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Impact of early intervention and rehabilitation on functional decline in patients hospitalised for acute heart failure

Acute heart failure (AHF) is the most common cause of admissions for patients aged 65 and over in the UK. The occurrence of functional decline in elderly adults with hospitalisation for acute illness is well established with decline occurring as early as day 2 of admission. With an average length of stay of 18.7 days, patient age of 71.4 years, and 77.1% of patients having at least one other chronic disease, the patients admitted to the Heart Failure Unit at St George's Hospital are high risk for functional decline throughout their stay. Traditionally these patients would not be seen by a physiotherapist until after their intravenous diuretic treatment was completed. The aim was to assess the impact of early and specialist physiotherapy assessment and intervention on functional decline during hospitalisation of patients with AHF.

Impact of Intensive Hyper-Acute Neurological Rehabilitation

There is strong evidence to support the provision of specialist and intensive rehabilitation programmes (BSRM 2014) and that the highest level of neurological recovery occurs within the first three months post injury (Broeks et al 1999, Feys et al 2000). However, clinical data from our patient cohort showed patients were not commencing rehabilitation until after this time window due to delays in access to specialist rehabilitation, specifically our local district general patients would wait on average 87.3 days, and patients awaiting repatriation to local hospitals would wait 35 days from being medically stable before transfer. On analysis of our patient caseload, 70% of the caseload had a Rehabilitation Complexity Score of more than 10 indicating a complex specialist service as determined by Turner- Stokes et al (2007), however our staff to patient ratio fell significantly short of the recommendations for this level of service. Funding for this service type traditionally comes from NHS England. It was hypothesised that these delays and service parameters impacted on patient’s functional outcome and on the wider health economy.

This service pilot aimed to examine whether provision of specialist rehabilitation to neurological patients receiving hyper-acute neurosciences care would result in clinically significant functional improvements and reduce length of stay, and transfers to specialist facilities.

Staff engagement in the provision and completion of patient diaries

Patients surviving critical illness are at high risk of developing psychological problems after discharge, with as many as 10% developing symptoms of post-traumatic stress disorder (Wake & Kitchener, 2013), positively correlated with length of intensive care unit (ICU) stay. NICE recommends commencement of rehabilitation as soon as clinically possible in this group. Diaries have been shown to assist patients with fragmented delusional memories and difficulty recollecting their experience, and are hypothesized to work similarly to cognitive behavioural therapy. Factors including lack of awareness, time constraints and the non-compulsory nature has led to inconsistent staff engagement with the patient diary system at Medway Maritime Hospital.This project aimed to increase provision, consistency and overall multidisciplinary team (MDT) engagement with diaries for patients admitted to ICU for over 72 hours.

Delivering self-management for low back pain via a digital solution in primary care

Most low back pain (LBP) does not need specific or specialist treatment and will often resolve if people follow simple evidence-based advice. Access to this advice is inconsistent with people often self-managing via untrusted resources online. Using digital technology to provide immediate day-by-day support whilst connecting people to their local MSK pathway and support services, has the potential to deliver trusted evidence-based advice in a consistent and standardised way. We are introducing a self-management solution (getUBetter) into the routine care of patients with LBP. Implementation should lead to quicker recovery, better outcomes, and a reduction in overall healthcare spend.

Patient experience of physiotherapy input on a specialist heart unit

Acute heart failure care is recommended to be delivered by a multidisciplinary team, incorporating education, and advocating self-management and patient centred care. With this in mind in 2016 a specialist 11 bedded heart failure unit (HFU) was opened to cohort patients with acute heart failure with the aim of improving outcomes in quality of life, 30 day readmission rates, and mortality. As heart failure is often associated with marked reductions in quality of life and high levels of debility, a full time specialist physiotherapist was funded to work as part of the multidisciplinary specialist team. The aim was to assess the impact of exercise education and early physiotherapy intervention on patient experience.

Patient experiences of residential orthopaedic rehabilitation programmes at a national specialist centre

Within a national specialist orthopaedic hospital, residential rehabilitation programmes are available for patients with complex orthopaedic needs. Two such rehabilitation programmes, the lower limb (LL) and upper limb (UL) have an emphasis on the rehabilitation of long term (LT) musculoskeletal (MSK) conditions. These programmes are physiotherapy (PT) and occupational therapy (OT) led with access to psychology and psychiatry as appropriate. Both programmes' outcome data has demonstrated their effectiveness. Exploring service user experience was thought to be essential for continuing patient centred care as these services evolve to meet their increased demand.

The use of electrical stimulation in the treatment of adult traumatic brachial plexus injuries

Traditionally the Electrical Stimulation (ES) of muscles was a frequently used adjunct for rehabilitation following nerve injury. More recently its use has been in decline. An international collaborative group of therapists with a special interest in Traumatic Brachial Plexus Injuries (TBPI) was formed in 2017. One of the objectives of the group is to assess and improve the evidence base surrounding the rehabilitation of TBPI. Disparity within the group with regards to the use of ES highlighted the need to explore current practice and the reasons for variability in use.

Web-based and smartphone based exercise prescription program

  • Evaluate the quality and adherence of patients with MSK conditions to agreed exercise programmes when using a digital platform compared to a printed version.
  • Evaluate the patient´s experience when engaging with an exercise programme and their interaction with clinicians and any differences related to patient characteristics (age, gender).
  • Evaluate the impact on generic patient reported outcome measures (PROMS) (eg PSFS, EQ5D, MSKHQ)
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