Rehabilitation

South Tees Integrated Falls Prevention Strategy

South Tees has had a CCG commissioned falls service since 2007 and has had significant year on year growth in referral rates. Despite this, the team have operated on the same resource and the service had become reactive rather than proactive.

 

Year      Male      Female      Total Referrals
2013   462   861   1323
             
2014   585   1027   1612
             
2015   684   1096   1780
             
2016   678   1047   1725
             
2017   639   1081   1720
             

 

Proposed key outcomes of the review were: A mapping exercise of existing services against NICE guidance was used to identify areas for improvement which created an opportunity to review the current service with a view to develop a system-wide approach to falls prevention.

  • Reduced falls and injuries
  • A region-wide falls pathway
  • Coordinated, individualised risk assessment and interventions
  • Improved partnership working

ICU and Beyond – Establishing a Post ICU Rehabilitation Pathway and Virtual Class

Within our consultant led ICU follow up clinic we recognised that there were an increasing number of patients presenting with on-going physical and psychological problems relating to their stay. Many of these patients reported lack of access to longer term rehabilitation and psychological support.

The purpose was to develop a specialist therapy pathway for patients following an intensive care stay; to improve physical and psychological outcomes, and the overall experience and support for patients and families.

Aspects included working towards;

  • Specialist Supported discharge home.
  • Joint handover of care and on-going support to community teams
  • 3 month review in line with NICE guidance.
  • Provision of MDT rehab class.
  • Capacity to provide hydrotherapy in the future.
  • Development of MDT follow up clinics
  • Psychology support with specific reference to ICU and critical illness

Beyond – Establishing a Virtual Post ICU Rehabilitation Class

 

The COVID-19 pandemic forced us to rethink how we could deliver Post ICU support and ensure rehabilitation needs of those leaving ICU were met.

The redeployment of staff during the first wave allowed us to pilot a virtual Post ICU rehabilitation class.

The Greenwich Pulmonary Rehabilitation Programme: a virtual delivery model & a QI project

The Greenwich Pulmonary Rehabilitation (PR) Service consists of 0.1 WTE team lead, 1.0 WTE band 6 split between 2 part time staff, a fixed term 3 month contract band 5 physiotherapist and 1.0 WTE rehab assistant.

The driver behind the project was to address the issue of the suspension of our face to face supervised PR classes (4 sessions per week at local leisure centres) during the COVID pandemic. With a mounting waiting list and an expectation that we would not be able to return to business as usual, we had to adapt.

Our primary objective was to design a programme that was effective, safe and that patients would enjoy.

A secondary objective alongside the Oxleas QI team was to increase patient completion rates over a 3 year period.

Current completion rates for the Greenwich Pulmonary Rehab programme was low at 40%.

The end point of the project was to be able to confidently offer increased patient choice on how to access PR.

There is an ongoing national challenge to manage patient drop out rates, which are multifactorial in nature. The redesign and delivery of a virtual programme could address problems such as: difficulties travelling to the class, poor weather conditions and psychological challenges where patients feel unable to leave their home to attend.

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.

Maximising impact of gait analysis reports on non-surgical management of children with neurodisability.

Instrumented gait analysis (IGA) impacts clinical decision-making in orthopaedic management planning for ambulant children with neurodisability (CwND). Studies shown that IGA influences paediatric surgery planning, but clarity on paediatric physiotherapy practice impact is sparse. Physiotherapists play an important role in helping ambulant CwND fulfil functional potential through management of walking ability, gait improvement training, equipment and post-operative gait rehabilitation but possibly under-use IGA. The study aim was to improve utilisation of IGA reports in inter-disciplinary management of CwND.

Paediatric Anterior Cruciate Ligament (ACL) reconstruction rehabilitation pathway

Decreased activity levels as well as earlier sport specialism in paediatric populations are leading to an increase in number of patients with traumatic ACL rupture. ACL repairs are preferred due to evidence of adverse long term outcomes with conservative management. Therefore, the demand for ACL reconstruction rehabilitation is increasing. Additionally, high re-injury rate (29%) in adolescents post reconstruction surgery has been documented. In order to provide optimal evidence based rehabilitation and prevent re-injury in these patients the ACL Pathway was created. This service evaluation investigates the effectiveness of the pathway since it was implemented 18 months ago.

Goal-Directed and person-centred Rehabilitation for spasticity post-stroke and brain injury.

Stroke and brain injury-survivors have difficulty controlling muscles and in many cases, 'tightness' of muscles called spasticity. Spasticity is often painful, akin to muscle-cramp. It can limit mobility and independence and cause distressing complications of contractures, skin breakdown and pressure sores.

The aim of this work was to development a preliminary model 'goal-Directed and person-centred Rehabilitation (Direct-Rehab)', to link clinical decision making for patient centred treatment, with the goals and process of treatment. This requires a focus on linking physical rehabilitation treatments (often in combination with pharmacological treatments such as botulinum toxin) to person-centred goals.

Effects of Aerobic and Strengthening Exercise Combined with Behaviour Change Interventions in Fatigue Management of People with Multiple Sclerosis(pwMS).

Fatigue is one of the more debilitating symptoms as it affects the ability to carry out daily activities. Despite the increasing evidence for the effectiveness of exercise and behavioural change interventions for fatigue management in pwMS, there have been no published critical review that has investigated a combination of exercise and behavioural change interventions. This review aims to investigate the effect of aerobic and strengthening exercise combined with behavioural change interventions in fatigue management in pwMS.

The Importance of Leadership in Community Physiotherapy

Supporting Community Rehabilitation is a core priority for the Chartered Society of Physiotherapy. With increasing national pressures to move care into the community and out of hospital, we know there is a significant challenge ahead. We hear anecdotally that community physiotherapy services are under resourced, carry long waiting lists and are considered unattractive roles by many working in other specialities. Many services are blighted by issues of recruitment and retention. We know we have an ageing population and rising numbers of people have multiple long term conditions. The rehabilitation needs associated with those conditions is often provided by physiotherapists working in the community. We wanted to understand the realities of working community physiotherapy, the models of care that have been used to support service improvements and to design a package to support members in practice.

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