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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 and case studies 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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How a team challenge with teenagers and young adults positively impacts activity levels and engagement.

Current guidelines suggest teenagers should complete 60 minutes of physical activity a day, including strengthening exercises 3 days a week. Research shows that only 20% of teenagers meet these recommendations. Teenage years can be challenging for a variety of reasons; this period is made even harder when you are given a life changing diagnosis of cancer. At the University College London Hospitals Macmillan Cancer Centre we initiated the #JOGLE challenge on our teenage and young adult (TYA) unit. The challenge was to collectively travel the distance from John O'Groats to Land's End - a total of 874 miles - using the equipment in the therapy gym. This service evaluation aimed to look at the impact of this challenge on physical activity levels and engagement with therapy services in TYA with a diagnosis of cancer.

The benefits of providing a local serial casting service for children and young people in Powys.

Serial casting is a common conservative intervention for children and young people who are idiopathic toe walkers, or who have cerebral palsy and develop calf muscle contracture. The main aims of serial casting are to improve calf muscle length, walking pattern and efficiency. There is a strong evidence base showing serial casting is effective in improving calf muscle length. Historically in the large and rural county of Powys serial casting has been provided by out-of-county hospitals, making access difficult and involving children, young people and their families travelling long distances. A local physiotherapy-led serial casting service has been piloted within Powys for the last 1 year and 9 months, with capacity to provide treatment in local hospitals and schools as well as client´s homes. A retrospective audit was carried out to assess the benefits and effectiveness of this service.

Can patients with Bronchiectasis in Grampian use online Physiotherapy resources and patient information leaflets to self manage their condition?

At present within NHS Grampian there is minimal Respiratory Physiotherapy provision in primary care. Aberdeenshire is a large geographical area, with the specialist respiratory services based in Aberdeen Royal Infirmary. This requires patients to travel long distances for a Respiratory specialist review. Furthermore due to a lack of standardised pathway for patients with Bronchiectasis, there is an even greater waiting time before they are seen, even in the acute sector.

To add to this, there are ongoing staff recruitment difficulties locally which mean there is only resource for more complex patients to be assessed. With this, a Bronchiectasis toolkit was developed to provide airway clearance advice to all patients in NHS Grampian. The aim of the toolkit is to provide information that is accessible to all patients within the area, to reduce the length of time before they are provided with physiotherapy advice about airway clearance,exercise and improve patient outcomes.

Rehabilitation Following Hip Fracture; How Data Can Drive Service Development and Improvement

The Scottish Standards of Care for Hip Fracture Patients were developed in 2014 to improve quality of care and outcomes for patients, by reducing the national variation in practice. Standard 8 Physiotherapy (PT) Assessment and mobilisation; Standard 9 Occupational Therapy (OT) Assessment relate to therapy interventions specifically. The standards were updated in 2018 with both therapy areas remaining unchanged.

NHS Fife performed poorly in relation to standards 8 and 9 in 2014. Only 39% of patients were mobilised by the end of day one, with 83% having a PT assessment by the end of day 2 and 55% having an OT assessment by the end of day 3 post admission.

The primary objective was to increase the percentage of patients achieving standards 8 and 9 to 100% for PT and OT assessment and 90% for mobilisation.

Improving information-giving to critical care patients to guide post discharge rehabilitation: a quality improvement project

ICU survivors have a 1-year mortality rate of 30%, and a reduced quality of life associated with post-ICU syndrome; a triad of cognitive decline, physical weakness and psychiatric disorders. Early rehabilitation improves outcomes, leading to greater independence. The NICE CG83 guidelines instruct the provision of rehabilitation information to critical care patients on discharge. Currently, only a third of UK trusts meet these guidelines.

Within 20 weeks, we aimed to achieve 100% patient and therapist satisfaction with the rehabilitation information given to patients at risk of physical morbidity on discharge from critical care at Medway Maritime hospital.

Developing Patient Understanding - The Effectiveness of an Educational and Exercise Programme for Persistent Lower Back Pain

Lower back pain (LBP) is one of the ten leading causes of disease burden globally. It is widely recognised that LBP produces significant detrimental effects on physical and emotional wellbeing whilst having a substantial economic burden for society. There is an inverse relationship between socio-economic status and the prevalence of pain. Increasing patients understanding of non-specific lower back pain including pain physiology, combined with completing exercises can provide optimal management. Therefore, the effectiveness of a locally run 'Back to Fitness Programme' (education and exercises) in the most deprived local authority area in England was evaluated.

The purpose was to evaluate the effectiveness of the Back to Fitness programme upon patients' understanding of pain, ability to function, symptom-report and physical outcomes.

Evaluation of the optimal physiotherapy-led mobilisation on critical care following the implementation of a mobility guideline.

Every patient on critical care should be assessed daily for the potential to begin functional rehabilitation including mobilisation.

Levels of agitation and sedation, as measured by the Richmond Agitation and Sedation Score (RASS) and consciousness measured by the Glasgow Coma Scale (GCS), can impact on the type of activity delivered by physiotherapy. A new mobility guideline was initiated on the general intensive care unit (ICU) to maximise patient rehabilitation within the limitations of their RASS score.

The purpose of this evaluation is to establish that the maximum level of rehabilitation/mobility was safely performed within each patient's physical, medical and cognitive abilities.