West Midlands

Data analysis on the role of the Independent Prescriber in Physiotherapy led spasticity clinics

The purpose of this project was to demonstrate the positive impact an Independent Prescriber Physiotherapist could have on the service delivery in outpatient spasticity clinics. The project aimed to demonstrate reduced patient waiting times for review appointments, reduced cost per appointment and demonstrate high patient satisfaction.  The overdue waiting period for spasticity reviews is a long standing problem for the spasticity service and on the Trust risk register. Historically spasticity clinics were managed in multidisciplinary team (MDT) clinics involving a Consultant and a Physiotherapist. A proposal was put forward to the team and agreed. This proposal was for a single Physiotherapist Independent Prescriber, with experience in management of spasticity and neuropathic pain, to set-up a pilot period of Independent Physiotherapy led spasticity review clinics.

Medicines optimisation for the treatment of spasticity and neuropathic pain led by a Physiotherapist Independent Prescriber

The purpose of this project was to improve medicines optimisation for the management of patients with spasticity or neuropathic pain who attended multidisciplinary specialist neuro outpatient clinics at West Midlands Rehabilitation Centre. The secondary purpose was to identify how much input was required to optimise medication after a change in medication was advised and if this input could be adequately carried out by a Physiotherapist Independent Prescriber.

Historically the Consultant (prescriber) would review and make changes as required to a patient’s medication for managing their spasticity and neuropathic pain.  Patients could contact in case of concerns, however, there was usually no medication follow up initiated by the Consultant between clinic appointments. This was due to limitations on Consultant capacity. Time periods between clinic appointments for each patient could be between 3-12 months depending on the request of the Consultant. This meant that if there were issues with obtaining or taking the medication and the patient did not initiate contact, the issue would not be addressed until the patient returned to clinic.

NICE provides guidance that the prescriber should review the patient with regards to their medication after starting or altering a medication within a timely period. This is important as it ensures that patients receive the right choice of medication for them, at the right dose and right time to benefit their health.

Medication reviews following a face to face appointment do not necessitate a face to face appointment and telephone reviews can be completely adequate.  This is because patient achievement of goals of treatment with medication is primarily identified through subjective assessment. The standard in this project was set that all patients who required a medication change in clinic would be reviewed, on time via telephone consultation(s). The time at which the patient would be need to be reviewed would be dependent on the time period in which the prescriber advised the medication change to occur over.

Functional Restoration Service

To provide group based, interdisciplinary, combined physical and psychological treatment (CPPP) service to patients with persistent non-specific back pain, to help restore function and quality of life. 

The service’s aim is to train patients to become experts at understanding their persistent low back pain, to manage flare-ups in pain effectively, to set goals to improve function, to reduce reliance on analgesic medication, and to engage in healthy behaviours

The service uses a cognitive behavioural approach, as recommended in the National Back Pain and Radicular Pain Pathway (Pathfinder) (2017) and NICE Guidelines (2016) as an effective way to manage persistent non-specific back pain and disability.

Prescribed Only Medications (POMs) issued in a musculoskeletal physiotherapy primary care

Non-medical prescribing was introduced in the United Kingdom (UK) to improve healthcare service efficiency, access to medicines and support service innovation. From 2013, independent prescribing was extended to include physiotherapists. Patients are facing increasingly long waiting times to see their GPs, and delays getting medication to aid their musculoskeletal ailments. This report aims to explore patient satisfaction of this service in a primary care musculoskeletal physiotherapy setting. IPOPS started provision of independent prescribing during physiotherapy sessions by a single physiotherapy practitioner in March 2017.

Implementing and evaluating a pilot physiotherapist-led osteoarthritis clinic in general practice

Joint pain due to osteoarthritis (OA) is a major cause of disability, work-loss and reduced quality of life in older adults. NICE clinical guidelines recommend core OA treatment should include education, exercise and weight-loss (when applicable). However, despite the evidence-base, many people with OA do not currently receive these treatments. This report describes and evaluates the implementation of a clinical-academic physiotherapist OA clinic embedded into a general practice.

Producing a data-inputting and analysis calculator to facilitate the standardisation of outcome measures

The advantages for using patient-reported outcome measures (PROMS) have been well documented in the literature. The need for physiotherapists to use standardised PROMS has been recognised and is recommended in clinical guidelines. Although the importance of standardising the use of PROMS within the physiotherapy profession is well recognised, it has largely failed to be delivered in practice. A number of barriers for implementation of standardised outcome measures has been reported including the lack of knowledge and the lack of instructions in relation to the application, scoring and interpretation of the outcome measure(s).

Musculoskeletal (MSK) physiotherapy teams within Staffordshire and Stoke on Trent Partnership Trust (SSOTP) used a variety of outcome measures including the EuroQol (EQ-5D-5L) alongside condition specific PROMS and a patient experience-reported experience measure, in line with CSP recommendations. Nevertheless, the teams did not use the same outcome measure and data collection, inputting and analysis methods varied considerably. Therefore, the use of outcome measures and data collection needed to be standardised.

Physiotherapy assistants in the musculoskeletal outpatients setting

Physiotherapy assistants accounted for approximately 20% of the physiotherapy workforce across Stoke on Trent Community Health Services. Although their job descriptions clearly stated that the post was primarily clinical, their role depended heavily on the qualified physiotherapists and how they utilised the clinical skills of physiotherapy assistants. As a result in some clinics/clinical areas physiotherapy assistants had a predominant clinical role whereas in others they fulfilled what was primarily an administrative role. This latter trend led to physiotherapy assistants not being able to utilise their clinical skills and to job dissatisfaction as well as disparity in the clinical service provided to patients of equal clinical needs.

Routine x-rays for suspected Frozen Shoulder: a retrospective review

Frozen shoulder is a common condition and current guidelines state that it is a diagnosis of exclusion. Along with a history and clinical examination, routine x-ray is mandated to rule out any masquerading pathology such as fracture, dislocation, metastatic lesions or severe OA. Despite the certainty of the guidelines there is a lack of evidence to support the use of routine x-rays in this situation.

Subscribe to West Midlands