Patient outcomes

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.

An evaluation of virtual physiotherapy as an alternative to in-person treatment.

Until recently, virtual physiotherapy services represented the minority of support offered by the private and public healthcare sectors. The Covid-19 outbreak created a sudden need for digital health services to be rolled out more widely.

Ascenti wanted to use its dataset of 27,000+ virtual appointments to see how results for online physiotherapy compared with those for in-clinic care and to gather views from patients and clinicians to enable further improvement.

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 benefits of providing a local serial casting service for children and young people in Powys.

Serial casting is a common conservative intervention for children and young people who are idiopathic toe walkers, or who have cerebral palsy and develop calf muscle contracture. The main aims of serial casting are to improve calf muscle length, walking pattern and efficiency. There is a strong evidence base showing serial casting is effective in improving calf muscle length. Historically in the large and rural county of Powys serial casting has been provided by out-of-county hospitals, making access difficult and involving children, young people and their families travelling long distances. A local physiotherapy-led serial casting service has been piloted within Powys for the last 1 year and 9 months, with capacity to provide treatment in local hospitals and schools as well as client´s homes. A retrospective audit was carried out to assess the benefits and effectiveness of this service.

How a team challenge with teenagers and young adults positively impacts activity levels and engagement.

Current guidelines suggest teenagers should complete 60 minutes of physical activity a day, including strengthening exercises 3 days a week. Research shows that only 20% of teenagers meet these recommendations. Teenage years can be challenging for a variety of reasons; this period is made even harder when you are given a life changing diagnosis of cancer. At the University College London Hospitals Macmillan Cancer Centre we initiated the #JOGLE challenge on our teenage and young adult (TYA) unit. The challenge was to collectively travel the distance from John O'Groats to Land's End - a total of 874 miles - using the equipment in the therapy gym. This service evaluation aimed to look at the impact of this challenge on physical activity levels and engagement with therapy services in TYA with a diagnosis of cancer.

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.

Testing models of Integrated working in acute hospital wards to scope models of healthcare for the future.

With a national picture of a shortfall of qualified nurses and continued NHS cost improvements, Sheffield teaching hospitals wanted to test using Integrated wards to scope new models of healthcare for the future. Aiming to be cost efficient, whilst delivering high quality care to patients and creating an improved working environment for staff. The project looked for ways to share skills and work more closely between the therapy and nursing professions, to avoid duplication, deliver the care patients need in a timely way and optimise time for each Profession to give their expertise to the patients who need it.

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.

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