Innovations

There is limited published evidence to guide physiotherapists when treating patients with atraumatic shoulder instability. The aim of this study was to update the results of a previous small service evaluation investigating the outcomes for patients following a specific structured physiotherapy programme.

Tennis elbow is a common condition in the UK but there are no guidelines on how best to manage the condition. The purpose of this study was to establish the current UK practice in managing patients with chronic tennis elbow (symptoms over six months).

Moving care out of hospital settings and into the community is a key focus of the NHS Five Year Forward View. We explored if it was feasible for NHS physiotherapists to deliver free back classes within local council leisure centres, and if they effectively helped to increase participant activity levels. A review of the back pain pathway within Wiltshire generated a desire to use a stratified approach to interventions. We chose to begin with those scoring low risk on the STarT back tool, aiming to deliver messages to foster a positive approach to exercise and prevent unhelpful beliefs developing. This service evaluation will inform the wider back pain pathway in Wiltshire and may provide insight to other physiotherapists planning similar projects.

Current evidence advocates physiotherapy treatment, for the management of cervicogenic headaches (CGH). A reasoned assessment and clear knowledge of red flags is essential.

An MSK physiotherapy team from southern England received training sessions for CGH. Topics included assessment, evidence based treatment, clinical reasoning and red flags. Physiotherapists completed a questionnaire on headache red flags and signs and symptoms, preceding and following training.

10 patient cases were examined, exploring treatments, against current best practice, after training. Effectiveness was evaluated using patient outcomes before and after intervention.

The purpose/objectives of this study was to:-

• Evaluate participant's knowledge of red flag and signs and symptoms of CGH headache, preceding and following training.
• Examine treatments used by participants for 10 CGH patient cases, against current best practice after training.
• Review patient treatment outcomes, of the 10 CGH patient cases after training.

The Department of Heath estimate that 62% of hospital bed days are occupied by patients over the age of 65. Of these bed days 2.7 million are occupied by patients no longer needing or not requiring acute care in the first place. Of those who are admitted unnecessarily, the Emergency Department (ED) is often where the decision to admit is made. Furthermore, the longer a patient spends in the ED the longer their associated inpatient stay in the hospital will likely be, with the risk of losing up to 5% of their muscle strength per day.

During May and June 2016 the Emergency Care Improvement Programme (ECIP) reviewed Urgent and Emergency Care at Basingstoke and North Hampshire Hospital (BNHH). This was due to reduced ED performance. BNHH did not have an established dedicated Therapy team in ED, despite national evidence and ECIP recommendations. Therapies are well placed in ED to facilitate early patient discharge and help prevent admission of patients who do not require acute hospital care. The project aimed to eliminate avoidable non-medical admissions to inpatient base ward beds in patients over 65 years presenting to ED at BNHH by September 2017.

The service objectives are to:

1. Reduce workload of GPs
2. Provide assessment and self-management
3. Provide high quality care and a good patient experience to patients with MSK problems
4. Support patients to remain in/return to work
5. Provide staff with a positive experience.

The purpose of this project was to evaluate and monitor the progress and growth of the service against our service objectives

Some of the driving forces behind the Advanced Physiotherapy Practitioner (APP) are the 5 Year Forward View, GP Forward View, local Sustainability and Transformation Partnerships and local GP Cluster priorities. These drivers focused on workforce transformation within primary care and the MSK pathway. This service will enable patients to access a specialist MSK services at the beginning of the pathway.

This project also aimed to examine the outcomes of APP appointments to determine referring habits, changes in referral patterns and effects on GP workload and secondary care referrals.

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.

The Five Year Forward View report¹ highlighted the need to take advantage of opportunities technology offers patients. 81% of UK Adults (91% 18-44) have touch screen smart phones with the majority (89%) 4G enabled.

Our service initiative utilises App and web based technology to provide patients with a credible, evidence based source of education and advice on musculoskeletal and mental health issues. Our aims:

• Ability to complete visual triage assessments via web and App based solutions, enabling enhanced remote assessments and treatment.
• To offer various mediums for patients to gain knowledge, fitting their learning styles. Through provision of evidence-based information on different platforms including; website, webinars, podcasts, blogs and an app.

This special interest abstract is to share our innovations with the wider physiotherapy community offering alternative ways of delivering services in the 21^st century.

Low Back Pain (LBP) is the largest cause of years lived with disability worldwide^. UK guidelines recommend a combined physical and psychological programme (CPPP), preferably delivered in groups, as a treatment option. A CPPP based on the fear avoidance model of pain was evaluated in 2013, where just 36% of patients achieved a clinically meaningful improvement in disability. The programme was revised (2017) to include a focus on pain self-efficacy, the largest mediating factor in LBP-related disability. The aim of this service evaluation (SE) was to evaluate whether the revised programme improves LBP-related disability, with a secondary aim to evaluate the programme content.

Acute heart failure (AHF) is the most common cause of admissions for patients aged 65 and over in the UK. The occurrence of functional decline in elderly adults with hospitalisation for acute illness is well established with decline occurring as early as day 2 of admission. With an average length of stay of 18.7 days, patient age of 71.4 years, and 77.1% of patients having at least one other chronic disease, the patients admitted to the Heart Failure Unit at St George's Hospital are high risk for functional decline throughout their stay. Traditionally these patients would not be seen by a physiotherapist until after their intravenous diuretic treatment was completed. The aim was to assess the impact of early and specialist physiotherapy assessment and intervention on functional decline during hospitalisation of patients with AHF.