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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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A 3 month prospective audit of physiotherapy referrals to a Community Rehabilitation Team and trial of alternative triage process.

The Community Rehabilitation Team (CRT) provides intermediate care and rehabilitation to individuals unable to leave their homes or who do not meet referral criteria for specialist services. Therapists are generalists whose specialism is managing complexity.

Current practice required all clinical staff (B4 and above) to triage referrals for suitability, and to assign appropriate referrals to immediate action (within 5 days) or a waiting list (up to 18 weeks), according to clinical need. This decision was commonly made directly from information contained within the referral.  

Staff expressed anxiety and frustration with the process, and an inability to affect change or provide support to colleagues. Referrals from traditionally hierarchical superiors could be challenging, especially when declining inappropriate referrals, with concern that this may affect future commissioning.  

This audit of physiotherapy referrals, aimed to classify our caseload through collection of quantitative data, and to trial an alternative triage process.

A Rapid Review of evidence for management of patients that frequently attend Emergency Departments with Chronic Pain.

Frequent attenders (FA) (defined as individuals that attend more than 5 times per annum) of ED have been reported to account for 13% of the total cohort. A common reason for presentation is chronic pain. Guidelines recommended that Frequent Attenders are identified, that case management may assist with involving other services and that multidisciplinary case conferences may aid patient engagement.

  • To critique evidence for case management of patients that frequently attend ED with chronic pain.
  • To utilise the evidence to support an innovative rapid access pathway to a pain rehabilitation service.

NICE Guidance and Quality Standard Assurance Evaluation: a process redesign to improve effectiveness and efficiency.

NICE assurances processes which evaluate local clinical practice and services against NICE guidance, quality standards and interventions are important clinical effectiveness and quality improvement strategies. Trusts are required to undertake a local NICE assurance process and results of evaluations are reported centrally.

The aim of this project was to develop a more efficient, robust and meaningful approach to our NICE assurance process across our complex, multi-professional clinical division. Our division has over 30 different clinical services in acute and community settings across East Sussex. The objective was to create a single, unified and responsive approach across all our uni- and multi-professional services.

Improving access to Paediatric Physiotherapy services within a community team - Physiotherapy drop-in screening service

The purpose of establishing the physiotherapy drop in service was:

  1. To improve the appropriateness of referrals being sent to the Physiotherapy department
  2. To provide a universal Paediatric Physiotherapy screening service within the borough for all children and young people
  3. To signpost Children and Young People to the required services or provide information and advice where appropriate

The above purpose links with the aims of the universal service provided by the Physiotherapy department which include: To improve education within the borough about normal development, create free opportunities to develop gross motor skills and educate parents ensuring carryover to the home environment, to highlight the contribution that Physiotherapy can make to the prevention of illness and the promotion of good health through encouraging appropriate physical activity.

The effectiveness of hip strengthening exercises in the management of patellofemoral pain syndrome (PFPS) in females.

Patellofemoral pain syndrome (PFPS) is a common and often chronic knee condition with a high prevalence in females of working age. The regular presence of hip weakness in female patients with PFPS, has led to research emerging on hip strengthening exercises.

The aim of the systematic review was to examine the effectiveness of hip specific strengthening exercises on the management of patellofemoral pain syndrome (PFPS) specifically in females.

Secondly, to evaluate whether hip strengthening exercises should be identified as a primary treatment choice for managing PFPS in females.

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.