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Innovations - quality assured physiotherapy initiatives

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.

You can either filter the innovations by 'Region' or 'Type' or use the keyword search above to find specific words or phrases. 

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Engaging public and patients to develop a website to assist people to remain in or return to work.

Musculoskeletal conditions are the second biggest cause of absenteeism in the UK representing 28.2 million working days lost per annum. Current literature suggests that work issues are generally insufficiently addressed in primary healthcare and there is little evidence that evaluates any existing workplace interventions in this setting.

To address this issue locally, North West Boroughs Healthcare Physiotherapy Service is developing a new work and health pathway, 'Work Wise', to assist patients to remain in or return to work. An element of the pathway is the development of a website to provide accessible supportive resources and signposting material.

To inform website design and content we have undertaken extensive engagement with patients, public and employers and we wish to present our findings to assist the development of other initiatives in this important area.

Impact of a three-phase ACLR post-operative rehabilitation pathway on patient drop-out rates and return to sport outcomes.

Anterior cruciate ligament reconstruction (ACLR) is commonly recommended for patients aiming to return to level 1 sports (sports that involve cutting, jumping and pivoting). Completion of ACLR surgery does not guarantee patients will return to sports due to a spectrum of biopsychosocial factors. Large NHS patient referral volumes can make it challenging to balance the quality and quantity of sports-specific rehabilitation. Service evaluation offers an opportunity to review and propose innovative ways of working.

A recent service evaluation at Guys and St Thomas' NHS Foundation Trust (GSTFT) showed a high amount of ACLR patients drop out of physiotherapy 6 months post-operatively and do not progress to sports-specific rehabilitation; the goal which underpinned the original decision to undergo surgery. True return to sport rates post-ACLR is acknowledged to be variable.

The aim of the project was to implement a new ACLR post-operative rehabilitation pathway at GSTFT to optimise return to sport outcomes.  

Single-Arm Observational Service Evaluation: Efficacy of a Single Advanced Physiotherapy Practitioner Intervention for Patients with Chronic Musculoskeletal Pain.

Musculoskeletal (MSK) conditions account for a significant portion of General Practitioner (GP) consultations and are therefore a burden on our health service and especially primary care as these conditions are largely managed within primary and community care. Patients with chronic MSK conditions consult with their GP five times more often than those without and as the age of the population increased this burden is expected to add increased pressure to primary care.

First Contact Physiotherapists (FCP) work at an advanced level of practice as first contacts within primary care and provide a possible solution for these patients. The proliferation of these roles over the last few years has been supported in the literature through studies reporting on the impact of FCP services and satisfaction surveys. NHS documents such as the Long Term Plan also promote an increase in FCP roles and organisations such as the Chartered Society of Physiotherapy and the Royal College of General Practitioners have endorsed FCP. Patients find this role to be an acceptable alternative to accessing their GP for specific conditions which supports these roles from the patients’ perspective.

Despite this support there has been very little evidence to demonstrate the efficacy of FCP services on patient outcomes. This service evaluation therefore aimed to determine the efficacy of FCP interventions on patient outcomes.

An FCP consultation may comprise of an assessment, diagnosis, advice and exercise prescription and as these interventions have been demonstrated in the literature to improve pain self-efficacy (SE) it was decided to assess the outcome of FCP services on the pain self-efficacy of patients with chronic MSK pain.

The effectiveness of non-pharmacological interventions to treat orthostatic hypotension in people with stroke.

The prevalence of Orthostatic Hypotension (OH) post-stroke is high. OH can be a barrier to stroke rehabilitation, where mobilisation (out-of-bed activities such as sitting, standing and walking) is recommended at the earliest opportunity. The potential risk of harm with OH must be acknowledged and addressed since, in acute and sub-acute stroke, OH has the potential to cause further brain damage due to cerebral hypo-perfusion. This may result in increased disability and mortality. However, current guidelines for the management of people with stroke do not provide guidance on assessing and treating OH.

People with stroke are more likely to have multi-morbidity, thus are at greater risk of polypharmacy. Therefore, identifying non-pharmacological interventions to treat OH is of importance both to minimise polypharmacy, and optimise safe participation in early rehabilitation.

The aim of this systematic review was to summarise the best available evidence regarding the effectiveness of non-pharmacological interventions to treat OH in people with stroke.

MSK self-management smartphone app in General Practice

To investigate if the GPEP musculoskeletal self management app;

  1. is an acceptable alternative source of information for patients.
  2. results in a reduction in physiotherapy/secondary care referrals, analgesia prescriptions, repeat attendances to general practice.

Scoping review: Should physiotherapists recommend swimming to patients with low back pain and is further research warranted?

It is common practice to suggest to patients with low back pain (LBP) to try swimming as a form of exercise but what evidence is this recommendation based upon and is there a need for further research? This scoping review was carried out to prepare and support a research proposal which will investigate whether swimming is beneficial for patients with LBP and whether swimming could target some of the comorbidities associated with LBP.

South Tees Integrated Falls Prevention Strategy

South Tees has had a CCG commissioned falls service since 2007 and has had significant year on year growth in referral rates. Despite this, the team have operated on the same resource and the service had become reactive rather than proactive.


Year      Male      Female      Total Referrals
2013   462   861   1323
2014   585   1027   1612
2015   684   1096   1780
2016   678   1047   1725
2017   639   1081   1720


Proposed key outcomes of the review were: A mapping exercise of existing services against NICE guidance was used to identify areas for improvement which created an opportunity to review the current service with a view to develop a system-wide approach to falls prevention.

  • Reduced falls and injuries
  • A region-wide falls pathway
  • Coordinated, individualised risk assessment and interventions
  • Improved partnership working

ICU and Beyond – Establishing a Post ICU Rehabilitation Pathway and Virtual Class

Within our consultant led ICU follow up clinic we recognised that there were an increasing number of patients presenting with on-going physical and psychological problems relating to their stay. Many of these patients reported lack of access to longer term rehabilitation and psychological support.

The purpose was to develop a specialist therapy pathway for patients following an intensive care stay; to improve physical and psychological outcomes, and the overall experience and support for patients and families.

Aspects included working towards;

  • Specialist Supported discharge home.
  • Joint handover of care and on-going support to community teams
  • 3 month review in line with NICE guidance.
  • Provision of MDT rehab class.
  • Capacity to provide hydrotherapy in the future.
  • Development of MDT follow up clinics
  • Psychology support with specific reference to ICU and critical illness

Beyond – Establishing a Virtual Post ICU Rehabilitation Class


The COVID-19 pandemic forced us to rethink how we could deliver Post ICU support and ensure rehabilitation needs of those leaving ICU were met.

The redeployment of staff during the first wave allowed us to pilot a virtual Post ICU rehabilitation class.