London

A review of an innovative digital group therapy breathing & energy management programme designed to reduce symptoms of Long COVID.

The purpose of this programme was to implement a service for patients suffering with symptoms of Long COVID (symptoms for longer than 12 weeks post COVID). 

The two most common symptoms of Long COVID are breathlessness and fatigue1. Two physiotherapists who are committee members of the special interest groups Breathing Pattern Disorders (BPD) and ‘Physio for ME’ ( fatigue management) collaborated with RespiriCare (independent company consisting of specialist respiratory physiotherapists) and 3 patients suffering with Long COVID to create a live, virtual 6-week breathing & energy management programme.

The home-based educational programme encourages good quality rest, energy management, sleep management, re-establishing efficient breathing and optimal nutrition and hydration which are essential for the recovery from COVID2.

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.

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.

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.

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.

Implementing Prehabilitation in a Tertiary Vascular Centre A Quality Improvement Journey

Prehabilitation is enhancing a patient's functional capacity before surgery, with the aim of improving postoperative outcomes, and should include medical optimization, physical exercise, nutritional and psychological support. Prehabilitation prior to vascular surgery has been recognised in the more recent GIRFT report [2018] .We developed a prehabilitation programme for patients awaiting AAA repair at a tertiary referral vascular centre with a high number of patients undergoing aortic aneurysm surgery

Description of performance and functional trajectory of acute oncology inpatients at a London tertiary centre.

Advances in cancer care and its treatment mean that people living with a cancer diagnosis are living longer but not necessarily living well. It is reported that cancer patients present with multifaceted symptom burden that often impacts on physical performance.

At present exemplar models of cancer rehabilitation exist across the UK along with tumour and symptoms rehabilitation guidance in the form of NCAT Rehabilitation Pathways (National Cancer Action Team, Macmillian Cancer Support 2013). Implementation of these rehabilitation pathways into the inpatient setting can be challenging due to the multifactorial nature and interplay of symptoms cancer patients present with and the resources available.

Our local study primarily aimed to understand the functional trajectory of our acute inpatient population in order to determine how the cancer rehabilitation of the acute population can be optimised in future proposed work.

Key study aims:

  • To describe the acute inpatient oncology population
  • To describe the performance and functional trajectory of the acute inpatient oncology population
  • To feed into a wider project supported by fit for the future looking at “how do we optimise rehabilitation in acute oncology inpatients”

Metastatic Spinal Cord Compression - A Retrospective Audit of Current Practice on Medical Oncology and Haematology Wards at GSTT

Metastatic spinal cord compression (MSCC) is an oncological emergency that requires efficient and effective diagnosis, treatment and rehabilitation (NICE 2008).

 

The current MSCC quality standards for adults highlight the need for:

  • Early detection of MSCC through appropriate assessment by MSCC Co-ordinator, spinal surgeon and clinical oncologist, and imaging within 24 hours.
  • Treatment (dexamethasone, radiotherapy, surgery) commencement within 24 hours of confirmed diagnosis
  • Timely rehabilitation and discharge planning with patient and family input

 

The aim of this audit is to:

  • Determine whether the multidisciplinary team (MDT) management of MSCC patients meets national (NICE 2008) and local (KHP, 2016) guidelines at Guys and St Thomas Foundation Trust (GSTT)
  • To identify if and where improvements need to be made against both national and local guidance.
  • To assess components of the care pathway for timeliness, clinical decisions and processes – namely referrals to clinical oncologists, neuro/spinal surgeon, access to timely imaging, prescribing a suitable dexamethasone dose, timely treatment decisions, confirming spinal stability status and referral to rehabilitation services with provision of timely rehabilitation.
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