Innovations

Quality assured examples of successful initiatives 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.

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Innovations

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The Network Spinal Cord Compression Service

The incidence of cancer is increasing; people are living longer with better quality of life, however, the risk of developing MSCC remains high for many patients. Prompt diagnosis and treatment is essential to prevent paralysis and failure to recognise the early signs can have devastating implications with the added financial burden of caring for bedbound patients.

All front-line clinicians have a vital role to play in referring suspected MSCC patients into the MSCC service in a timely manner. This includes physiotherapists working in most settings, e.g. MSK, A&E, walk-in centres, community and private sector.

Physiotherapy assistants in the musculoskeletal outpatients setting

Physiotherapy assistants accounted for approximately 20% of the physiotherapy workforce across Stoke on Trent Community Health Services. Although their job descriptions clearly stated that the post was primarily clinical, their role depended heavily on the qualified physiotherapists and how they utilised the clinical skills of physiotherapy assistants. As a result in some clinics/clinical areas physiotherapy assistants had a predominant clinical role whereas in others they fulfilled what was primarily an administrative role. This latter trend led to physiotherapy assistants not being able to utilise their clinical skills and to job dissatisfaction as well as disparity in the clinical service provided to patients of equal clinical needs.

Physiotherapy-supported discharge in elective orthopaedics

Following total knee replacement (TKR), patients are not only required to be functionally and medically safe for discharge but also achieve set exercise goals before being allowed home. These set exercise goals are: · 90 degree knee flexion. · A straight leg raise with < 5 degree quadriceps lag. · Inner range quadriceps with < 5 degree quadriceps lag. These goals are set by the operating Consultants. A recent audit on length of stay (LOS) highlighted that out of 38 patients, 32 (84%) had exceeded their predicted date of discharge (PDD). Of these 32 patients, 19 (59%) had exceeded their PDD as a result of not achieving their exercise goals by this time, despite being deemed functionally and medically safe. Further audit over a 12 week period highlighted an additional 38 TKR patients remaining in hospital after being deemed functionally and medically safe in order to achieve the set exercise goals. This equated to 65 additional bed days over the 12 week period, approximately 5 additional bed days per week. With a standard overnight stay costing £400 per night, this equated to £26,000 over the 12 week period and therefore potentially £104,000 a year. It was suggested that providing a physiotherapy service to allow TKR patients to go home once functionally and medically safe but without achieving their exercise goals could facilitate discharge for these patients without compromising the quality of their care or outcomes

Producing a data-inputting and analysis calculator to facilitate the standardisation of outcome measures

The advantages for using patient-reported outcome measures (PROMS) have been well documented in the literature. The need for physiotherapists to use standardised PROMS has been recognised and is recommended in clinical guidelines. Although the importance of standardising the use of PROMS within the physiotherapy profession is well recognised, it has largely failed to be delivered in practice. A number of barriers for implementation of standardised outcome measures has been reported including the lack of knowledge and the lack of instructions in relation to the application, scoring and interpretation of the outcome measure(s).

Musculoskeletal (MSK) physiotherapy teams within Staffordshire and Stoke on Trent Partnership Trust (SSOTP) used a variety of outcome measures including the EuroQol (EQ-5D-5L) alongside condition specific PROMS and a patient experience-reported experience measure, in line with CSP recommendations. Nevertheless, the teams did not use the same outcome measure and data collection, inputting and analysis methods varied considerably. Therefore, the use of outcome measures and data collection needed to be standardised.

Cancer recovery and a personalised exercise service: A preliminary analysis

Previously people with long term illnesses such as cancer were often advised by their clinical team to rest and reduce their physical activity. But recent research has shown that exercise is not only safe and possible during cancer treatment, it can also improve an individual's level of physical functioning, increase their strength and stamina, improve their quality of life and help them to return to work. Studies have also shown that exercise can reduce their mortality and the risk of recurrent types of cancer by approximately 50%. The aim of our evaluation study was to explore the efficacy of a physiotherapy led exercise programme for people living with and beyond cancer to improve their overall health and wellbeing and fitness levels.  

Class format to improve the management of total knee replacement in an out-patient setting

Historically patients at North Manchester General Hospital received traditional 1:1 Physiotherapy treatments post total knee replacement (TKR). Literature suggests a class environment can be more cost effective and yield improved results. Therefore a TKR class was set up in 2015. This summary highlights the findings from the first year demonstrating clinical outcomes, patient satisfaction and cost-effectiveness.

Health literacy profile of a Musculoskeletal population

This paper reports on the findings of the first phase of a service improvement project that used the Ophelia approach developed by Deakin University, Australia to evaluate the health literacy (HL) needs of adults attending outpatients musculoskeletal (MSK) physiotherapy.

Little is known of the impact that the social determinates of health have on the health literacy needs of patients presenting with musculoskeletal pathologies so the relationship with demographic data, including the Welsh Index of Multiple Deprivation (WIMD) was explored.

The aim of the first phase was to profile adults' health literacy attending outpatient MSK physiotherapy. Objectives included:

  1. to evaluate adults across nine domains of health literacy
  2. to establish whether there is a relationship with measures of deprivation. The results of profiling will inform the development of specific health literacy interventions and resources for the local population in future phases.

UEA & Norwich City: A partnership approach

The poster provides an overview of the partnership established between the UEA and Norwich City over the past 5 years. It outlines the way that the MSc pre-registration physiotherapy students develop their research dissertation topics through a collaborative approach with physiotherapists at the Norwich City football club academy. It identifies the research questions investigated by current and previous Masters students. The final section demonstrates the benefits of using research to inform practice in the elite professional football academy setting and the value of making explicit links between research, education and practice. It does this through the narrative of the physiotherapists, students and academic staff themselves.

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.