Rehabilitation

Functional Restoration Service

To provide group based, interdisciplinary, combined physical and psychological treatment (CPPP) service to patients with persistent non-specific back pain, to help restore function and quality of life. 

The service’s aim is to train patients to become experts at understanding their persistent low back pain, to manage flare-ups in pain effectively, to set goals to improve function, to reduce reliance on analgesic medication, and to engage in healthy behaviours

The service uses a cognitive behavioural approach, as recommended in the National Back Pain and Radicular Pain Pathway (Pathfinder) (2017) and NICE Guidelines (2016) as an effective way to manage persistent non-specific back pain and disability.

Multimorbidity Rehabilitation- The Sustainable Way Forward

Recognising that there is limited funding for “doing more of the same” we looked at how we could increase our cardiac rehabilitation capacity by broadening our scope and expertise to encompass a range of long term conditions that cause a high impact on unscheduled care. We acknowledged that multi-morbidity is becoming increasingly prevalent.

We subsequently developed The Healthy and Active Rehabilitation Programme (HARP) and opened up referrals to include people affected by stroke, cancer, COPD, falls, diabetes, and other long-term conditions.  HARP enabled us to widen our rehabilitation capacity to include cardiac groups which are typically excluded due to resource limitations: angina, arrhythmias and devices.  We designed a programme that would embrace activity, self management and support lifestyle change, across all of these groups.

Thus, the overall aim of this project was to proactively support prevention and self-management in an ageing population with increasing prevalence of chronic multiple morbidities. To help reduce health inequality the project has specifically targeted deprived and rural communities.

Secondary objectives 

  • To develop an evidence base for multimorbidity rehabilitation that would support a new way of working
  • To prove that this new model was sustainable

Exploring hospital and physiotherapy length of stay following thoracic surgery

The number of thoracic surgical procedures performed in the United Kingdom continues to increase annually putting pressure on thoracic surgical bed capacity. Reducing hospital length of stay (LOS) following thoracic surgery can help to reduce pressure on hospital beds. The purpose of this service evaluation is to explore hospital and physiotherapy LOS for individuals following thoracic surgery at our hospital and identify whether any factors influence hospital and Physiotherapy LOS. The findings could potentially allow the identification of individuals at risk of longer LOS and help direct physiotherapy rehabilitation provision to these individuals.

Student-Led Neurological Rehabilitation Group

Adults with long-term neurological conditions have low levels of participation in physical activities and report many barriers to exercise. This study used a mixed methods approach to evaluate participant experiences and outcomes following participation in student-led, community-based neurological groups and to explore the feasibility of performing a full-scale study.

Using ANGEL taxonomy to triage referrals in Ceredigion community physiotherapy

To evaluate whether service improvements could be made to our community physiotherapy service through clinical streaming of patient referrals using underlying principles complexity science to consistently deploy the most appropriate member of the physiotherapy team to meet the needs of patients and improve the effectiveness of our service.

Physiotherapy Supported Discharge Service following knee arthroplasty

An audit on length of stay (LOS) for total knee replacement (TKR) patients following surgery highlighted that a number of patients were exceeding their predicted date of discharge (PDD), many due to not achieving traditional physiotherapy goals (90⁰ flexion, < 5 ° extension lack and good quadriceps function), despite being safely mobile and medically fit. This exposes patients to risk of harm due to prolonged stay within an acute hospital environment as well as inefficient utilisation of an in-patient bed. A Physiotherapy Supported Discharge Service (PSDS) had previously been piloted for six months. Phase 2 consisted of permanent service resign, continuing the PSDS and service evaluation.

Implementation of a new goal-planning process in an intermediate neuro-rehabilitation unit

It was recognised that the neuro-rehabilitation unit had a length of stay above the national average of 80 days. A new multidisciplinary goal planning process was implemented on the unit with the following aims; reduce length of stay to the national average; reduce the waiting list to 1 week; to consistently achieve greater than 70% patient and family/carer satisfaction.  The impact on the FIM/FAM outcome measure was monitored to ensure there were no adverse effects on patient outcome as a result of implementing the new process.

Stroke rehabilitation quality improvement plan

Oxford Health NHS Foundation Trust (OHFT) committed to a Stroke Quality Improvement (QI) Project to enhance the quality of rehabilitation for patients on the Oxfordshire Stroke Pathway. Following poor performance in the national indicators Sentinel Stroke National Audit Program (SSNAP) and local Key Performance Indicators (KPIs), the Stroke Quality meeting was initiated by the physiotherapy team to review care and develop a multi-professional improvement plan. Aligning service provision with that recommended in the 2016 Royal College of Physicians National Stroke Guidelines required consolidation of two stroke units, 14 miles apart, into one specialist stroke rehabilitation ward. This abstract outlines key objectives of the QI project, describe progress to date, and evaluates the impact on quality delivery and patient outcomes so far. The objective is to share positive experiences and challenges encountered during the project.

Patients with fibromyalgia attending primary care based education seminars and workshops

To ascertain patient feedback following their attendance at education seminars “Understanding Fibromyalgia”, “The role of medications in the management of Fibromyalgia” and a 'Moving forwards workshop' for people with a diagnosis of Fibromyalgia Syndrome (FMS). This is a change from usual practice where patients were seen in specialist secondary care by a member of the medical team. Education and exercise are now prioritised as first-line interventions.

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