Rehabilitation

Integrating Physiotherapy into an Adult Social Care Occupational Therapy service.

The Occupational Therapy (OT) service at Leicester City Council (LCC) faced some difficulties when they were working with a person who required Physiotherapy (PT) input in the community. Namely the long waitlist for input and an inability to establish a person’s baseline level of mobility when this was needed before recommending care packages, equipment or adaptations. The impacts on LCC were an increased need for formal care, equipment and adaptations as well as increases in OT staff’s workloads and/or delays in picking up new cases. Additionally, the cost to the person is highlighted as delays in accessing PT input can lead to further deterioration in their abilities (dependence) and/or the need to wait longer for equipment/ adaptations which may put them at risk.

The Front of House Team: Enabling and Supporting Discharge from the Emergency Department.

There is an increasing strain being placed all across the NHS systems. Emergency Departments up and down the country are being widely criticised for their performance against the national targets. We also have an aging population often with multiple co-morbidities that often present to the emergency department with both health issues and social care issues. The Royal Stoke Emergency department is one of the busiest in the country. In 2018 it had 111,091 attendances. 30,074. It had a higher than national average attendance to admission rate for over the age of 70. An external body wanted to see if creating a new MDT made up of senior decision makers with a background in the care of frail patients could make a difference.

Does Patients' Perception of Improvement following a Pain Management Programme, Match Reported Minimally Clinically Important Differences?

Clinical outcomes for patients attending a pain management programme were evaluated to determine whether patients who rated an improvement on a Global Impression of Change Score, achieved mean changes in BPI that were consistent with 'acceptable' change, and to determine mean changes on other outcomes in this population. It is suggested that a mean change of 2.09 in pain interference, as measured by the Brief Pain Inventory (BPI), could be considered acceptable to patients. Currently data is unavailable for changes in pain acceptance.

Collaborative cross-agency service delivery to address public health issues within an MSK setting: evaluation of ´Healthy Mind, Health Body´

Patients accessing Physiotherapy in Blackburn demonstrate multiple co-morbidities, physical and biopsychosocial issues. This unique, cost-effective, collaborative service redesign addresses the specific co-existing health issues and behaviours associated with MSK conditions in Blackburn and offers a cost-effective, high quality solution to empower and support the MSK population to better manage their own health and well-being in alignment with Public Health England priorities.

Service evaluation of the Anterior Cruciate Ligament Deficient Induction Clinic (ACLD) and Rehabilitation Class.

Historically, at GSTFT, patients with ACL pathology have been managed in weekly exercise classes. Anecdotally, Physiotherapists felt that they were unable to effectively manage both the post-operative and ACL deficient (ACLD) populations due to high class numbers. After an internal service evaluation and audit, a unique ACLD pathway was established to separate the ACLD population, and better manage both ACL cohorts. This included a specific fortnightly ACLD Induction Clinic and ACLD rehabilitation class.

This data collection aimed to:

  • Evaluate the demand for the ACLD pathway, including the new ACLD rehabilitation class, and analyse patient demographics
  • Ensure the ACLD pathway is utilised correctly, by monitoring patients being referred
  • Start analyzing the data and trends of patient attendance and onward management in the ACLD rehabilitation class and begin early root cause analysis.
  • Commence a systematic review around the quality of pre-operative physiotherapy intervention and how this effects outcomes post-operatively, in order to guide the temporality and content of our ACLD rehabilitation class.

Effects of a Multi-Disciplinary Physical and Psychological Programme on Kinesiophobia, Self-Efficacy and Functionality in Persistent Low Back Pain Service Users

Persistent Low Back Pain (PLBP) is the leading cause of disability worldwide. Disability and costs attributed to PLBP are projected to increase in coming decades (Hartvigsen et al, 2018). Research has now established that for people with PLBP, their cognitions and coping mechanisms play a bigger role in the progression from acute to persistent pain than physical features (Wertli et al, 2014). Clinical guidance (NICE, 2016) recommends that service users (SUs) who are not responding to routine management or have significant psychosocial obstacles to recovery, should be considered for a combined physical and psychological programme (CPPP). However, there are no clear current guidelines on the best format for a CPPP. The Back in Action (BiA) programme was introduced to address the needs of these SUs. This service evaluation aims to assess the effectiveness of the BiA 58 hour multi-disciplinary CPPP format on SUs pain related cognitions and function.

 

Effectiveness and optimal dosage of resistance training for chronic neck pain: a systematic review with a qualitative synthesis and meta-analysis

Ranked 4th for global disability neck pain is experienced by up to 50% of the population annually and is more common than low back pain in office-based workers. Clinical guidelines recommend multimodal physiotherapy that includes resistance training exercise (RET) for the neck and shoulders. Although RET programmes exist with different objective and physical outcomes (e.g. cervical isometrics, craniocervical flexor retraining etc.) no evidence synthesis has compared their effectiveness. Equally, despite being highly cited the dosage (repetitions, frequency, load) of RET varies considerably between studies. The aim of this study is 

1) to evaluate the effectiveness of RET in chronic non-specific neck pain (CNSNP)

2) to determine an optimal dosage.

Developing a Physiotherapy Foot Surgery Service and Patient Pathway

The foot surgery service was expanded in order to undertake more complex foot surgeries, this required an increase in physiotherapy input. Adaptations were made to our provision of physiotherapy to accommodate patients undergoing complex foot surgeries, patients with multiple co-morbidities and patients with complex social needs. This incorporated developing a robust protocol-led pathway including pre-op education and assessment with the aims of increasing attendance of our pre-op assessments “Foot School” and reducing length of stay (LOS).

An audit of injuries within a cohort of elite level professional speedway riders during the competitive season 2018-19

To identify ways to improve the performance, and the health and well-being, of speedway riders.

Due to a lack of quality evidence-base to underpin professional practice in this field, to establish the incidence, nature and severity of injuries affecting speedway riders.

To highlight implications for practice and/or recommendations that can be used to drive improvements in practice.

To identify further areas for future investigation.

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