Innovations

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.

Congenital heart disease is a lifelong condition. Many patients will require repeated open heart surgeries during their lifetime and others may go on to develop heart failure, arrhythmia or other problems associated with acquired heart disease. The benefits of regular exercise are well known. The overall aim of this pilot study is to determine the feasibility of introducing a supported exercise programme in to clinical practice to support physical and psychological well being in adults with congenital heart disease living in Scotland.

An advanced practice occupational health physiotherapist introduced a new fitness-for-work service to manage clients with work- related or impacting musculoskeletal disorders. The purpose was to shorten waiting times for clients to access specialist physiotherapy, reduce the number of referrals to GPs, OHPs and OHAs and secondary care, reduce sickness absence and improve productivity, and maintain excellent service user satisfaction.

The First Contact Physiotherapy Service was established as a pilot within the musculoskeletal service in January 2019.  This patient evaluation project was undertaken in order to:

• Ensure the service was meeting the needs of the patients accessing it.
• Capture patient experience.

Measuring the clinical effectiveness of all healthcare services is a fundamental component of evaluating the impact care has on the service user. A community-based MSK physiotherapy service in Mid Essex has been using a validated and multi-dimensional outcome tool, the Musculoskeletal Health Questionnaire (MSK-HQ), since April 2017 to evaluate clinical effectiveness.

The service also recognised the importance of working in different ways to improve efficiency and matching treatments based on prognostic subgroups (stratified care) has been shown to be both clinically and cost-effective in the management of low back pain using the STarT Back Screening Tool.  However, risk stratified care for all MSK disorders is in its relative infancy, with the Keele STarT MSK Tool yet to be fully validated scientifically, although Keele University granted permission for the MSK physiotherapy service to use the tool for clinical purposes in April 2018. 

The service was therefore able to collect data from all appropriate MSK patients receiving treatment from April 2018 to March 2019 to evaluate whether good clinical outcomes and positive patient experience were demonstrated whilst delivering a more efficient risk-stratified care approach.

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.

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.