Innovations

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.

The Community Respiratory Team supports patients living with Chronic Obstructive Pulmonary Disease (COPD) in their own homes.  They work with patients to improve self management of their condition and enable activity and enhanced quality of life when living with this long term condition. 

The project has resulted in shorter hospital stays, due to home based rehabilitation for COPD patients.

To provide group based, interdisciplinary, combined physical and psychological treatment (CPPP) service to patients with persistent non-specific back pain, to help restore function and quality of life. 

The service’s aim is to train patients to become experts at understanding their persistent low back pain, to manage flare-ups in pain effectively, to set goals to improve function, to reduce reliance on analgesic medication, and to engage in healthy behaviours

The service uses a cognitive behavioural approach, as recommended in the National Back Pain and Radicular Pain Pathway (Pathfinder) (2017) and NICE Guidelines (2016) as an effective way to manage persistent non-specific back pain and disability.

Recognising that there is limited funding for “doing more of the same” we looked at how we could increase our cardiac rehabilitation capacity by broadening our scope and expertise to encompass a range of long term conditions that cause a high impact on unscheduled care. We acknowledged that multi-morbidity is becoming increasingly prevalent.

We subsequently developed The Healthy and Active Rehabilitation Programme (HARP) and opened up referrals to include people affected by stroke, cancer, COPD, falls, diabetes, and other long-term conditions.  HARP enabled us to widen our rehabilitation capacity to include cardiac groups which are typically excluded due to resource limitations: angina, arrhythmias and devices.  We designed a programme that would embrace activity, self management and support lifestyle change, across all of these groups.

Thus, the overall aim of this project was to proactively support prevention and self-management in an ageing population with increasing prevalence of chronic multiple morbidities. To help reduce health inequality the project has specifically targeted deprived and rural communities.

Secondary objectives 

• To develop an evidence base for multimorbidity rehabilitation that would support a new way of working
• To prove that this new model was sustainable

The number of thoracic surgical procedures performed in the United Kingdom continues to increase annually putting pressure on thoracic surgical bed capacity. Reducing hospital length of stay (LOS) following thoracic surgery can help to reduce pressure on hospital beds. The purpose of this service evaluation is to explore hospital and physiotherapy LOS for individuals following thoracic surgery at our hospital and identify whether any factors influence hospital and Physiotherapy LOS. The findings could potentially allow the identification of individuals at risk of longer LOS and help direct physiotherapy rehabilitation provision to these individuals.