Research, quality improvement and implementation approaches

Spasticity interventions in cerebral palsy for people with and without intellectual disabilities - a comparative analysis

The main purpose for this narrative literature review is to analyse and describe the best available evidence for spasticity intervention in Cerebral Palsy for people with Intellectual Disabilities and provide the clinicians an overview of how the evidence could be used to inform decision-making, compare and choose the appropriate intervention in this population. This would be comprehensive resource for physiotherapy practitioners for evidence implementation of these interventions. This review also assisted in identifying the gaps in evidence and to discover new research areas.

Move, Groove Improve Quality Improvement Project

The purpose of this project was to reduce the effects of deconditioning and promote functional independence on an elderly care ward, with the ethos inspired by the End Pj Paralysis campaign. The first aim was for over 55% of patients to be sitting out daily for lunch on the ward. The aim was also for over 20% of patients to be wearing their own clothes daily on the ward. Secondary aims including improving patient experience, increasing staff knowledge on deconditioning and maintaining and reducing length of stay.

Lung ultrasound in the management of patients with cystic fibrosis: A literature review

Adults and children diagnosed with cystic fibrosis (CF) are regularly exposed to ionising radiation, from chest radiographs (CXR) and computed tomography (CT). This poses an issue as life expectancy has increased into the fifth decade of life.

Lung ultrasound (LUS) has the ability to assess many lung pathologies experienced in CF with accuracy close to CT but without the exposure to ionising radiation. The purpose of this review is to explore the literature to establish if LUS is being used to aid the management of patients with CF.

The use of a standardised outcome measure within the Musculoskeletal Physiotherapy Services across a Trust in Staffordshire

Musculoskeletal (MSK) physiotherapy teams within Midlands Partnership NHS Foundation Trust (MPFT) historically 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 Chartered Society of Physiotherapy (CSP) recommendations. However, teams used different outcome measures and data collection, inputting and analysis methods varied considerably.

In 2017, the MSK Health Questionnaire (MSK-HQ) was introduced and a data inputting and analysis calculator was developed following a consensus group exercise with the clinical and operational leads of MSK physiotherapy teams to facilitate the implementation of the MSK-HQ.

Use of a protocolised estimated discharge date following hip fracture surgery improves discharge planning and reduces length of stay

Prior to this service development, senior Physiotherapists observed that estimated discharge date setting for hip fracture patients at daily MDT board round was arbitrary and differed significantly based upon which staff members were in attendance that day. A service development was therefore completed to identify an effective and efficient means to use a validated outcome measure to set a protoclised, realistic and evidence-based discharge date on the day of surgery, based upon pre-morbid function.

The effects of a new Tendo-Achilles Pathway (TAP) on an orthopaedic department.

Achilles tendinopathy is a common pathology that is considered difficult to treat. At a time of austerity in the NHS it is essential to have carefully designed pathways that are monitored in terms of cost and effectiveness. However, a paucity of evidence exists for what the “best value” dedicated “joined up” pathway of care is for this difficult condition. Design, implement and evaluate the impact of a new therapist lead pathway for Tendon- Achilles Pain (TAP).

Supported Exercise programme for Adults with Congenital Heart disease (SEACHange)

Congenital heart disease is a lifelong condition. Many patients will require repeated open heart surgeries during their lifetime and others may go on to develop heart failure, arrhythmia or other problems associated with acquired heart disease. The benefits of regular exercise are well known. The overall aim of this pilot study is to determine the feasibility of introducing a supported exercise programme in to clinical practice to support physical and psychological well being in adults with congenital heart disease living in Scotland.

Data analysis on the role of the Independent Prescriber in Physiotherapy led spasticity clinics

The purpose of this project was to demonstrate the positive impact an Independent Prescriber Physiotherapist could have on the service delivery in outpatient spasticity clinics. The project aimed to demonstrate reduced patient waiting times for review appointments, reduced cost per appointment and demonstrate high patient satisfaction.  The overdue waiting period for spasticity reviews is a long standing problem for the spasticity service and on the Trust risk register. Historically spasticity clinics were managed in multidisciplinary team (MDT) clinics involving a Consultant and a Physiotherapist. A proposal was put forward to the team and agreed. This proposal was for a single Physiotherapist Independent Prescriber, with experience in management of spasticity and neuropathic pain, to set-up a pilot period of Independent Physiotherapy led spasticity review clinics.

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