On Your Marks - Are PDRU Patients Meeting Government Exercise Guidelines?

Purpose

The primary aim of the project was to review current practice and establish if our client group were meeting government exercise guidelines whilst attending the Physically Disabled Rehabilitation Unit (PDRU). In addition data was collected in relation to compliance rate of 1Repetition Maximum, exercise completion and recording of BORG RPE scores to determine intensity of treatment.

Approach

The project followed three phases; a reflective audit, a pilot study and a project phase. A reflective audit to review current practice in PDRU against government exercise guidelines was carried out. Twenty patients were included in a 4-week pilot study where patient paperwork was adapted to allow recording of BORG RPE and a protocol for measuring 1RM was introduced to allow measurement of intensity of exercise. Further changes to paperwork and the 1RM protocol were made after completion of the pilot study and these were implemented for a 5-week project phase. 

Outcomes

Thirty-four patients met the inclusion criteria, one did not. On average, 21 minutes of CV exercise was completed per patient per week meaning no patient met the CV guideline. An average of four muscle groups were exercised 1.5 times per patient per week. Seven patients met the strengthening guidelines on one week.

74% of patients had BORG RPE scores recorded for strengthening exercises and 63% recorded for CV exercises. 1RM's were completed by staff 94% of the time.

The results of the project have shown that the PDRU client group do not meet government exercise guidelines for either strength or CV fitness through the gym programs implemented. However, other factors impact on this as strength and CV exercises are often not the sole focus of their rehabilitation needs.

While completion of 1RM by staff was high, documentation of BORG RPE scores for strength and CV exercises was not and further work to improve this is needed. Staff did however report their knowledge surrounding exercise guidelines to have improved over the course of the project. The implementation of 1RM and use of BORG RPE allows staff to provide evidenced based practice towards strengthening and CV exercises which, in turn, improves patient care.

Cost and savings

  • Minimal administration costs.
  • ½ day per week of Band 6 Physio time allocated to the project over a period of 10 months.

Implications

Following on from this project, further work is needed to identify an easier way for staff to record BORG RPE score and document 1RM's to increase compliance. Addressing the low time spent on CV exercise while in PDRU would be beneficial for our client group, particularly with regards to encouraging supported self management of long term conditions. Further work is also needed to establish of clearer and more specific exercise guidelines for this patient population would be a worthwhile longer term outcome from this project.

Top three learning points

  1. Meet regularly with supervisor/mentor to keep your project on track.
  2. Keep the project small as they can quickly become overwhelming especially when trying to balance with a clinical caseload.
  3. Manage your time through setting shorter deadlines as it’s very easy to leave things to the last minute.

Fund acknowledgements

This work was not funded.

Additional notes

This work was presented at Physiotherapy UK 2019.

Thank you to Alison Barclay, Catriona Ralph, Donna Bisland, Kimberly Barton, Emma Jackson and Cheryl Gold who contributed to the project work.

Please see the attached Innovations poster below. 

 

For further information about this work please contact Jennifer Gemmell.  

 

References:

BILLINGER, SA., ARENA, R., BERNHARDT, J., ENG, JJ., FRANKLIN, BA., JOHNSON, CM., MACKAY-LYONS, M., MACKO, RF., MEAD,GE., ROTH, EJ., SHAUGHNESSEY, M., TANG, A. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014, 45, pp. 2532–2553.

DEPARTMENT OF HEALTH, 2011. Start Active, Stay Active. London: Department of Health

SCHERR, J., WOLFARTH, B., CHRISTIE, J., PRESSLER, A., WAGENPFEIL, S. & HALLE, M. Associations between Borg’s rating of perceived exertion and physiological measures of exercise intensity.  European Journal of Applied Physiology.  2013, 113, pp. 147-155.