Contributing to service development and enhancing patient care through the establishment of a balance class

Purpose

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.

We used a patient reported outcome measure (ConfBal)
which showed 67% improvement in patient confidence...
...and an objective outcome measure (TUG)
which showed 100% improvement in balance, sit to stand and walking.

Approach

We started by scoping out all the clinics to justify a balance class by gathering feedback and data from Physiotherapists regarding patient suitability and completing an audit on assistant run clinics. We needed a business plan looking at cost versus effectiveness, considering clinician time out from clinics to instruct, room hire cost, amongst other factors. Making links with other services enabled us to understand how similar classes were being run, helped avoid duplication and confirmed a gap in balance class provision.

Research was undertaken into the most effective balance training which concluded the OTAGO programme as most suitable. This was assisted by Physiotherapy students working towards their university projects on service development. We promoted our ideas and findings at team meetings and the clinical training conference. Following practical sessions for colleagues to experience the class and training assistants on the OTAGO exercises, we were able to develop a better awareness within our team and were granted the go ahead for a pilot class. We therefore established suitable referral criteria and set up a booking process. Following NICE guidelines we also put in place health and safety protocols so the classes can be run safely.

Outcomes

The pilot comprised of two six week courses with between seven to eight participants on each course. We used a patient reported outcome measure (ConfBal) which showed 67% improvement in patient confidence and an objective outcome measure (TUG) which showed 100% improvement in balance, sit to stand and walking. We also received service feedback with 93% of participants reporting a moderate to significant improvement in their confidence, balance and strength. Finally, we evaluated the cost effectiveness for the service which revealed the balance class is offering three times as much patient treatment for six hours less clinician time compared to 1:1 Physiotherapy.

The pilot of the balance class concluded that patient outcomes, service feedback and cost effectiveness have all shown excellent results. Therefore, a group balance class based on OTAGO is desirable when treating patients over fifty with a balance deficit. Our future plans include rolling it out city wide and researching into the potential of a group based exercise class for patients under fifty with a balance deficit.

Cost and savings

We evaluated the cost effectiveness for the service which revealed the balance class is offering three times as much patient treatment for six hours less clinician time compared to 1:1 Physiotherapy.

Implications

The current running of this cost effective class has enhanced service provision and patient centered care, augmenting Physiotherapy treatment within the musculoskeletal department. Clinicians have also benefited individually by developing a varied skill set whilst helping to run the classes.

Top three learning points

  1. Don’t be afriad to speak out about your ideas to develop a service as this group based balance class has proven more cost effective and produced better clinical outcomes compared to 1:1 physiotherapy clinics.
  2. OTAGO is an effective exercise programme for treating patients over 50 with a balance deficit in a group setting.
  3. ConfBal and TUAG are effective outcome measures in evaluating the progress of patients with a balance deficit.

Fund acknowledgements

None. 

Additional notes

This work was presented at Physiotherapy UK 2019

Please see the attached Innovations poster below. 

 

For further information about this work please contact Katherine Panton-Kent and/or Chris Ridley.