The Occupational Therapy (OT) service at Leicester City Council (LCC) faced some difficulties when they were working with a person who required Physiotherapy (PT) input in the community. Namely the long waitlist for input and an inability to establish a person’s baseline level of mobility when this was needed before recommending care packages, equipment or adaptations. The impacts on LCC were an increased need for formal care, equipment and adaptations as well as increases in OT staff’s workloads and/or delays in picking up new cases. Additionally, the cost to the person is highlighted as delays in accessing PT input can lead to further deterioration in their abilities (dependence) and/or the need to wait longer for equipment/ adaptations which may put them at risk.
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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.
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There is an increasing strain being placed all across the NHS systems. Emergency Departments up and down the country are being widely criticised for their performance against the national targets. We also have an aging population often with multiple co-morbidities that often present to the emergency department with both health issues and social care issues. The Royal Stoke Emergency department is one of the busiest in the country. In 2018 it had 111,091 attendances. 30,074. It had a higher than national average attendance to admission rate for over the age of 70. An external body wanted to see if creating a new MDT made up of senior decision makers with a background in the care of frail patients could make a difference.
Effects of a Multi-Disciplinary Physical and Psychological Programme on Kinesiophobia, Self-Efficacy and Functionality in Persistent Low Back Pain Service Users
Persistent Low Back Pain (PLBP) is the leading cause of disability worldwide. Disability and costs attributed to PLBP are projected to increase in coming decades (Hartvigsen et al, 2018). Research has now established that for people with PLBP, their cognitions and coping mechanisms play a bigger role in the progression from acute to persistent pain than physical features (Wertli et al, 2014). Clinical guidance (NICE, 2016) recommends that service users (SUs) who are not responding to routine management or have significant psychosocial obstacles to recovery, should be considered for a combined physical and psychological programme (CPPP). However, there are no clear current guidelines on the best format for a CPPP. The Back in Action (BiA) programme was introduced to address the needs of these SUs. This service evaluation aims to assess the effectiveness of the BiA 58 hour multi-disciplinary CPPP format on SUs pain related cognitions and function.
Spinal Triage by Extended Scope Physiotherapists in a diagnostic interface clinic: Spinal unit conversion rates from a 12-month service evaluation.
The Back and Neck Service (BaNS) was established in Suffolk (2003) as an interface clinic with the aim of reducing unnecessary referrals into the secondary care Spinal unit for surgical opinion. Since this time the service has expanded and now consists of six Extended Scope Physiotherapists (ESP) across the East (BaNS-East) and West (BaNS-West) localities. Importantly, the BaNS is embedded within a wider spinal pathway spanning both primary and secondary care which allows timely self-referral to musculoskeletal physiotherapy via a Single Point of Access (SPOA) portal. Patients with radiating symptoms failing to improve at 6-weeks, or those with axial symptoms that have failed appropriate management can be referred into the BaNS by their treating physiotherapist or via their General Practitioner. Following assessment and, where indicated, investigation(s), suitable cases are reviewed with a spinal consultant at a weekly meeting where appropriate patients can be directly referred into the secondary care spinal unit. The purpose of this service evaluation was to establish the effectiveness of the BaNS in triaging patients with axial and/or radiating symptoms into secondary care and to report the conversion rate to surgically led interventions (nerve root block injections & surgery). A secondary aim was to establish patient satisfaction with the service.
Effectiveness and optimal dosage of resistance training for chronic neck pain: a systematic review with a qualitative synthesis and meta-analysis
Ranked 4th for global disability neck pain is experienced by up to 50% of the population annually and is more common than low back pain in office-based workers. Clinical guidelines recommend multimodal physiotherapy that includes resistance training exercise (RET) for the neck and shoulders. Although RET programmes exist with different objective and physical outcomes (e.g. cervical isometrics, craniocervical flexor retraining etc.) no evidence synthesis has compared their effectiveness. Equally, despite being highly cited the dosage (repetitions, frequency, load) of RET varies considerably between studies. The aim of this study is
1) to evaluate the effectiveness of RET in chronic non-specific neck pain (CNSNP)
2) to determine an optimal dosage.
Using digital technology and user-centred design to develop a physiotherapy self-referral service for back pain
14 million people in England use GP online services. Harnessing digital technology in primary care to develop a physiotherapy self-referral service provides an opportunity to make physiotherapists the first point of contact for patients suffering back pain, whilst enabling service-users to make decisions about how they wish to receive care. A previous self-referral model of telephone and email access yielded low uptake and made inefficient use of administration resources. The aim of this 'proof of concept' project was to explore if a digital physiotherapy self-referral service is safe and acceptable to patients with back pain.
Spasticity interventions in cerebral palsy for people with and without intellectual disabilities - a comparative analysis
The main purpose for this narrative literature review is to analyse and describe the best available evidence for spasticity intervention in Cerebral Palsy for people with Intellectual Disabilities and provide the clinicians an overview of how the evidence could be used to inform decision-making, compare and choose the appropriate intervention in this population. This would be comprehensive resource for physiotherapy practitioners for evidence implementation of these interventions. This review also assisted in identifying the gaps in evidence and to discover new research areas.
Redesigning a Rural Physiotherapy Service’s Documentation Audit Process: Improving Quality whilst Promoting Honest & Meaningful Conversations
The aim of this project is to capture the experiences of staff using a new documentation audit tool and to explore if embedding the audit process in to quarterly, one-to-one reviews improves quality and leads to further discussion related to professional matters and staff wellbeing.
Getting the Know-How: The Feasibility of Delivering a Digital Self-Management Programme for Axial Spondyloarthritis
Despite recommendations by the National Institute for Health and Care Excellence in the management of Axial Spondyloarthritis (AS), adherence to exercise and self-management education is reported to be variable. The Axial Spondyloarthritis Know-How (ASK) self-management programme offers service-users a single attendance exercise and education workshop supported by a self-management digital toolkit. The digital toolkit consists of a short educational film and self-assessment tool prior to attendance and an interactive self-management handbook to support health behaviour change following attendance. The feasibility of delivering a digital self-management programme for adults with AS was explored prior to implementation.
Early detection of post-operative pulmonary complications such as pneumonia using physiotherapy-led lung ultrasound: A case study
Lung ultrasound (LUS) has been shown to have higher diagnostic accuracy (95% sensitivity and 95% specificity) in the detection of pneumonia in patients with respiratory symptoms when compared to chest radiograph (CXR) (49% sensitivity and 92% specificity). Physiotherapists trained in LUS could use this diagnostic technique to monitor patients for pneumonia especially when they begin to show signs of post-operative pulmonary complications (PPC).