Rehabilitation

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.

The Active Back Programme - A model for multidisciplinary persistent lower back pain rehabilitation.

The RNOH Active Back Programme (ABP) is a residential multi-disciplinary rehabilitation programme for people with persistent lower back pain. The aims of the ABP are to decrease the effects of pain on lifestyle by facilitating behavioural change through building self-efficacy and confidence. The long term goal is to reduce healthcare utilisation and hence the economic burden of back pain. Recent emerging evidence has highlighted the importance of targeting patient-specific fear avoidance. This shift in approach has significantly impacted the outcomes that therapy can achieve in terms of pain reduction and disability.

The purpose of this evaluation was to gauge the short-term outcomes at three months following completion of the ABP using measures of self-efficacy, confidence and physical capacity.

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.

What is the patient experience of a functional goal orientated back group?

Chronic low back pain causes a significant physical, psychological and financial burden to a wide variety of the population and health care services.

Despite a large field of research, optimum long term management remains unknown. The NICE guidelines recommend group exercise for the management of low back pain.

Recently, functional rehabilitation including the restoration of normal movement patterns has gained increasing evidence in the literature. However, there is limited research outlining the effectiveness of a combined approach, involving functional rehabilitation in a group setting.

The aim of this study was to understand the patient experience of a functional goal orientated back group in a South Yorkshire NHS secondary care hospital

The Front of House Team: Enabling and Supporting Discharge from the Emergency Department.

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 3 month prospective audit of physiotherapy referrals to a Community Rehabilitation Team and trial of alternative triage process.

The Community Rehabilitation Team (CRT) provides intermediate care and rehabilitation to individuals unable to leave their homes or who do not meet referral criteria for specialist services. Therapists are generalists whose specialism is managing complexity.

Current practice required all clinical staff (B4 and above) to triage referrals for suitability, and to assign appropriate referrals to immediate action (within 5 days) or a waiting list (up to 18 weeks), according to clinical need. This decision was commonly made directly from information contained within the referral.  

Staff expressed anxiety and frustration with the process, and an inability to affect change or provide support to colleagues. Referrals from traditionally hierarchical superiors could be challenging, especially when declining inappropriate referrals, with concern that this may affect future commissioning.  

This audit of physiotherapy referrals, aimed to classify our caseload through collection of quantitative data, and to trial an alternative triage process.

A Rapid Review of evidence for management of patients that frequently attend Emergency Departments with Chronic Pain.

Frequent attenders (FA) (defined as individuals that attend more than 5 times per annum) of ED have been reported to account for 13% of the total cohort. A common reason for presentation is chronic pain. Guidelines recommended that Frequent Attenders are identified, that case management may assist with involving other services and that multidisciplinary case conferences may aid patient engagement.

  • To critique evidence for case management of patients that frequently attend ED with chronic pain.
  • To utilise the evidence to support an innovative rapid access pathway to a pain rehabilitation service.

Does Patients' Perception of Improvement following a Pain Management Programme, Match Reported Minimally Clinically Important Differences?

Clinical outcomes for patients attending a pain management programme were evaluated to determine whether patients who rated an improvement on a Global Impression of Change Score, achieved mean changes in BPI that were consistent with 'acceptable' change, and to determine mean changes on other outcomes in this population. It is suggested that a mean change of 2.09 in pain interference, as measured by the Brief Pain Inventory (BPI), could be considered acceptable to patients. Currently data is unavailable for changes in pain acceptance.

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