Innovations

In 2011 in Scotland, approximately 8% of older people who fell received multifactorial assessment (MFA) and intervention delivered by NHS services. Our aim is to reach 20% by implementing the Falls Framework for Action for Scotland. Tests of opportunistic screening have demonstrated low uptake of MFA; many people don't want - or need - formal intervention from NHS services. A growing number of people over 60 use the internet (59%) with Scotland increasingly investing in technology solutions to improve health and well being. NHS 24's Smartcare Programme, provided the opportunity to explore the use technology to support self-management of falls risk. Our aim was to develop an online self management tool to enable users to assess falls risk and create a personalised falls prevention plan.

• Evaluate the quality and adherence of patients with MSK conditions to agreed exercise programmes when using a digital platform compared to a printed version.
• Evaluate the patient´s experience when engaging with an exercise programme and their interaction with clinicians and any differences related to patient characteristics (age, gender).
• Evaluate the impact on generic patient reported outcome measures (PROMS) (eg PSFS, EQ5D, MSKHQ)

Recent scandals relating to care failings within the NHS have led the UK government to recommend that providers examine the recruitment methods for healthcare professional education programmes and initiate better screening of those entering the professions (Francis, 2013). The School of Healthcare Sciences at Cardiff University has committed to interviewing all applicants prior to enrolment and have instigated a multiple mini-interview (MMI) structure to do so.

In MMIs candidates have many opportunities to make a first impression, meeting different assessors at each station, suggesting the process is fairer and more consistent when compared to traditional panel interviews (Eva et al, 2004). However, if MMIs are designed to select for specific attributes and personalities, do they result in a homogenous student population and thus reduce the diversity of experiences, thoughts and behaviours within? Is the process which is thought to be 'fair' actually fraught with bias?

This project aimed to investigate bias within the MMI structure for Physiotherapy recruitment at Cardiff University. It considers the design and scoring of interview stations and their inclusivity, through the monitoring of performance at each station by applicants with differing characteristics.  

The incidence of cancer is increasing; people are living longer with better quality of life, however, the risk of developing MSCC remains high for many patients. Prompt diagnosis and treatment is essential to prevent paralysis and failure to recognise the early signs can have devastating implications with the added financial burden of caring for bedbound patients.

All front-line clinicians have a vital role to play in referring suspected MSCC patients into the MSCC service in a timely manner. This includes physiotherapists working in most settings, e.g. MSK, A&E, walk-in centres, community and private sector.

Physiotherapy assistants accounted for approximately 20% of the physiotherapy workforce across Stoke on Trent Community Health Services. Although their job descriptions clearly stated that the post was primarily clinical, their role depended heavily on the qualified physiotherapists and how they utilised the clinical skills of physiotherapy assistants. As a result in some clinics/clinical areas physiotherapy assistants had a predominant clinical role whereas in others they fulfilled what was primarily an administrative role. This latter trend led to physiotherapy assistants not being able to utilise their clinical skills and to job dissatisfaction as well as disparity in the clinical service provided to patients of equal clinical needs.

Following total knee replacement (TKR), patients are not only required to be functionally and medically safe for discharge but also achieve set exercise goals before being allowed home. These set exercise goals are: · 90 degree knee flexion. · A straight leg raise with < 5 degree quadriceps lag. · Inner range quadriceps with < 5 degree quadriceps lag. These goals are set by the operating Consultants. A recent audit on length of stay (LOS) highlighted that out of 38 patients, 32 (84%) had exceeded their predicted date of discharge (PDD). Of these 32 patients, 19 (59%) had exceeded their PDD as a result of not achieving their exercise goals by this time, despite being deemed functionally and medically safe. Further audit over a 12 week period highlighted an additional 38 TKR patients remaining in hospital after being deemed functionally and medically safe in order to achieve the set exercise goals. This equated to 65 additional bed days over the 12 week period, approximately 5 additional bed days per week. With a standard overnight stay costing £400 per night, this equated to £26,000 over the 12 week period and therefore potentially £104,000 a year. It was suggested that providing a physiotherapy service to allow TKR patients to go home once functionally and medically safe but without achieving their exercise goals could facilitate discharge for these patients without compromising the quality of their care or outcomes

The advantages for using patient-reported outcome measures (PROMS) have been well documented in the literature. The need for physiotherapists to use standardised PROMS has been recognised and is recommended in clinical guidelines. Although the importance of standardising the use of PROMS within the physiotherapy profession is well recognised, it has largely failed to be delivered in practice. A number of barriers for implementation of standardised outcome measures has been reported including the lack of knowledge and the lack of instructions in relation to the application, scoring and interpretation of the outcome measure(s).

Musculoskeletal (MSK) physiotherapy teams within Staffordshire and Stoke on Trent Partnership Trust (SSOTP) used a variety of outcome measures including the EuroQol (EQ-5D-5L) alongside condition specific PROMS and a patient experience-reported experience measure, in line with CSP recommendations. Nevertheless, the teams did not use the same outcome measure and data collection, inputting and analysis methods varied considerably. Therefore, the use of outcome measures and data collection needed to be standardised.

Previously people with long term illnesses such as cancer were often advised by their clinical team to rest and reduce their physical activity. But recent research has shown that exercise is not only safe and possible during cancer treatment, it can also improve an individual's level of physical functioning, increase their strength and stamina, improve their quality of life and help them to return to work. Studies have also shown that exercise can reduce their mortality and the risk of recurrent types of cancer by approximately 50%. The aim of our evaluation study was to explore the efficacy of a physiotherapy led exercise programme for people living with and beyond cancer to improve their overall health and wellbeing and fitness levels.  

Historically patients at North Manchester General Hospital received traditional 1:1 Physiotherapy treatments post total knee replacement (TKR). Literature suggests a class environment can be more cost effective and yield improved results. Therefore a TKR class was set up in 2015. This summary highlights the findings from the first year demonstrating clinical outcomes, patient satisfaction and cost-effectiveness.

This paper reports on the findings of the first phase of a service improvement project that used the Ophelia approach developed by Deakin University, Australia to evaluate the health literacy (HL) needs of adults attending outpatients musculoskeletal (MSK) physiotherapy.

Little is known of the impact that the social determinates of health have on the health literacy needs of patients presenting with musculoskeletal pathologies so the relationship with demographic data, including the Welsh Index of Multiple Deprivation (WIMD) was explored.

The aim of the first phase was to profile adults' health literacy attending outpatient MSK physiotherapy. Objectives included:

1. to evaluate adults across nine domains of health literacy
2. to establish whether there is a relationship with measures of deprivation. The results of profiling will inform the development of specific health literacy interventions and resources for the local population in future phases.