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 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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Single-Arm Observational Service Evaluation: Efficacy of a Single Advanced Physiotherapy Practitioner Intervention for Patients with Chronic Musculoskeletal Pain.

Musculoskeletal (MSK) conditions account for a significant portion of General Practitioner (GP) consultations and are therefore a burden on our health service and especially primary care as these conditions are largely managed within primary and community care. Patients with chronic MSK conditions consult with their GP five times more often than those without and as the age of the population increased this burden is expected to add increased pressure to primary care.

First Contact Physiotherapists (FCP) work at an advanced level of practice as first contacts within primary care and provide a possible solution for these patients. The proliferation of these roles over the last few years has been supported in the literature through studies reporting on the impact of FCP services and satisfaction surveys. NHS documents such as the Long Term Plan also promote an increase in FCP roles and organisations such as the Chartered Society of Physiotherapy and the Royal College of General Practitioners have endorsed FCP. Patients find this role to be an acceptable alternative to accessing their GP for specific conditions which supports these roles from the patients’ perspective.

Despite this support there has been very little evidence to demonstrate the efficacy of FCP services on patient outcomes. This service evaluation therefore aimed to determine the efficacy of FCP interventions on patient outcomes.

An FCP consultation may comprise of an assessment, diagnosis, advice and exercise prescription and as these interventions have been demonstrated in the literature to improve pain self-efficacy (SE) it was decided to assess the outcome of FCP services on the pain self-efficacy of patients with chronic MSK pain.

The effectiveness of non-pharmacological interventions to treat orthostatic hypotension in people with stroke.

The prevalence of Orthostatic Hypotension (OH) post-stroke is high. OH can be a barrier to stroke rehabilitation, where mobilisation (out-of-bed activities such as sitting, standing and walking) is recommended at the earliest opportunity. The potential risk of harm with OH must be acknowledged and addressed since, in acute and sub-acute stroke, OH has the potential to cause further brain damage due to cerebral hypo-perfusion. This may result in increased disability and mortality. However, current guidelines for the management of people with stroke do not provide guidance on assessing and treating OH.

People with stroke are more likely to have multi-morbidity, thus are at greater risk of polypharmacy. Therefore, identifying non-pharmacological interventions to treat OH is of importance both to minimise polypharmacy, and optimise safe participation in early rehabilitation.

The aim of this systematic review was to summarise the best available evidence regarding the effectiveness of non-pharmacological interventions to treat OH in people with stroke.

MSK self-management smartphone app in General Practice

To investigate if the GPEP musculoskeletal self management app;

  1. is an acceptable alternative source of information for patients.
  2. results in a reduction in physiotherapy/secondary care referrals, analgesia prescriptions, repeat attendances to general practice.

Scoping review: Should physiotherapists recommend swimming to patients with low back pain and is further research warranted?

It is common practice to suggest to patients with low back pain (LBP) to try swimming as a form of exercise but what evidence is this recommendation based upon and is there a need for further research? This scoping review was carried out to prepare and support a research proposal which will investigate whether swimming is beneficial for patients with LBP and whether swimming could target some of the comorbidities associated with LBP.

South Tees Integrated Falls Prevention Strategy

South Tees has had a CCG commissioned falls service since 2007 and has had significant year on year growth in referral rates. Despite this, the team have operated on the same resource and the service had become reactive rather than proactive.

 

Year      Male      Female      Total Referrals
2013   462   861   1323
             
2014   585   1027   1612
             
2015   684   1096   1780
             
2016   678   1047   1725
             
2017   639   1081   1720
             

 

Proposed key outcomes of the review were: A mapping exercise of existing services against NICE guidance was used to identify areas for improvement which created an opportunity to review the current service with a view to develop a system-wide approach to falls prevention.

