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Innovations - quality assured physiotherapy initiatives

Our quality assured examples of successful initiatives aim to promote physiotherapy as an innovative and cost effective approach to improving patient pathways and promoting public health. We welcome examples and case studies from all aspects of physiotherapy practice, research, education, and service delivery.

You can either filter the innovations by 'Region' or 'Type' or use the keyword search above to find specific words or phrases. 

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Improving information-giving to critical care patients to guide post discharge rehabilitation: a quality improvement project

ICU survivors have a 1-year mortality rate of 30%, and a reduced quality of life associated with post-ICU syndrome; a triad of cognitive decline, physical weakness and psychiatric disorders. Early rehabilitation improves outcomes, leading to greater independence. The NICE CG83 guidelines instruct the provision of rehabilitation information to critical care patients on discharge. Currently, only a third of UK trusts meet these guidelines.

Within 20 weeks, we aimed to achieve 100% patient and therapist satisfaction with the rehabilitation information given to patients at risk of physical morbidity on discharge from critical care at Medway Maritime hospital.

Developing Patient Understanding - The Effectiveness of an Educational and Exercise Programme for Persistent Lower Back Pain

Lower back pain (LBP) is one of the ten leading causes of disease burden globally. It is widely recognised that LBP produces significant detrimental effects on physical and emotional wellbeing whilst having a substantial economic burden for society. There is an inverse relationship between socio-economic status and the prevalence of pain. Increasing patients understanding of non-specific lower back pain including pain physiology, combined with completing exercises can provide optimal management. Therefore, the effectiveness of a locally run 'Back to Fitness Programme' (education and exercises) in the most deprived local authority area in England was evaluated.

The purpose was to evaluate the effectiveness of the Back to Fitness programme upon patients' understanding of pain, ability to function, symptom-report and physical outcomes.

Evaluation of the optimal physiotherapy-led mobilisation on critical care following the implementation of a mobility guideline.

Every patient on critical care should be assessed daily for the potential to begin functional rehabilitation including mobilisation.

Levels of agitation and sedation, as measured by the Richmond Agitation and Sedation Score (RASS) and consciousness measured by the Glasgow Coma Scale (GCS), can impact on the type of activity delivered by physiotherapy. A new mobility guideline was initiated on the general intensive care unit (ICU) to maximise patient rehabilitation within the limitations of their RASS score.

The purpose of this evaluation is to establish that the maximum level of rehabilitation/mobility was safely performed within each patient's physical, medical and cognitive abilities.  

Patient and public beliefs about the role of imaging in the management of non-specific low back pain: A scoping review

Routine imaging for non-specific low back pain is not in line with current guidelines yet imaging continues to occur despite evidence that clinicians are aware of and in agreement with guidelines. Patient and public beliefs regarding imaging may be a driving factor contributing to this and there have been suggestions that patient desire for imaging may lead to inappropriate requests from clinicians.

The objective of this study was to review the current evidence in relation to patient and public beliefs regarding imaging for low back pain.

Hemiarthroplasty for hip fracture: Are post-operative hip precautions necessary?

The purpose of patients being asked to follow post-operative 'hip precautions' is to restrict range of movement at the hip joint in order to reduce the risk of dislocation.

There has been increasing recent evidence in literature to suggest that these hip precautions may not be required following hip surgery.

Following discussion and consideration of the evidence available, all orthopaedic surgeons at our Orthopaedic Trauma unit agreed to discontinue the implementation of these hip precautions for all patients undergoing trauma hip hemiarthroplasty; and jointly signed a paper informing of this decision.

The aim of this study was therefore to assess any effects of this change upon the post-operative dislocation rate for this patient group.

A Physiotherapist in the Paediatric Haemophilia Clinic at University Hospital Southampton: - Patient and Family Satisfaction

Previous to September 2016 paediatric haemophilia patients at Southampton Children's Hospital were seen within the general outpatient caseload of a band 7 Paediatric Physiotherapist.

As a result:

  • The children did not have timely accessibility to physiotherapy
  • There was a high rate of was not brought (WNB) as physiotherapy appointments were extra to clinic appointments therefore requiring a separate visit.
  • The children were not seen from their diagnosis, therefore often did not meet the therapist until age 4 when a Haemophilia Joint Health Score could be performed.

In September 2016 a physiotherapist started to attend the Paediatric Haemophilia Clinic. 

The purpose of this review is to evaluate patient/ family satisfaction with the introduction of a physiotherapist into the monthly clinic. Each Family were also asked 'what it means to each family having a physiotherapist in clinic?'

Does delay to theatre influence patients' ability to achieve early mobilisation following surgical fixation of a hip fracture?

The National Hip Fracture Database (NHFD) publishes performance data which includes achievement of early post-operative mobility - defined as 'Mobilised on day of, or day following, surgery'.

It had been anecdotally noted on our Orthopaedic trauma unit that patients who experience a delay to surgery find it more difficult to achieve this early mobility target (with 'delay' to surgery defined here as failure to meet the NICE clinical guideline for hip fracture: 'Perform surgery on the day of, or the day after, admission').

This study therefore aimed to objectively investigate this supposition.