South West

Oxygen and Non-Invasive Ventilation Pathways in an Adult Cystic Fibrosis Centre

Cystic Fibrosis (CF) is a genetically inherited condition affecting more than 10,000 people in the United Kingdom. A progressive cycle of infection and lung damage occurs. Worsening lung function results in hypoventilation and ultimately leads to respiratory failure that may require supplementary oxygen and/or mechanical support such as Non-Invasive Ventilation (NIV). Guidelines support the use of NIV for nocturnal hypoventilation, hypercapnic respiratory failure and as a bridge to transplant. At the time of development, there were no published guidelines on the use of oxygen therapy in CF and no published pathways on the set up and management of supplementary oxygen or NIV in CF. This special interest report documents the development of separate oxygen and NIV pathways through interdisciplinary working in an adult CF centre.

Objective To develop pathways for supplementary oxygen and the set up and management of NIV in an adult CF centre.

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.

Therapy led Stroke Early Supported Discharge: outcomes in mild to moderate stroke survivors

The Stroke Early Supported Discharge (ESD) service enables accelerated discharge to service users providing seven days a week specialist rehabilitation and social support in the community to mild and moderately impaired stroke survivors. Service provision is focused around time specific goals and will consider the needs and ability of their carers. The main focus is to save bed days and improve patient outcomes and goals in the community setting.

The main aims and objectives is to demonstrate the outcomes particularly in relation to physiotherapy with ESD input in patients who have had a mild to moderate stroke.

Patient satisfaction and outcomes of MSK pain patients accessing Advanced Physiotherapy Practitioner in primary care

The service objectives are to:

  1. Reduce workload of GPs
  2. Provide assessment and self-management
  3. Provide high quality care and a good patient experience to patients with MSK problems
  4. Support patients to remain in/return to work
  5. Provide staff with a positive experience.

The purpose of this project was to evaluate and monitor the progress and growth of the service against our service objectives

Some of the driving forces behind the Advanced Physiotherapy Practitioner (APP) are the 5 Year Forward View, GP Forward View, local Sustainability and Transformation Partnerships and local GP Cluster priorities. These drivers focused on workforce transformation within primary care and the MSK pathway. This service will enable patients to access a specialist MSK services at the beginning of the pathway.

This project also aimed to examine the outcomes of APP appointments to determine referring habits, changes in referral patterns and effects on GP workload and secondary care referrals.

Collaborating with council services to encourage people with low back pain to self-manage in community settings

Moving care out of hospital settings and into the community is a key focus of the NHS Five Year Forward View. We explored if it was feasible for NHS physiotherapists to deliver free back classes within local council leisure centres, and if they effectively helped to increase participant activity levels. A review of the back pain pathway within Wiltshire generated a desire to use a stratified approach to interventions. We chose to begin with those scoring low risk on the STarT back tool, aiming to deliver messages to foster a positive approach to exercise and prevent unhelpful beliefs developing. This service evaluation will inform the wider back pain pathway in Wiltshire and may provide insight to other physiotherapists planning similar projects.

Increasing healthy lifestyle conversations with patients in the community

The population of older people is rapidly growing and many are not living in good health; this escalating problem has significant economic and resource implications but more importantly impacts on individual quality of life in later years. In recognition of this 'perfect storm' the importance of embedding prevention strategies and health promotion interventions specific to older people is widely recognised. One approach to tackling this, Making Every Contact Count (MECC), empowers staff to initiate opportunistic conversations with people who report 'risky' health behaviours, supporting the first positive steps towards health behaviour change and self-management.

This quality improvement project was initiated following a record keeping audit which identified that healthy lifestyle conversations were recorded in only 19% of clinical records. It aimed to increase the number of documented healthy lifestyle conversations that clinicians have with Integrated Community Team patients.

Evaluation of treatments and outcomes, red flags and signs and symptoms for cervicogenic headache in a musculoskeletal setting

Current evidence advocates physiotherapy treatment, for the management of cervicogenic headaches (CGH). A reasoned assessment and clear knowledge of red flags is essential.

An MSK physiotherapy team from southern England received training sessions for CGH. Topics included assessment, evidence based treatment, clinical reasoning and red flags. Physiotherapists completed a questionnaire on headache red flags and signs and symptoms, preceding and following training.

10 patient cases were examined, exploring treatments, against current best practice, after training. Effectiveness was evaluated using patient outcomes before and after intervention.

The purpose/objectives of this study was to:-

  • Evaluate participant's knowledge of red flag and signs and symptoms of CGH headache, preceding and following training.
  • Examine treatments used by participants for 10 CGH patient cases, against current best practice after training.
  • Review patient treatment outcomes, of the 10 CGH patient cases after training.

Physiotherapy Triage Service for Cancer Patients – a service evaluation.

Individuals with cancer experience a plethora of symptoms from diagnosis, through treatment and beyond into survivorship. Allied Health Professionals are uniquely placed to impact upon these symptoms by engaging individuals in rehabilitation. Scoping of rehabilitation services amongst individuals with cancer undergoing haematological and oncological treatment highlighted various issues with fatigue, loss of function, pain and breathlessness. A pilot programme was implemented to address these unmet needs.

Cognitively informed exercise and educational group in persistent low back pain

Low Back Pain (LBP) is the largest cause of years lived with disability worldwide. UK guidelines recommend a combined physical and psychological programme (CPPP), preferably delivered in groups, as a treatment option. A CPPP based on the fear avoidance model of pain was evaluated in 2013, where just 36% of patients achieved a clinically meaningful improvement in disability. The programme was revised (2017) to include a focus on pain self-efficacy, the largest mediating factor in LBP-related disability. The aim of this service evaluation (SE) was to evaluate whether the revised programme improves LBP-related disability, with a secondary aim to evaluate the programme content.

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