  • Reduced falls and injuries
  • A region-wide falls pathway
  • Coordinated, individualised risk assessment and interventions
  • Improved partnership working

ICU and Beyond – Establishing a Post ICU Rehabilitation Pathway and Virtual Class

Within our consultant led ICU follow up clinic we recognised that there were an increasing number of patients presenting with on-going physical and psychological problems relating to their stay. Many of these patients reported lack of access to longer term rehabilitation and psychological support.

The purpose was to develop a specialist therapy pathway for patients following an intensive care stay; to improve physical and psychological outcomes, and the overall experience and support for patients and families.

Aspects included working towards;

  • Specialist Supported discharge home.
  • Joint handover of care and on-going support to community teams
  • 3 month review in line with NICE guidance.
  • Provision of MDT rehab class.
  • Capacity to provide hydrotherapy in the future.
  • Development of MDT follow up clinics
  • Psychology support with specific reference to ICU and critical illness

Beyond – Establishing a Virtual Post ICU Rehabilitation Class

 

The COVID-19 pandemic forced us to rethink how we could deliver Post ICU support and ensure rehabilitation needs of those leaving ICU were met.

The redeployment of staff during the first wave allowed us to pilot a virtual Post ICU rehabilitation class.

The Greenwich Pulmonary Rehabilitation Programme: a virtual delivery model & a QI project

The Greenwich Pulmonary Rehabilitation (PR) Service consists of 0.1 WTE team lead, 1.0 WTE band 6 split between 2 part time staff, a fixed term 3 month contract band 5 physiotherapist and 1.0 WTE rehab assistant.

The driver behind the project was to address the issue of the suspension of our face to face supervised PR classes (4 sessions per week at local leisure centres) during the COVID pandemic. With a mounting waiting list and an expectation that we would not be able to return to business as usual, we had to adapt.

Our primary objective was to design a programme that was effective, safe and that patients would enjoy.

A secondary objective alongside the Oxleas QI team was to increase patient completion rates over a 3 year period.

Current completion rates for the Greenwich Pulmonary Rehab programme was low at 40%.

The end point of the project was to be able to confidently offer increased patient choice on how to access PR.

There is an ongoing national challenge to manage patient drop out rates, which are multifactorial in nature. The redesign and delivery of a virtual programme could address problems such as: difficulties travelling to the class, poor weather conditions and psychological challenges where patients feel unable to leave their home to attend.

Role-Emerging Physiotherapy Placements in Dementia Care; a Service Improvement.

Physiotherapy role-emerging placements can occur at sites where there is minimal or no physiotherapy service or established physiotherapy role. Lack of physiotherapy provision has been identified in care home settings, and this lack impacts on the quality of care in managing complex physical and mental health conditions such as dementia.

The Care Home Liaison team uses a multi-disciplinary model to develop interventions to support individuals living with dementia to have positive lived experiences of the care home setting. However, where physical health is a component of the individual's mental well-being, the team is limited to over-stretched community physiotherapy services.

This gap in knowledge and practice highlights the unique role physiotherapy could offer in managing such a complex client group. Physiotherapists working in dementia care offer an important role in the management of physical conditions, together with promoting and maintaining mobility and function. This has a positive impact on the behavioural and psychological symptoms of dementia and so reduces the use of pharmacological interventions.

Role-emerging placements can highlight the value and impact physiotherapy has, and allows students to develop skills and experience in increasingly diverse, complex and evolving workplaces.

Recorded Physiotherapy Webinars: Innovative provision of CPD to Physiotherapists working in busy independent sector, MSK clinical environments.

The purpose of this service evaluation was to help better understand the impact and value of running a Recorded Physiotherapy Webinar (RPW) programme to Nuffield Health Physiotherapists.

RPW's are a series of 20-40 minute presentations recorded with both visuals (PowerPoint) and audio (presenter's voice). They are delivered by subject matter experts from across Nuffield Health and aim to promote learning on clinical topics (i.e. ACL rehabilitation, Shoulder red-flags and Cervicogenic headaches).

A total of 14 self-selected RPW's are currently available and can be accessed from anywhere, at any time after the recording via a Learning Management System (LMS).