East of England

Spinal Triage by Extended Scope Physiotherapists in a diagnostic interface clinic: Spinal unit conversion rates from a 12-month service evaluation.

The Back and Neck Service (BaNS) was established in Suffolk (2003) as an interface clinic with the aim of reducing unnecessary referrals into the secondary care Spinal unit for surgical opinion. Since this time the service has expanded and now consists of six Extended Scope Physiotherapists (ESP) across the East (BaNS-East) and West (BaNS-West) localities. Importantly, the BaNS is embedded within a wider spinal pathway spanning both primary and secondary care which allows timely self-referral to musculoskeletal physiotherapy via a Single Point of Access (SPOA) portal. Patients with radiating symptoms failing to improve at 6-weeks, or those with axial symptoms that have failed appropriate management can be referred into the BaNS by their treating physiotherapist or via their General Practitioner. Following assessment and, where indicated, investigation(s), suitable cases are reviewed with a spinal consultant at a weekly meeting where appropriate patients can be directly referred into the secondary care spinal unit. The purpose of this service evaluation was to establish the effectiveness of the BaNS in triaging patients with axial and/or radiating symptoms into secondary care and to report the conversion rate to surgically led interventions (nerve root block injections & surgery). A secondary aim was to establish patient satisfaction with the service.

An audit of injuries within a cohort of elite level professional speedway riders during the competitive season 2018-19

To identify ways to improve the performance, and the health and well-being, of speedway riders.

Due to a lack of quality evidence-base to underpin professional practice in this field, to establish the incidence, nature and severity of injuries affecting speedway riders.

To highlight implications for practice and/or recommendations that can be used to drive improvements in practice.

To identify further areas for future investigation.

Priming elderly patients for surgery - the development of a pre-operative service for frail elderly patients

The Peri-operative Review Informing Management of the Elderly (PRIME) Clinic was developed in response to the increasingly frail population undergoing complex major surgery. Due to this, it was recognised that clinicians with advanced skills were required to manage and optimise this patient group pre-operatively, which led to the formation of a multi-disciplinary team consisting of consultant geriatricians, consultant anaesthetists, a senior physiotherapist and a senior occupational therapist. The aim of the team was to optimise patients from a medical, physical and social viewpoint.

The focus of physiotherapy input was to increase physical activity pre-operatively, improve respiratory function and identify falls risks in order to contribute to a reduction in post -op length of stay and improve patient function.

This service evaluation demonstrates the benefit of a highly specialised MDT model with frail elderly elective surgery patients.

Clinical Outcomes Review within a Musculoskeletal (MSK) Risk Stratified Model of Care

Measuring the clinical effectiveness of all healthcare services is a fundamental component of evaluating the impact care has on the service user. A community-based MSK physiotherapy service in Mid Essex has been using a validated and multi-dimensional outcome tool, the Musculoskeletal Health Questionnaire (MSK-HQ), since April 2017 to evaluate clinical effectiveness.

The service also recognised the importance of working in different ways to improve efficiency and matching treatments based on prognostic subgroups (stratified care) has been shown to be both clinically and cost-effective in the management of low back pain using the STarT Back Screening Tool.  However, risk stratified care for all MSK disorders is in its relative infancy, with the Keele STarT MSK Tool yet to be fully validated scientifically, although Keele University granted permission for the MSK physiotherapy service to use the tool for clinical purposes in April 2018. 

The service was therefore able to collect data from all appropriate MSK patients receiving treatment from April 2018 to March 2019 to evaluate whether good clinical outcomes and positive patient experience were demonstrated whilst delivering a more efficient risk-stratified care approach.

A musculoskeletal single point of referral in primary care

A single point of referral was implemented in partnership between Allied Health Professionals Suffolk (AHPS) and Norfolk Community Health and Care (NCHC) forming the Integrated Therapy Partnership (ITP). This aimed to standardise the care pathways for musculoskeletal conditions and ensure primary care referrals are processed to the correct provider first time around. This should avoid unnecessary secondary care referrals, where patients are seen in secondary care, receive no treatment and are referred back to community providers. Referrals are triaged by senior physiotherapists. Similar models have been suggested as effective methods of service delivery by the British Orthopaedic Association (Lennox & Karstad, 2013). This was coupled with the implementation of online self-referral for physiotherapy and occupational therapy, where patients were issued advice and exercise within 24 hours. Advice and exercise are issued for patients triaged for physiotherapy through the single point of referral. AHPs are responsible all patient administrative tasks and provide the triaging clinicians. NCHC provide clinical physiotherapy, occupational therapy and orthopaedic triage services. This is contracted to the Norwich and South Norfolk Clinical Commissioning Group and they set key performance indicators for patients being seen. Routine patients to be seen in 28 working days, urgent patients to be seen in 7 days and orthopaedic triage patients to be seen in 14 working days.

The digital future of physiotherapy

The Five Year Forward View report1 highlighted the need to take advantage of opportunities technology offers patients. 81% of UK Adults (91% 18-44) have touch screen smart phones with the majority (89%) 4G enabled.

Our service initiative utilises App and web based technology to provide patients with a credible, evidence based source of education and advice on musculoskeletal and mental health issues. Our aims:

  • Ability to complete visual triage assessments via web and App based solutions, enabling enhanced remote assessments and treatment.
  • To offer various mediums for patients to gain knowledge, fitting their learning styles. Through provision of evidence-based information on different platforms including; website, webinars, podcasts, blogs and an app.

This special interest abstract is to share our innovations with the wider physiotherapy community offering alternative ways of delivering services in the 21st century.

Cancer recovery and a personalised exercise service: A preliminary analysis

Previously people with long term illnesses such as cancer were often advised by their clinical team to rest and reduce their physical activity. But recent research has shown that exercise is not only safe and possible during cancer treatment, it can also improve an individual's level of physical functioning, increase their strength and stamina, improve their quality of life and help them to return to work. Studies have also shown that exercise can reduce their mortality and the risk of recurrent types of cancer by approximately 50%. The aim of our evaluation study was to explore the efficacy of a physiotherapy led exercise programme for people living with and beyond cancer to improve their overall health and wellbeing and fitness levels.  

UEA & Norwich City: A partnership approach

The poster provides an overview of the partnership established between the UEA and Norwich City over the past 5 years. It outlines the way that the MSc pre-registration physiotherapy students develop their research dissertation topics through a collaborative approach with physiotherapists at the Norwich City football club academy. It identifies the research questions investigated by current and previous Masters students. The final section demonstrates the benefits of using research to inform practice in the elite professional football academy setting and the value of making explicit links between research, education and practice. It does this through the narrative of the physiotherapists, students and academic staff themselves.

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