Innovations

To identify ways to improve the performance, and the health and well-being, of speedway riders.

Due to a lack of quality evidence-base to underpin professional practice in this field, to establish the incidence, nature and severity of injuries affecting speedway riders.

To highlight implications for practice and/or recommendations that can be used to drive improvements in practice.

To identify further areas for future investigation.

The requirement for a balance exercise class was identified whilst working in a musculoskeletal clinic that receives many referrals for patients who attend with balance deficit. We needed a class that would allow patients to improve upon confidence, mobility, functional balance and lower limb strength whilst being fun and augmenting individual Physiotherapy care. This class would also free up the popular assistant rehabilitation clinics.

Clinical outcomes for patients attending a pain management programme were evaluated to determine whether patients who rated an improvement on a Global Impression of Change Score, achieved mean changes in BPI that were consistent with 'acceptable' change, and to determine mean changes on other outcomes in this population. It is suggested that a mean change of 2.09 in pain interference, as measured by the Brief Pain Inventory (BPI), could be considered acceptable to patients. Currently data is unavailable for changes in pain acceptance.

The foot surgery service was expanded in order to undertake more complex foot surgeries, this required an increase in physiotherapy input. Adaptations were made to our provision of physiotherapy to accommodate patients undergoing complex foot surgeries, patients with multiple co-morbidities and patients with complex social needs. This incorporated developing a robust protocol-led pathway including pre-op education and assessment with the aims of increasing attendance of our pre-op assessments “Foot School” and reducing length of stay (LOS).

General Practice is currently experiencing considerable capacity and sustainability challenges. With General Practice carrying out 90% of patient contacts in the NHS and musculoskeletal (MSK) conditions accounting for 10 - 30% of GP appointments it is essential to explore new ways of coping with this demand.

In Midlothian, half the practices were operating with restricted lists as a result of increasing demand: a demand which is predicted to quickly rise as the influx of new housing has resulted in Midlothian being the fastest growing local authority area in Scotland.

The strategic principle of this work is therefore to redirect appropriate patients from General Practice to MSK APP services with the aim of:

•           improving GP capacity.

•           improving patient outcomes.

•           improving the patient experience.

•           being cost effective and efficient.

•           enabling quick and easy access to highly specialised musculoskeletal input.

•           reducing referrals to secondary care, helping throughput and improving the conversion rate to surgery.

The purpose of this project was to evaluate the role of the nursing HCA as part of the critical care multi professional rehabilitation team, with the express purpose of boosting rehabilitation during periods when there was no therapies services, and to fully embed the ethos of 24/7 hour rehabilitation into the critical care culture.  

The role of the Advanced Practice Physiotherapist (APP) has been well established in our Rheumatology team for more than 10 years. However, following the semi-retirement of one of the medical consultants there has been an option to pilot Consultant-level Physiotherapy input to the Rheumatology team. This process of using allied health professionals to replace medics has been called “Practitioner Substitution” and is seen as an important part of improving care and patient outcomes whilst delivering the efficiencies the NHS needs. The aims of the pilot Consultant post were: to independently manage and streamline the pathway for the non-inflammatory / pain service in Rheumatology, to reduce wait times and to ensure a more inflammatory-heavy caseload for the remaining Rheumatology medical team.

The purpose of this project was to reduce the effects of deconditioning and promote functional independence on an elderly care ward, with the ethos inspired by the End Pj Paralysis campaign. The first aim was for over 55% of patients to be sitting out daily for lunch on the ward. The aim was also for over 20% of patients to be wearing their own clothes daily on the ward. Secondary aims including improving patient experience, increasing staff knowledge on deconditioning and maintaining and reducing length of stay.

The primary aim of the project was to review current practice and establish if our client group were meeting government exercise guidelines whilst attending the Physically Disabled Rehabilitation Unit (PDRU). In addition data was collected in relation to compliance rate of 1Repetition Maximum, exercise completion and recording of BORG RPE scores to determine intensity of treatment.

Prior to this service development, senior Physiotherapists observed that estimated discharge date setting for hip fracture patients at daily MDT board round was arbitrary and differed significantly based upon which staff members were in attendance that day. A service development was therefore completed to identify an effective and efficient means to use a validated outcome measure to set a protoclised, realistic and evidence-based discharge date on the day of surgery, based upon pre-morbid function.