Serial casting is a common conservative intervention for children and young people who are idiopathic toe walkers, or who have cerebral palsy and develop calf muscle contracture. The main aims of serial casting are to improve calf muscle length, walking pattern and efficiency. There is a strong evidence base showing serial casting is effective in improving calf muscle length. Historically in the large and rural county of Powys serial casting has been provided by out-of-county hospitals, making access difficult and involving children, young people and their families travelling long distances. A local physiotherapy-led serial casting service has been piloted within Powys for the last 1 year and 9 months, with capacity to provide treatment in local hospitals and schools as well as client´s homes. A retrospective audit was carried out to assess the benefits and effectiveness of this service.
Audit of patients presenting to Emergency Department with suspected CES and their subsequent management including Surgery.
To identify presenting signs and symptoms of patients, attending the Emergency Department, who were suspected of having Cauda Equina Syndrome (CES) and to describe the variable presentations of patients who subsequently require surgical intervention.
There is an increasing strain being placed all across the NHS systems. Emergency Departments up and down the country are being widely criticised for their performance against the national targets. We also have an aging population often with multiple co-morbidities that often present to the emergency department with both health issues and social care issues. The Royal Stoke Emergency department is one of the busiest in the country. In 2018 it had 111,091 attendances. 30,074. It had a higher than national average attendance to admission rate for over the age of 70. An external body wanted to see if creating a new MDT made up of senior decision makers with a background in the care of frail patients could make a difference.
A Thematic Synthesis considering the factors which influence Multiple sclerosis related Fatigue during physical activity.
To identify the fatigue related consequences from exercise or physical activity in patients with Multiple Sclerosis (PwMS) and consider the reasons and the extent that fatigue perception inhibits the will of PwMS to participate in physical activities.
Effectiveness and optimal dosage of resistance training for chronic neck pain: a systematic review with a qualitative synthesis and meta-analysis
Ranked 4th for global disability neck pain is experienced by up to 50% of the population annually and is more common than low back pain in office-based workers. Clinical guidelines recommend multimodal physiotherapy that includes resistance training exercise (RET) for the neck and shoulders. Although RET programmes exist with different objective and physical outcomes (e.g. cervical isometrics, craniocervical flexor retraining etc.) no evidence synthesis has compared their effectiveness. Equally, despite being highly cited the dosage (repetitions, frequency, load) of RET varies considerably between studies. The aim of this study is
1) to evaluate the effectiveness of RET in chronic non-specific neck pain (CNSNP)
2) to determine an optimal dosage.
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.
Contributing to service development and enhancing patient care through the establishment of a balance class
The requirement for a balance exercise class was identified whilst working in a musculoskeletal clinic that receives many referrals for patients who attend with balance deficit. We needed a class that would allow patients to improve upon confidence, mobility, functional balance and lower limb strength whilst being fun and augmenting individual Physiotherapy care. This class would also free up the popular assistant rehabilitation clinics.
The use of a standardised outcome measure within the Musculoskeletal Physiotherapy Services across a Trust in Staffordshire
Musculoskeletal (MSK) physiotherapy teams within Midlands Partnership NHS Foundation Trust (MPFT) historically used a variety of outcome measures including the EuroQol (EQ-5D-5L) alongside condition specific PROMS and a patient experience-reported experience measure, in line with Chartered Society of Physiotherapy (CSP) recommendations. However, teams used different outcome measures and data collection, inputting and analysis methods varied considerably.
In 2017, the MSK Health Questionnaire (MSK-HQ) was introduced and a data inputting and analysis calculator was developed following a consensus group exercise with the clinical and operational leads of MSK physiotherapy teams to facilitate the implementation of the MSK-HQ.
The purpose of this project was to demonstrate the positive impact an Independent Prescriber Physiotherapist could have on the service delivery in outpatient spasticity clinics. The project aimed to demonstrate reduced patient waiting times for review appointments, reduced cost per appointment and demonstrate high patient satisfaction. The overdue waiting period for spasticity reviews is a long standing problem for the spasticity service and on the Trust risk register. Historically spasticity clinics were managed in multidisciplinary team (MDT) clinics involving a Consultant and a Physiotherapist. A proposal was put forward to the team and agreed. This proposal was for a single Physiotherapist Independent Prescriber, with experience in management of spasticity and neuropathic pain, to set-up a pilot period of Independent Physiotherapy led spasticity review clinics.
Medicines optimisation for the treatment of spasticity and neuropathic pain led by a Physiotherapist Independent Prescriber
The purpose of this project was to improve medicines optimisation for the management of patients with spasticity or neuropathic pain who attended multidisciplinary specialist neuro outpatient clinics at West Midlands Rehabilitation Centre. The secondary purpose was to identify how much input was required to optimise medication after a change in medication was advised and if this input could be adequately carried out by a Physiotherapist Independent Prescriber.
Historically the Consultant (prescriber) would review and make changes as required to a patient’s medication for managing their spasticity and neuropathic pain. Patients could contact in case of concerns, however, there was usually no medication follow up initiated by the Consultant between clinic appointments. This was due to limitations on Consultant capacity. Time periods between clinic appointments for each patient could be between 3-12 months depending on the request of the Consultant. This meant that if there were issues with obtaining or taking the medication and the patient did not initiate contact, the issue would not be addressed until the patient returned to clinic.
NICE provides guidance that the prescriber should review the patient with regards to their medication after starting or altering a medication within a timely period. This is important as it ensures that patients receive the right choice of medication for them, at the right dose and right time to benefit their health.
Medication reviews following a face to face appointment do not necessitate a face to face appointment and telephone reviews can be completely adequate. This is because patient achievement of goals of treatment with medication is primarily identified through subjective assessment. The standard in this project was set that all patients who required a medication change in clinic would be reviewed, on time via telephone consultation(s). The time at which the patient would be need to be reviewed would be dependent on the time period in which the prescriber advised the medication change to occur over.