Innovations

First Contact Physiotherapy (FCP) is a new primary healthcare model in which a specialist physiotherapist in Musculoskeletal Disorders (MSKDs) located within general practice, undertakes the first patient assessment, diagnosis and management without the requirement for prior GP consultation. It is intended to provide additional capacity and diversify the primary care workforce to meet the high demand for MSKD appointments and the challenges of recruiting and retaining GP staff. Initial audits of the service propose the FCP model may free up GP appointments, reduce secondary care referrals and scan requests, improve patient satisfaction, and produce cost savings. However, there is a lack of robust research evidence, and limited understanding of how best to implement FCP given contextual variation in general practices across the UK. This rapid realist synthesis generated and refined programme theories to develop insight into “What it is about FCP in Primary Care that works, for whom, in what circumstances, how and why?”. This was the second stage of a four-part project exploring the FCP role.

The current paediatric population are not reaching targeted government's guidelines of physical activity. This can lead to serious implications to children's health and wellbeing. Furthermore children with chronic health conditions and/or impairments participate in activity less than the general population. Activity apps have been shown to support positive behavioural change. Although many apps exist, promoting physical activity, an opportunity to design an app inclusive and accessible for children with challenging health conditions and disabilities was identified. The aims of this study were:  

• To design an app that parents and children would use that promotes inclusive physical activity.
• To evaluate the feasibility of using the app.
• To use feedback and demand from users to make adjustments to app functionality prior to public release.

Patients with spinal pathologies can range from simple mechanical low back pain to complex pathology requiring urgent medical or surgical intervention. The national low back pain pathway recommends the use of 'triage and treat' practitioners working at an advanced level to manage the majority of these patients, yet the skill mix of such services varies throughout the country resulting in delays for complex patients and unnecessary waits for surgical services for others who could be adequately managed conservatively.

Falls with minor injury are common within the ageing population and a common cause of fragility fractures. Following a fall many older people suffer a loss of confidence and reduction in independence and reduced function. Older people admitted to hospital following a fall may also experience further challenges such as hospital induced disability and deconditioning as a result of admission. SPPOT, specialist paramedic, physiotherapist and occupational therapist service was developed to provide a specialist intervention for the assessment treatment of people over the age of 65 who fall at home with the aim of reducing conveyance of this group to the emergency department.

Musculoskeletal conditions are prevalent, often chronic, disorders that impact both physical and mental wellbeing. Exercise therapy is a common physiotherapy treatment, yet adherence to home exercise programmes is low, due in part to pain during exercise. Virtual reality therapy has been shown to be effective at treating acute pain conditions (e.g. burns and dental pain) by disrupting the pain matrix pathways, reducing perception of pain. However, such therapies have not been reviewed in the context of MSK pain. The primary objective of this systematic review was to determine the efficacy of virtual reality (VR) and augmented reality (AR) in the treatment of pain from MSK conditions. The secondary objective was to investigate the impact of VR and AR on disability levels from MSK conditions.

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

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.

Fatigue is one of the more debilitating symptoms as it affects the ability to carry out daily activities. Despite the increasing evidence for the effectiveness of exercise and behavioural change interventions for fatigue management in pwMS, there have been no published critical review that has investigated a combination of exercise and behavioural change interventions. This review aims to investigate the effect of aerobic and strengthening exercise combined with behavioural change interventions in fatigue management in pwMS.

With a national picture of a shortfall of qualified nurses and continued NHS cost improvements, Sheffield teaching hospitals wanted to test using Integrated wards to scope new models of healthcare for the future. Aiming to be cost efficient, whilst delivering high quality care to patients and creating an improved working environment for staff. The project looked for ways to share skills and work more closely between the therapy and nursing professions, to avoid duplication, deliver the care patients need in a timely way and optimise time for each Profession to give their expertise to the patients who need it.

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.