Innovations

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Innovations - quality assured physiotherapy initiatives

Our quality assured examples of successful initiatives aim to promote physiotherapy as an innovative and cost effective approach to improving patient pathways and promoting public health. We welcome examples from all aspects of physiotherapy practice, research, education, and service delivery.

You can either filter the innovations by 'Region' or 'Type' or use the keyword search above to find specific words or phrases. 

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Telephone-based triage and diagnostic accuracy of spinal pathologies

Advanced Level Physiotherapy (ALP) is a term used to describe a level of practice for a physiotherapist to be working at. It includes utilising a combination of advanced skills, knowledge and clinical reasoning to successfully and safely manage patients, recognising where a clinical presentation is outside an individual's scope, and taking appropriate action. Utilising advanced clinical reasoning and making appropriate radiology referrals enables physiotherapists to exclude serious pathology and determine the appropriate pathway for a patient. Being able to safely triage and direct patients to conservative management or escalate to an orthopaedic review where suitable is the cornerstone of a clinically-effective service, and highlights the benefits of having experienced physiotherapists on hand to guide patients appropriately. Many studies have looked at whether the diagnostic accuracy of physiotherapists is comparable to orthopaedic consultants, but the diagnostic accuracy of a telephone based ALP triage service has not previously been investigated. The aim of this study was to audit the diagnostic accuracy of radiology investigations performed for spinal pain (cervical, thoracic, lumbar and sacroiliac) by a telephone based ALP triage service.

Early identification of respiratory impairment in motor neurone disease

Respiratory function significantly predicts both survival and quality of life in people with Motor Neurone Disease (MND). Early referral to specialist respiratory services at the onset of symptoms is vital to facilitate decisions regarding respiratory management. Effective management of respiratory symptoms is likely to have a positive impact on the quality of life of the person with MND. Objective measures of respiratory function allow clinicians and patients to self-monitor respiratory symptoms at home. A challenge of working within a multi-disciplinary (MDT) community neurological therapy team was the lack of easy to use, accessible, accurate objective measures of respiratory function. We describe the development of the team's MND respiratory assessment, which aimed to improve early identification of people with respiratory impairment. A further aim was to improve the referral pathway between the community team and its local sleep and ventilation service.

Working with complex persistent pain

To describe the role of an Advanced Physiotherapy Practitioner (APP) working within a multidisciplinary team with people with complex persistent pain in acute hospital, outpatient and community settings.

To describe relevant physiotherapy skills required in these settings

To describe the clinical outcomes of the service

Transformation of Therapy Services

To examine the key factors influencing the transformation of Therapy Services within our institution, creating links to sustainable service quality improvements. In 2014 Salisbury NHS Foundation Trust (SFT) carried out a service wide consultation of Physiotherapy and Occupatonal Therapy provision with the aim of transforming Therapy Services. The key outcome from the consultation was the re-organisation of Therapy Services into defined team "clusters" under a single management structure, creating a Head of Therapy Services who reports directly to the Chief Operating Officer and Director of Nursing. The key challenges were addressing the collaborative working within Therapies and across the hospital taking into consideration professional isolation within Directorates, localities, Wiltshire and Wessex Deanary; staffing, recruitment and retention; morale and innovation; and patient flow.

Compliance with NICE Metastatic Spinal Cord Compression Guidelines

1) To identify variations from NICE MSCC guidelines in the MSK pathway for patients regarding timelines from early detection and time to MRI 2) To use this clinical audit data to inform clinical commissioning groups (CCGs) and local hospital providers about access of referral

Cultural shift in the value of patient time

Time: Ours to organise, ours to spend and equally ours to waste- but what about when that control is taken. In a culture where our days are filled with loved ones, work and activity, we choose to balance our time across these. However, when you are admitted to an acute hospital, this aspect of choice is often taken away.

As physiotherapists one of our key roles in inpatient care is to improve and regain function to allow our patients to return to their home at their baseline level. By making simple changes- getting patients dressed into day clothes, walking to the toilet and sitting in a chair for meals there can be a clear correlation with the speed of a patient's rehabilitation.

Transnational collaborative digital learning project

Physiotherapy programmes must prepare graduates to live and work in a globally interconnected society. Internationalised learning experiences have the potential to break down ethnocentric worldviews by exposing students to analysis and critique of practice from different cultural perspectives. Such experiences may enable transformative learning by developing the student's ability to shift perspective and reflect critically on how disciplinary practice can change with the social context. Opportunities to study abroad can only be offered to a minority of students. In contrast, digital technology such as discussion forums and video conferencing provide an inclusive platform to make international experiences available to all students on a programme. The aim of this educational project was to engage physiotherapy students in a transnational collaborative group task in order to increase awareness of different international perspectives on clinical practice and healthcare provision and facilitate reflection on their local context.

The National Physiotherapy Hip Sprint Audit

The purpose of the audit is to gain a detailed understanding of the physiotherapy management of patients with hip fracture, so that recommendations can be made which will result in improvements. By using a standardised national audit tool, data and information will enable physiotherapists to understand how to improve both the service delivery and the experience of physiotherapy for hip fracture patients. This audit will also demonstrate to external stakeholders the professions readiness to embrace the findings from the audit, in order to make improvements

Physiotherapy target measure for hip fracture

'Advancing Quality' (AQ) was launched in 2008 across all hospitals in the north west of England with the aim of improving patient outcomes and reducing costs (Advancing Quality Alliance 2016). In 2015 the management of hip fracture was added as a key clinical area for evaluation/improvement, and included the measure: 'HFR-07 - Physiotherapy assessment within 24 hours of surgery'. Our Trust audit department therefore started producing monthly data for AQ hip fracture targets, which initially revealed our compliance with the above physiotherapy measure to be at 78% (target set at 100%). The purpose of this project was therefore to improve the achievement of this measure. A Plan-Do-Study-Act (PDSA) service improvement approach was chosen - as initially described by Deming (1986), and then later adapted specifically for use in healthcare by Langley et. al. (1996).

Physiotherapy use of thoracic ultrasound

The use of diagnostic thoracic ultrasound (TUS) by physiotherapists to examine the pleura, lung parenchyma and diaphragm is gaining in popularity. In the medical profession it has been shown to have efficacy in the diagnosis of pulmonary conditions such as pneumonia, pleural effusions and diaphragm dysfunction. It is unclear how effective TUS is in the hands of a physiotherapist. The aim of this scoping review is to explore the emerging evidence surrounding physiotherapy use of TUS to inform research and clinical practice.