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.
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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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Impact of early intervention and rehabilitation on functional decline in patients hospitalised for acute heart failure
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.
Acute heart failure care is recommended to be delivered by a multidisciplinary team, incorporating education, and advocating self-management and patient centred care. With this in mind in 2016 a specialist 11 bedded heart failure unit (HFU) was opened to cohort patients with acute heart failure with the aim of improving outcomes in quality of life, 30 day readmission rates, and mortality. As heart failure is often associated with marked reductions in quality of life and high levels of debility, a full time specialist physiotherapist was funded to work as part of the multidisciplinary specialist team. The aim was to assess the impact of exercise education and early physiotherapy intervention on patient experience.
This study evaluates the First Contact MSK Physiotherapy (FCP) role within Primary Care in Taunton, Somerset.
The population of older people is rapidly growing and many are not living in good health; this escalating problem has significant economic and resource implications but more importantly impacts on individual quality of life in later years. In recognition of this 'perfect storm' the importance of embedding prevention strategies and health promotion interventions specific to older people is widely recognised. One approach to tackling this, Making Every Contact Count (MECC), empowers staff to initiate opportunistic conversations with people who report 'risky' health behaviours, supporting the first positive steps towards health behaviour change and self-management.
This quality improvement project was initiated following a record keeping audit which identified that healthy lifestyle conversations were recorded in only 19% of clinical records. It aimed to increase the number of documented healthy lifestyle conversations that clinicians have with Integrated Community Team patients.
To describe the transformation process undertaken over two and half years and share our experience of the redesign in both terms of success and challenges.
Traditionally the Electrical Stimulation (ES) of muscles was a frequently used adjunct for rehabilitation following nerve injury. More recently its use has been in decline. An international collaborative group of therapists with a special interest in Traumatic Brachial Plexus Injuries (TBPI) was formed in 2017. One of the objectives of the group is to assess and improve the evidence base surrounding the rehabilitation of TBPI. Disparity within the group with regards to the use of ES highlighted the need to explore current practice and the reasons for variability in use.
Advancement in healthcare has led to people living longer. This has made older adults' care become a concern in the United Kingdom. There is added pressure on hospitals, social services and the government in the human and financial resources needed for their care. County councils are using reablement which focuses on relearning skills for independence to reduce older adults' care cost. This study focused on evaluating the reablement of older adults in a centre in the north of England for areas of improvement. The centre helps facilitate discharges from hospitals. The evaluation became necessary due to the recurrent admissions of some clients. It was also important to know the perceptions of the recipients of reablement to incorporate in improvement of the service.
The purpose of the study was to find out the perceptions of older adults 65 years and over admitted in a specialist care centre about the reablement provided to increase their independence to return home.
Metastatic spinal cord compression (MSCC) is a well-recognised complication of cancer. The National Institute of Clinical Excellence (NICE) provided clinical guidelines regarding assessment and management of patients with back pain and cancer history with suspected spinal cord compression; NICE CG-75. This study aims to determine if patients are managed appropriately and in a timely manner, according to these guidelines.
Adults with long-term neurological conditions have low levels of participation in physical activities and report many barriers to exercise. This study used a mixed methods approach to evaluate participant experiences and outcomes following participation in student-led, community-based neurological groups and to explore the feasibility of performing a full-scale study.