Service evaluation of the Anterior Cruciate Ligament Deficient Induction Clinic (ACLD) and Rehabilitation Class.

Historically, at GSTFT, patients with ACL pathology have been managed in weekly exercise classes. Anecdotally, Physiotherapists felt that they were unable to effectively manage both the post-operative and ACL deficient (ACLD) populations due to high class numbers. After an internal service evaluation and audit, a unique ACLD pathway was established to separate the ACLD population, and better manage both ACL cohorts. This included a specific fortnightly ACLD Induction Clinic and ACLD rehabilitation class.

This data collection aimed to:

  • Evaluate the demand for the ACLD pathway, including the new ACLD rehabilitation class, and analyse patient demographics
  • Ensure the ACLD pathway is utilised correctly, by monitoring patients being referred
  • Start analyzing the data and trends of patient attendance and onward management in the ACLD rehabilitation class and begin early root cause analysis.
  • Commence a systematic review around the quality of pre-operative physiotherapy intervention and how this effects outcomes post-operatively, in order to guide the temporality and content of our ACLD rehabilitation class.

Improving information-giving to critical care patients to guide post discharge rehabilitation: a quality improvement project

ICU survivors have a 1-year mortality rate of 30%, and a reduced quality of life associated with post-ICU syndrome; a triad of cognitive decline, physical weakness and psychiatric disorders. Early rehabilitation improves outcomes, leading to greater independence. The NICE CG83 guidelines instruct the provision of rehabilitation information to critical care patients on discharge. Currently, only a third of UK trusts meet these guidelines.

Within 20 weeks, we aimed to achieve 100% patient and therapist satisfaction with the rehabilitation information given to patients at risk of physical morbidity on discharge from critical care at Medway Maritime hospital.

Impact of a three-phase ACLR post-operative rehabilitation pathway on patient drop-out rates and return to sport outcomes.

Anterior cruciate ligament reconstruction (ACLR) is commonly recommended for patients aiming to return to level 1 sports (sports that involve cutting, jumping and pivoting). Completion of ACLR surgery does not guarantee patients will return to sports due to a spectrum of biopsychosocial factors. Large NHS patient referral volumes can make it challenging to balance the quality and quantity of sports-specific rehabilitation. Service evaluation offers an opportunity to review and propose innovative ways of working.

A recent service evaluation at Guys and St Thomas' NHS Foundation Trust (GSTFT) showed a high amount of ACLR patients drop out of physiotherapy 6 months post-operatively and do not progress to sports-specific rehabilitation; the goal which underpinned the original decision to undergo surgery. True return to sport rates post-ACLR is acknowledged to be variable.

The aim of the project was to implement a new ACLR post-operative rehabilitation pathway at GSTFT to optimise return to sport outcomes.  

Physiotherapist Experiences and Perceptions of Telephone Triage and Barriers faced when Triaging

This study aims to identify Physiotherapist's perceptions and experiences of Telephone Triage, as well as identifying any barriers they may face when triaging.

Professional barriers to PTT have been suggested demonstrating clinician reluctance despite patient satisfaction. Little is known about the effect of the role change on the Physiotherapist, and the inability to physically examine the patient.

This research will help direct training and the working experience for Physiotherapists, improve current Triage structures and provide justification to organisations implementing the service. Understanding barriers to PTT will assist with service planning and change management.

Using digital technology and user-centred design to develop a physiotherapy self-referral service for back pain

14 million people in England use GP online services. Harnessing digital technology in primary care to develop a physiotherapy self-referral service provides an opportunity to make physiotherapists the first point of contact for patients suffering back pain, whilst enabling service-users to make decisions about how they wish to receive care. A previous self-referral model of telephone and email access yielded low uptake and made inefficient use of administration resources. The aim of this 'proof of concept' project was to explore if a digital physiotherapy self-referral service is safe and acceptable to patients with back pain.

Move, Groove Improve Quality Improvement Project

The purpose of this project was to reduce the effects of deconditioning and promote functional independence on an elderly care ward, with the ethos inspired by the End Pj Paralysis campaign. The first aim was for over 55% of patients to be sitting out daily for lunch on the ward. The aim was also for over 20% of patients to be wearing their own clothes daily on the ward. Secondary aims including improving patient experience, increasing staff knowledge on deconditioning and maintaining and reducing length of stay.

Getting the Know-How: The Feasibility of Delivering a Digital Self-Management Programme for Axial Spondyloarthritis

Despite recommendations by the National Institute for Health and Care Excellence in the management of Axial Spondyloarthritis (AS), adherence to exercise and self-management education is reported to be variable. The Axial Spondyloarthritis Know-How (ASK) self-management programme offers service-users a single attendance exercise and education workshop supported by a self-management digital toolkit. The digital toolkit consists of a short educational film and self-assessment tool prior to attendance and an interactive self-management handbook to support health behaviour change following attendance. The feasibility of delivering a digital self-management programme for adults with AS was explored prior to implementation.

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