Patient experiences of residential orthopaedic rehabilitation programmes at a national specialist centre

Purpose

Within a national specialist orthopaedic hospital, residential rehabilitation programmes are available for patients with complex orthopaedic needs. Two such rehabilitation programmes, the lower limb (LL) and upper limb (UL) have an emphasis on the rehabilitation of long term (LT) musculoskeletal (MSK) conditions. These programmes are physiotherapy (PT) and occupational therapy (OT) led with access to psychology and psychiatry as appropriate. Both programmes' outcome data has demonstrated their effectiveness. Exploring service user experience was thought to be essential for continuing patient centred care as these services evolve to meet their increased demand.

Approach

Qualitative focus groups were chosen in order to explore patient experience. Four (LL) and five (UL) patients who had previously attended their respective inpatient rehab programmes were invited to attend and participate in a discussion group. Patients supported the development of the discussion group questions. Patients were asked to share their perceptions, opinions and experiences of the service. The LL discussion group was facilitated by UL clinicians and vice versa to reduce bias and the sessions were audio recorded. Thematic analysis was undertaken by the therapists of their respective patient groups. Direct transcription of relevant quotes was undertaken to illustrate the key themes.

Outcomes

Key positive feedback was consistent across both groups:

  • The rehabilitation programme facilitated their return to hobbies and work as it was tailored to their individual needs and goals.
  • Patients recognised the importance of a multidisciplinary and holistic approach: physiotherapy taught patients to work through their musculoskeletal impairments while occupational therapy assisted in integrating this into function and routine within their lives.
  • Access to psychological support services was valued.
  • Peer support whilst on the ward and after discharge was beneficial to patients.
  • Regular review, continuity of care (seeing the same therapists) and flexible contact with the therapists was deemed helpful in supporting progression and overcoming setbacks after rehabilitation.
  • Key constructive feedback:
  • Patients want improved information throughout the pathway. This would better prepare the patient for what to expect.
  • Consideration to ward environment and facilities (such as heating and food).
  • Patients suggested a more flexible approach to follow up post rehab e.g. videoconferencing, telephone, email, with patient led timeframes.
  • Delay between referral and admission negatively affected the patient experience.

Implications

Patients found the residential multidisciplinary rehabilitation programmes were valuable for the management of their long term musculoskeletal conditions. They felt that the effectiveness of the program was due to: · Ongoing continuity of the clinician / patient relationship. · Facilitation of a network of peer support whilst on the ward. · The inclusion of a functional and psychological approach in the management of their musculoskeletal condition. Focus groups are a useful way to gain patient perspectives to prioritise service improvement projects.  

The following service improvement initiatives will be conducted: 1. Development of streamlined patient pathways with clearly identified timescales. 2. The creation of information packs for patients. 3. To explore alternative venues to hold the programme.

Fund acknowledgements

This work was unfunded.

Additional notes

This work was presented at Physiotherapy UK 2018.