Innovations

Clinical outcomes are a vital part of understanding quality in healthcare. As part of this, a large Musculoskeletal (MSK) physiotherapy department in Hampshire has measured the clinical outcomes for all of the patients referred into the service. The outcome tool employed was the MSK-HQ (Musculoskeletal Health Questionnaire), a 14 point outcome measure developed to identify and measure the multi-dimensional aspects of musculoskeletal pain. A multi-dimensional tool was chosen to reflect the complexities and co-morbidities that patients with musculoskeletal conditions commonly present with. The MSK-HQ is a tool that can identify the impact that physiotherapy has had on patient health and well-being as opposed to their musculoskeletal complaint in isolation. The aim was to use the data to improve working practices within the service.

A single point of referral was implemented in partnership between Allied Health Professionals Suffolk (AHPS) and Norfolk Community Health and Care (NCHC) forming the Integrated Therapy Partnership (ITP). This aimed to standardise the care pathways for musculoskeletal conditions and ensure primary care referrals are processed to the correct provider first time around. This should avoid unnecessary secondary care referrals, where patients are seen in secondary care, receive no treatment and are referred back to community providers. Referrals are triaged by senior physiotherapists. Similar models have been suggested as effective methods of service delivery by the British Orthopaedic Association (Lennox & Karstad, 2013). This was coupled with the implementation of online self-referral for physiotherapy and occupational therapy, where patients were issued advice and exercise within 24 hours. Advice and exercise are issued for patients triaged for physiotherapy through the single point of referral. AHPs are responsible all patient administrative tasks and provide the triaging clinicians. NCHC provide clinical physiotherapy, occupational therapy and orthopaedic triage services. This is contracted to the Norwich and South Norfolk Clinical Commissioning Group and they set key performance indicators for patients being seen. Routine patients to be seen in 28 working days, urgent patients to be seen in 7 days and orthopaedic triage patients to be seen in 14 working days.

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.