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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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Patient and public beliefs about the role of imaging in the management of non-specific low back pain: A scoping review

Routine imaging for non-specific low back pain is not in line with current guidelines yet imaging continues to occur despite evidence that clinicians are aware of and in agreement with guidelines. Patient and public beliefs regarding imaging may be a driving factor contributing to this and there have been suggestions that patient desire for imaging may lead to inappropriate requests from clinicians.

The objective of this study was to review the current evidence in relation to patient and public beliefs regarding imaging for low back pain.

Hemiarthroplasty for hip fracture: Are post-operative hip precautions necessary?

The purpose of patients being asked to follow post-operative 'hip precautions' is to restrict range of movement at the hip joint in order to reduce the risk of dislocation.

There has been increasing recent evidence in literature to suggest that these hip precautions may not be required following hip surgery.

Following discussion and consideration of the evidence available, all orthopaedic surgeons at our Orthopaedic Trauma unit agreed to discontinue the implementation of these hip precautions for all patients undergoing trauma hip hemiarthroplasty; and jointly signed a paper informing of this decision.

The aim of this study was therefore to assess any effects of this change upon the post-operative dislocation rate for this patient group.

A Physiotherapist in the Paediatric Haemophilia Clinic at University Hospital Southampton: - Patient and Family Satisfaction

Previous to September 2016 paediatric haemophilia patients at Southampton Children's Hospital were seen within the general outpatient caseload of a band 7 Paediatric Physiotherapist.

As a result:

  • The children did not have timely accessibility to physiotherapy
  • There was a high rate of was not brought (WNB) as physiotherapy appointments were extra to clinic appointments therefore requiring a separate visit.
  • The children were not seen from their diagnosis, therefore often did not meet the therapist until age 4 when a Haemophilia Joint Health Score could be performed.

In September 2016 a physiotherapist started to attend the Paediatric Haemophilia Clinic. 

The purpose of this review is to evaluate patient/ family satisfaction with the introduction of a physiotherapist into the monthly clinic. Each Family were also asked 'what it means to each family having a physiotherapist in clinic?'

Does delay to theatre influence patients' ability to achieve early mobilisation following surgical fixation of a hip fracture?

The National Hip Fracture Database (NHFD) publishes performance data which includes achievement of early post-operative mobility - defined as 'Mobilised on day of, or day following, surgery'.

It had been anecdotally noted on our Orthopaedic trauma unit that patients who experience a delay to surgery find it more difficult to achieve this early mobility target (with 'delay' to surgery defined here as failure to meet the NICE clinical guideline for hip fracture: 'Perform surgery on the day of, or the day after, admission').

This study therefore aimed to objectively investigate this supposition.

Physiotherapist Experiences and Perceptions of Telephone Triage and Barriers faced when Triaging

This study aims to identify Physiotherapist's perceptions and experiences of Telephone Triage, as well as identifying any barriers they may face when triaging.

Professional barriers to PTT have been suggested demonstrating clinician reluctance despite patient satisfaction. Little is known about the effect of the role change on the Physiotherapist, and the inability to physically examine the patient.

This research will help direct training and the working experience for Physiotherapists, improve current Triage structures and provide justification to organisations implementing the service. Understanding barriers to PTT will assist with service planning and change management.

A pilot study; the feasibility of very early exercise after COPD exacerbation to improve patient outcomes, experience and healthcare costs.

To ascertain whether the inclusion of very early exercise post-COPD exacerbation via the addition of a full-time technician to the COPD Team improves patient outcomes, experience and healthcare related costs above and beyond outcomes already achieved by the existing service.

In addition, to reduce barriers to participation in physical activity and pulmonary rehabilitation attendance commonly observed within this patient group, including being housebound, transport difficulties, geographical inequality in service provision, carer responsibilities, disease severity and high levels of physical and mental comorbidity. Currently inactivity, activity avoidance owing to anxiety regarding dyspnoea and a poor uptake and/ or completion of pulmonary rehabilitation are demonstrated within this cohort of patients, who often have severe disease, which is advocated as a key management strategy nationally and internationally for COPD .

The purpose of this service change is to facilitate other options in assisting patients to achieve better outcomes and an enhanced quality of life through early exercise in conjunction with pre-existing self-management support.

Goal-Directed and person-centred Rehabilitation for spasticity post-stroke and brain injury.

Stroke and brain injury-survivors have difficulty controlling muscles and in many cases, 'tightness' of muscles called spasticity. Spasticity is often painful, akin to muscle-cramp. It can limit mobility and independence and cause distressing complications of contractures, skin breakdown and pressure sores.

The aim of this work was to development a preliminary model 'goal-Directed and person-centred Rehabilitation (Direct-Rehab)', to link clinical decision making for patient centred treatment, with the goals and process of treatment. This requires a focus on linking physical rehabilitation treatments (often in combination with pharmacological treatments such as botulinum toxin) to person-centred goals.

Interprofessional education for practice: moving and handling for people with complex needs in contemporary healthcare.

Obesity is a growing problem in the UK affecting all areas of the NHS, with over a quarter of all adults falling into this category. The additional risks and co-mobidities that obesity is linked with leads to a high number of hospital admissions.

The multidisciplinary teams working with these people require appropriate knowledge and skills to deliver safe and effective care, with the National Institute for Health and Care Excellence (2014) recommending that staff be appropriately trained to use specialist equipment when working with this complex group of people.

Research has shown that interprofessional team working can play an important part in improving patient safety. This report details the process an interprofessional team have undertaken to develop a simulated bariatric scenario as part of the learning materials that complement practical moving and handling sessions for undergraduate students.