the symptoms initially reported to follow the evolution of recovery or the lack of it (in which a different treatment strategy is chosen). I also check whether the therapeutic exercises are being done correctly and if increasing the exercise load is necessary.

Prescription

Prescriptions for physiotherapy are usually written by either a general practitioner or a specialist. In certain cases, physiotherapy is prescribed right away while in other cases they are given only after imaging e.g., MRI, X-rays.

A standardized prescription format is generally issued by medical practitioners in Luxembourg. See sample below:

Doctors can issue prescriptions for any of the following: 

  • Common pathology
  • Serious pathology
  • Post-surgical rehabilitation

For common pathologies, a maximum of 8 sessions can be prescribed, while for serious pathology and post-surgical rehabilitation, 64 and 32 sessions respectively are the maximum.

Things to double-check on your prescriptions (see highlights in the sample above) to ensure they will be accepted by CNS are as follows:

  • your personal details are correct (full legal names, social security number, address)
  • correct name and details (code medicin, address , phone number, signature and stamp) of the prescribing physician.
  • prescription is not older than 31 days (physiotherapy prescriptions has a validity of one month after which it will NOT be accepted by CNS)
  • type of prescription (New, Assessment, Extension) is indicated
  • type of treatment is indicated (one of three pathologies – common, serious, or post-surgical)
  • Number of sessions, type of rehab, body part (where applicable), treatment at home (if necessary)

Once a patient presents a valid prescription (not older than 31 days), the physiotherapist sends it to CNS through a secure electronic system. CNS replies via the same system usually within 12-24 hours, providing the authorization (Titre de prise en charge). The validity of the authorization (i.e., the period within which the treatment must be completed) varies depending on the type of pathology – 90 days for common pathology, 180 days for post-surgical rehabilitation, and 1 year for serious pathology.

Important: All treatment must be carried out within the time window authorized by CNS.

More information on how physiotherapy works in Luxembourg can be found here:

Kinésithérapie – Assuré – CNS – Luxembourg (public.lu)

Payment

The patient pays his/her part of the treatment cost at the end of each sessions and the final invoice will be issued after the final session or upon closure of the treatment.

Payment methods accepted are:

  • Bank card
  • Cash
  • DigiCash

Appointments and Cancellations

New patients can either book appointments here, on Doctena.com or via telephone. Subsequent appointments are agreed upon at the end of each session as the decision will sometimes depend on observations from reassessment carried out in during the session.

In accordance with provisions of the law, a patient is required to inform the physiotherapist on time if he/she will arrive late or be absent. Also, patients are typically expected to book appointments for slots not earlier than 8 am and not later 7 pm during weekdays. If any of these conditions are not met, the following cost supplements will apply in addition to the original cost of the treatment:

  • patient arrives late by 15 minutes or more or fails to cancel the appointment (i.e., no-show) at least 24 hours earlier, he/she will be charged the full cost of that session as a supplement.
  • in case of urgent requests for appointment before 8 am, after 7pm, appointments on weekends (Saturday or Sunday) or public holidays, or other requests that requires physiotherapists to work outside normal working hours, a supplement equivalent to 50% of the cost of one session will apply.
  • if a patient requests urgent treatment without prior appointment, a supplement equivalent to 50% of the cost of one session will apply.

In view of the above, here are a few recommendations:

  • if you wish to cancel or reschedule an appointment, do so no less than 24 hours before the appointment.
  • ensure to arrive for your appointments no more than 15 minutes late.

Clothing

It is advised to come in comfortable clothing, preferably sports clothing – shorts and T-shirt or tracksuit (or yoga pants etc.). This is particularly useful because I use points in distant parts of the body to treat pain/stiffness in other parts e.g., using the lower leg to treat the shoulder.

In case patients prefer coming in and changing upon arrival, there is a provision for that. 

First session

The first session with a new patient starts with assessment and evaluation to confirm the medical diagnosis or imaging result. Afterwards, the goal of the treatment is discussed with patient and the path to achieving that goal is agreed upon before the commencement of the treatment. 

The treatment itself starts with patient education on – root cause, therapeutic exercise, and the chosen hands-on technique. The patient is walked through therapeutic exercises and any questions he/she may are addressed. Hands-on technique is applied (in most cases to instantly modify symptoms – pain and/or range of motion) and set the path to recovery. 

At the end of the session, I demonstrate the exercises once again to ensure the patient remembers and the next appointment (s) is/are scheduled.

End of treatment

The end of treatment is when all prescribed sessions are completed. In certain cases, some patients recover before the prescribed sessions are completed, in this case the treatment is closed at that point whether the authorization is still valid or not. 

It is also possible for treatment to be closed upon the request of the patient, in that case a copy of the authorization (which is still valid) is given to the patients along with the closing documents i.e., prescription, imaging results (if applicable) and final invoice.

Extension

In case a patient will require more sessions than prescribed by the doctor, e.g., a prescription of 8 sessions for ankle sprain, knee sprain etc., the patient can ask the prescribing physician for an extension of the treatment duration. If necessary, I can issue a note to justify the need for extending the treatment.