Patient outcomes

Implementing Prehabilitation in a Tertiary Vascular Centre A Quality Improvement Journey

Prehabilitation is enhancing a patient's functional capacity before surgery, with the aim of improving postoperative outcomes, and should include medical optimization, physical exercise, nutritional and psychological support. Prehabilitation prior to vascular surgery has been recognised in the more recent GIRFT report [2018] .We developed a prehabilitation programme for patients awaiting AAA repair at a tertiary referral vascular centre with a high number of patients undergoing aortic aneurysm surgery

Virtual reality, augmented reality and mirror therapy for musculoskeletal pain

Musculoskeletal conditions are prevalent, often chronic, disorders that impact both physical and mental wellbeing. Exercise therapy is a common physiotherapy treatment, yet adherence to home exercise programmes is low, due in part to pain during exercise. Virtual reality therapy has been shown to be effective at treating acute pain conditions (e.g. burns and dental pain) by disrupting the pain matrix pathways, reducing perception of pain. However, such therapies have not been reviewed in the context of MSK pain. The primary objective of this systematic review was to determine the efficacy of virtual reality (VR) and augmented reality (AR) in the treatment of pain from MSK conditions. The secondary objective was to investigate the impact of VR and AR on disability levels from MSK conditions.

The role of Men's Sheds in promoting the physical and mental well-being of older men.

The active and healthy ageing agenda challenges the perception that old age is a negative experience and recognises the positive contributions that older adults can make to their communities. However, successful ageing in place requires community-based support for older adults that facilitates social participation, independence and being active. Older men are less likely to join community groups where they can develop social ties and less gender specific support services are available for them.

Men's Sheds (MiS) is an initiative that aims to mitigate this by fostering the building of social networks between older men by providing social space for them to meet and undertake physical activities such as woodwork or metalwork.

The purpose of this research is to investigate the impact of MiS on the physical health and mental well-being of the attendees.

Managing Falls- avoiding the need for conveyance to hospital with early community therapy and specialist paramedic intervention, a winter initiative.

Falls with minor injury are common within the ageing population and a common cause of fragility fractures. Following a fall many older people suffer a loss of confidence and reduction in independence and reduced function. Older people admitted to hospital following a fall may also experience further challenges such as hospital induced disability and deconditioning as a result of admission. SPPOT, specialist paramedic, physiotherapist and occupational therapist service was developed to provide a specialist intervention for the assessment treatment of people over the age of 65 who fall at home with the aim of reducing conveyance of this group to the emergency department.

The value of a Consultant Physiotherapist within a Primary Care Musculoskeletal Interface Services: Part of the Spinal Multi-Disciplinary Team

Patients with spinal pathologies can range from simple mechanical low back pain to complex pathology requiring urgent medical or surgical intervention. The national low back pain pathway recommends the use of 'triage and treat' practitioners working at an advanced level to manage the majority of these patients, yet the skill mix of such services varies throughout the country resulting in delays for complex patients and unnecessary waits for surgical services for others who could be adequately managed conservatively.

Description of performance and functional trajectory of acute oncology inpatients at a London tertiary centre.

Advances in cancer care and its treatment mean that people living with a cancer diagnosis are living longer but not necessarily living well. It is reported that cancer patients present with multifaceted symptom burden that often impacts on physical performance.

At present exemplar models of cancer rehabilitation exist across the UK along with tumour and symptoms rehabilitation guidance in the form of NCAT Rehabilitation Pathways (National Cancer Action Team, Macmillian Cancer Support 2013). Implementation of these rehabilitation pathways into the inpatient setting can be challenging due to the multifactorial nature and interplay of symptoms cancer patients present with and the resources available.

Our local study primarily aimed to understand the functional trajectory of our acute inpatient population in order to determine how the cancer rehabilitation of the acute population can be optimised in future proposed work.

Key study aims:

  • To describe the acute inpatient oncology population
  • To describe the performance and functional trajectory of the acute inpatient oncology population
  • To feed into a wider project supported by fit for the future looking at “how do we optimise rehabilitation in acute oncology inpatients”

Metastatic Spinal Cord Compression - A Retrospective Audit of Current Practice on Medical Oncology and Haematology Wards at GSTT

Metastatic spinal cord compression (MSCC) is an oncological emergency that requires efficient and effective diagnosis, treatment and rehabilitation (NICE 2008).

 

The current MSCC quality standards for adults highlight the need for:

  • Early detection of MSCC through appropriate assessment by MSCC Co-ordinator, spinal surgeon and clinical oncologist, and imaging within 24 hours.
  • Treatment (dexamethasone, radiotherapy, surgery) commencement within 24 hours of confirmed diagnosis
  • Timely rehabilitation and discharge planning with patient and family input

 

The aim of this audit is to:

  • Determine whether the multidisciplinary team (MDT) management of MSCC patients meets national (NICE 2008) and local (KHP, 2016) guidelines at Guys and St Thomas Foundation Trust (GSTT)
  • To identify if and where improvements need to be made against both national and local guidance.
  • To assess components of the care pathway for timeliness, clinical decisions and processes – namely referrals to clinical oncologists, neuro/spinal surgeon, access to timely imaging, prescribing a suitable dexamethasone dose, timely treatment decisions, confirming spinal stability status and referral to rehabilitation services with provision of timely rehabilitation.

Critter Quest: An Inclusive Physical Activity App for Children

The current paediatric population are not reaching targeted government's guidelines of physical activity. This can lead to serious implications to children's health and wellbeing. Furthermore children with chronic health conditions and/or impairments participate in activity less than the general population. Activity apps have been shown to support positive behavioural change. Although many apps exist, promoting physical activity, an opportunity to design an app inclusive and accessible for children with challenging health conditions and disabilities was identified. The aims of this study were:  

  • To design an app that parents and children would use that promotes inclusive physical activity.
  • To evaluate the feasibility of using the app.
  • To use feedback and demand from users to make adjustments to app functionality prior to public release.
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