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.
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.
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.
To evaluate the effectiveness of a community based Exercise After Stroke Group (EASG) in patient outcomes and service delivery.
- 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)
Advanced Level Physiotherapy (ALP) is a term used to describe a level of practice for a physiotherapist to be working at. It includes utilising a combination of advanced skills, knowledge and clinical reasoning to successfully and safely manage patients, recognising where a clinical presentation is outside an individual's scope, and taking appropriate action. Utilising advanced clinical reasoning and making appropriate radiology referrals enables physiotherapists to exclude serious pathology and determine the appropriate pathway for a patient. Being able to safely triage and direct patients to conservative management or escalate to an orthopaedic review where suitable is the cornerstone of a clinically-effective service, and highlights the benefits of having experienced physiotherapists on hand to guide patients appropriately. Many studies have looked at whether the diagnostic accuracy of physiotherapists is comparable to orthopaedic consultants, but the diagnostic accuracy of a telephone based ALP triage service has not previously been investigated. The aim of this study was to audit the diagnostic accuracy of radiology investigations performed for spinal pain (cervical, thoracic, lumbar and sacroiliac) by a telephone based ALP triage service.
Respiratory function significantly predicts both survival and quality of life in people with Motor Neurone Disease (MND). Early referral to specialist respiratory services at the onset of symptoms is vital to facilitate decisions regarding respiratory management. Effective management of respiratory symptoms is likely to have a positive impact on the quality of life of the person with MND. Objective measures of respiratory function allow clinicians and patients to self-monitor respiratory symptoms at home. A challenge of working within a multi-disciplinary (MDT) community neurological therapy team was the lack of easy to use, accessible, accurate objective measures of respiratory function. We describe the development of the team's MND respiratory assessment, which aimed to improve early identification of people with respiratory impairment. A further aim was to improve the referral pathway between the community team and its local sleep and ventilation service.
Approximately 20,000 sick days (1500 staff members) at St. George's University Hospitals NHS Trust (SGUHT) are due to musculoskeletal issues. This costs the trust approximately £3.4 million per year. Despite this it is the only trust within inner London that, currently, does not have a physiotherapy service within their Occupational Health (OH) offering. The argument for delivering the service is clear, supported by previous research, service evaluations and local data analysis.
To describe the role of an Advanced Physiotherapy Practitioner (APP) working within a multidisciplinary team with people with complex persistent pain in acute hospital, outpatient and community settings.
To describe relevant physiotherapy skills required in these settings
To describe the clinical outcomes of the service