Research, quality improvement and implementation approaches

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.

Interprofessional education for practice: moving and handling for people with complex needs in contemporary healthcare.

Obesity is a growing problem in the UK affecting all areas of the NHS, with over a quarter of all adults falling into this category. The additional risks and co-mobidities that obesity is linked with leads to a high number of hospital admissions.

The multidisciplinary teams working with these people require appropriate knowledge and skills to deliver safe and effective care, with the National Institute for Health and Care Excellence (2014) recommending that staff be appropriately trained to use specialist equipment when working with this complex group of people.

Research has shown that interprofessional team working can play an important part in improving patient safety. This report details the process an interprofessional team have undertaken to develop a simulated bariatric scenario as part of the learning materials that complement practical moving and handling sessions for undergraduate students.

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.

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.

Developing programme theories to understand 'First Contact Physiotherapy' in Primary Care: A rapid realist review (FRONTIER)

First Contact Physiotherapy (FCP) is a new primary healthcare model in which a specialist physiotherapist in Musculoskeletal Disorders (MSKDs) located within general practice, undertakes the first patient assessment, diagnosis and management without the requirement for prior GP consultation. It is intended to provide additional capacity and diversify the primary care workforce to meet the high demand for MSKD appointments and the challenges of recruiting and retaining GP staff. Initial audits of the service propose the FCP model may free up GP appointments, reduce secondary care referrals and scan requests, improve patient satisfaction, and produce cost savings. However, there is a lack of robust research evidence, and limited understanding of how best to implement FCP given contextual variation in general practices across the UK. This rapid realist synthesis generated and refined programme theories to develop insight into “What it is about FCP in Primary Care that works, for whom, in what circumstances, how and why?”. This was the second stage of a four-part project exploring the FCP role.

Increasing long-term participation in sports based activities in children and young people with acquired brain injury.

Participation in sports can play a key role in a child’s quality of life, development and learning (Willis, 2018). Children and young people (CYP) with acquired brain injury (ABI) face significant barriers in accessing sporting and leisure activities.  This reduces the likelihood of participation in regular sporting and leisure activities (Anaby,2018),  both in the recovery period and the later stages (Willis, 2018).

This is a quality improvement project that explores the implementation of a sports based group in a neurorehabilitation centre for CYP with ABI.

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