Prehabilitation has been shown in clinical trials to improve fitness, improve quality of life, reduce complications, reduce hospital length of stay and improve recovery. It is not currently standard of care in routine clinical practice. This prospective observational study reports the outcomes of a newly introduced prehabilitation service for patients undergoing major abdominal surgery for cancer.
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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Tennis elbow is a common painful condition that may affect daily function and ability to work. Physiotherapy is the most commonly used primary intervention but there is a wide range of treatment options within the umbrella of physiotherapy. Our aim was to report which treatments are currently used by physiotherapists in a UK National Health Service setting.
Patients surviving critical illness are at high risk of developing psychological problems after discharge, with as many as 10% developing symptoms of post-traumatic stress disorder (Wake & Kitchener, 2013), positively correlated with length of intensive care unit (ICU) stay. NICE recommends commencement of rehabilitation as soon as clinically possible in this group. Diaries have been shown to assist patients with fragmented delusional memories and difficulty recollecting their experience, and are hypothesized to work similarly to cognitive behavioural therapy. Factors including lack of awareness, time constraints and the non-compulsory nature has led to inconsistent staff engagement with the patient diary system at Medway Maritime Hospital.This project aimed to increase provision, consistency and overall multidisciplinary team (MDT) engagement with diaries for patients admitted to ICU for over 72 hours.
Communication within pathways of care in hip fracture physiotherapy rehabilitation in England and Wales
Hip fracture is a leading cause of morbidity in people over 60 years old. People experiencing hip fracture require rehabilitation, often from a number of teams, throughout their recovery period. Communication between these different teams poses a challenge to the continuity of care. Communication between professionals delivering care is essential to ensure safe and effective care, continuity of treatment and rehabilitation planning. We used data from the national 'Hip Sprint' audit to understand the flow of information across the hip fracture pathway.
Following the building of a local state of the art hydrotherapy facility a local umbrella charity Bolton Neuro Voices approached SP Therapy Services to design and deliver a 5 week hydrotherapy programme to persons living with a neurological conditions in Bolton and the surrounding area.
The brief was to be safe, inclusive and effective and to be within a specific budgetary and time constraints of a specified charity bursary. In addition we needed to provide sufficient evidence to enable future applications for bursary funding.
Anecdotal evidence from annual reviews of claims against the CSP Professional Liability Insurance scheme suggested that mis-diagnosis of Cauda Equine Syndrome (CES) was being seen more frequently with potential for resultant multi-million awards for damages, defence and claimant costs. This retrospective study sought to assess and quantify all claims notified and specifically claims of alleged failure to diagnose Cauda Equina Syndrome, to inform future risk mitigation.
COPD exacerbations can occur frequently causing lengthy hospital admissions with high re-exacerbation rates. Investment in a COPD EDS is an effective way in improving service and patient outcomes. Other areas may wish to consider adopting this model of care.
There is strong evidence to support the provision of specialist and intensive rehabilitation programmes (BSRM 2014) and that the highest level of neurological recovery occurs within the first three months post injury (Broeks et al 1999, Feys et al 2000). However, clinical data from our patient cohort showed patients were not commencing rehabilitation until after this time window due to delays in access to specialist rehabilitation, specifically our local district general patients would wait on average 87.3 days, and patients awaiting repatriation to local hospitals would wait 35 days from being medically stable before transfer. On analysis of our patient caseload, 70% of the caseload had a Rehabilitation Complexity Score of more than 10 indicating a complex specialist service as determined by Turner- Stokes et al (2007), however our staff to patient ratio fell significantly short of the recommendations for this level of service. Funding for this service type traditionally comes from NHS England. It was hypothesised that these delays and service parameters impacted on patient’s functional outcome and on the wider health economy.
This service pilot aimed to examine whether provision of specialist rehabilitation to neurological patients receiving hyper-acute neurosciences care would result in clinically significant functional improvements and reduce length of stay, and transfers to specialist facilities.
Increased customer satisfaction is associated with reduced complaints, a positive business reputation and often financial return. Within the clinical setting it has more importantly been shown to have a direct correlation with improved clinical outcomes. The therapeutic relationship is one area that can impact on a patients overall experience and their engagement in treatment. This relationship can be improved by making sure that the patients expectations and perceptions are not only acknowledged but clearly understood. A number of physiotherapists identify that they struggle with changing mind-sets of their patients or find that they are unprepared for having those difficult conversations. Supporting physiotherapists to have effective communication skills, the ability to listen and engage and have awareness of the impact of verbal and non verbal cues is essential in improving the patient experience. Training was required to address the gap in skill and knowledge.
The primary objective for sharing our activity via a Special Interest Report is to illustrate the need for independent measurable compliance of all physiotherapy services against HCPC and CSP Regulations and Standards.
Currently the HCPC re registration focus is on continuous professional development and the Care Quality Commission does not have jurisdiction to regulate standalone physiotherapy services: Therefore, all other regulatory checking is undertaken and reliant on the individual alone. The secondary objective of is to encourage physiotherapists to consider in depth and ensure they appreciate what are they stating, what they agree they are doing when they reregister and sign to state that they comply with all standards and regulations? Could auditing prove that this was the case and, if not, then why are they signing?