Wales

Effects of a Multi-Disciplinary Physical and Psychological Programme on Kinesiophobia, Self-Efficacy and Functionality in Persistent Low Back Pain Service Users

Persistent Low Back Pain (PLBP) is the leading cause of disability worldwide. Disability and costs attributed to PLBP are projected to increase in coming decades (Hartvigsen et al, 2018). Research has now established that for people with PLBP, their cognitions and coping mechanisms play a bigger role in the progression from acute to persistent pain than physical features (Wertli et al, 2014). Clinical guidance (NICE, 2016) recommends that service users (SUs) who are not responding to routine management or have significant psychosocial obstacles to recovery, should be considered for a combined physical and psychological programme (CPPP). However, there are no clear current guidelines on the best format for a CPPP. The Back in Action (BiA) programme was introduced to address the needs of these SUs. This service evaluation aims to assess the effectiveness of the BiA 58 hour multi-disciplinary CPPP format on SUs pain related cognitions and function.

 

Single-Arm Observational Service Evaluation: Efficacy of a Single Advanced Physiotherapy Practitioner Intervention for Patients with Chronic Musculoskeletal Pain.

Musculoskeletal (MSK) conditions account for a significant portion of General Practitioner (GP) consultations and are therefore a burden on our health service and especially primary care as these conditions are largely managed within primary and community care. Patients with chronic MSK conditions consult with their GP five times more often than those without and as the age of the population increased this burden is expected to add increased pressure to primary care.

First Contact Physiotherapists (FCP) work at an advanced level of practice as first contacts within primary care and provide a possible solution for these patients. The proliferation of these roles over the last few years has been supported in the literature through studies reporting on the impact of FCP services and satisfaction surveys. NHS documents such as the Long Term Plan also promote an increase in FCP roles and organisations such as the Chartered Society of Physiotherapy and the Royal College of General Practitioners have endorsed FCP. Patients find this role to be an acceptable alternative to accessing their GP for specific conditions which supports these roles from the patients’ perspective.

Despite this support there has been very little evidence to demonstrate the efficacy of FCP services on patient outcomes. This service evaluation therefore aimed to determine the efficacy of FCP interventions on patient outcomes.

An FCP consultation may comprise of an assessment, diagnosis, advice and exercise prescription and as these interventions have been demonstrated in the literature to improve pain self-efficacy (SE) it was decided to assess the outcome of FCP services on the pain self-efficacy of patients with chronic MSK pain.

A pilot study; the feasibility of very early exercise after COPD exacerbation to improve patient outcomes, experience and healthcare costs.

To ascertain whether the inclusion of very early exercise post-COPD exacerbation via the addition of a full-time technician to the COPD Team improves patient outcomes, experience and healthcare related costs above and beyond outcomes already achieved by the existing service.

In addition, to reduce barriers to participation in physical activity and pulmonary rehabilitation attendance commonly observed within this patient group, including being housebound, transport difficulties, geographical inequality in service provision, carer responsibilities, disease severity and high levels of physical and mental comorbidity. Currently inactivity, activity avoidance owing to anxiety regarding dyspnoea and a poor uptake and/ or completion of pulmonary rehabilitation are demonstrated within this cohort of patients, who often have severe disease, which is advocated as a key management strategy nationally and internationally for COPD .

The purpose of this service change is to facilitate other options in assisting patients to achieve better outcomes and an enhanced quality of life through early exercise in conjunction with pre-existing self-management support.

Spasticity interventions in cerebral palsy for people with and without intellectual disabilities - a comparative analysis

The main purpose for this narrative literature review is to analyse and describe the best available evidence for spasticity intervention in Cerebral Palsy for people with Intellectual Disabilities and provide the clinicians an overview of how the evidence could be used to inform decision-making, compare and choose the appropriate intervention in this population. This would be comprehensive resource for physiotherapy practitioners for evidence implementation of these interventions. This review also assisted in identifying the gaps in evidence and to discover new research areas.

The effects of a new Tendo-Achilles Pathway (TAP) on an orthopaedic department.

Achilles tendinopathy is a common pathology that is considered difficult to treat. At a time of austerity in the NHS it is essential to have carefully designed pathways that are monitored in terms of cost and effectiveness. However, a paucity of evidence exists for what the “best value” dedicated “joined up” pathway of care is for this difficult condition. Design, implement and evaluate the impact of a new therapist lead pathway for Tendon- Achilles Pain (TAP).

Using ANGEL taxonomy to triage referrals in Ceredigion community physiotherapy

To evaluate whether service improvements could be made to our community physiotherapy service through clinical streaming of patient referrals using underlying principles complexity science to consistently deploy the most appropriate member of the physiotherapy team to meet the needs of patients and improve the effectiveness of our service.

Physiotherapy Supported Discharge Service following knee arthroplasty

An audit on length of stay (LOS) for total knee replacement (TKR) patients following surgery highlighted that a number of patients were exceeding their predicted date of discharge (PDD), many due to not achieving traditional physiotherapy goals (90⁰ flexion, < 5 ° extension lack and good quadriceps function), despite being safely mobile and medically fit. This exposes patients to risk of harm due to prolonged stay within an acute hospital environment as well as inefficient utilisation of an in-patient bed. A Physiotherapy Supported Discharge Service (PSDS) had previously been piloted for six months. Phase 2 consisted of permanent service resign, continuing the PSDS and service evaluation.

Trial of diagnostic ultrasound in the orthopaedic setting

Historically, provision of MSK Ultrasound diagnostics has been via a referral to Radiology. However, there is increasing evidence that assessment, investigation and initiating treatment at the initial appointment is shown to be cost-effective, increasing patient satisfaction. Utilising this approach also reduces repeated hospital visits for further diagnostics and appointment times for results. The aim of using Point of Care (POC) ultrasound is to enhance the patient experience through instant access to diagnosis, timely implementation of most appropriate clinical pathway and achievement of the optimal outcome in the shortest possible time.

This study aims to investigate the benefits of point of care (POC) and schedule ultrasound clinics using a proof of concepts approach in the orthopaedic setting.

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