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.

 

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.

Management of Motor Neurone Disease (MND) clients in their own homes

A service for clients with MND was developed over the past 5 years within VCRS to allow this group of service users easy access to the multidisciplinary team (MDT) throughout the duration of their illness.

We are interested in improving the coordination, communication and care of patients with MND, from diagnosis to end of life, supported by NICE (2016) and MNDA guidelines. We developed individual speciality pathways to encourage prudent healthcare and bridged links in service provision to reduce individual therapy visits, duplication of referrals and assessments and ineffective communication within VCRS and the wider MDT.

The purpose of the service evaluation was to examine if the current service provision actually meets the needs of the service users and their families. We also wanted to identify areas which require further improvement.

We are keen to share this piece of work to demonstrate how existing practices can be altered in order to provide a more prudent and equitable service to this group of clients.

COPD early discharge service

COPD exacerbations can occur frequently causing lengthy hospital admissions with high re-exacerbation rates. Investment in a COPD EDS is an effective way in improving service and patient outcomes. Other areas may wish to consider adopting this model of care.

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