North West

Developing Patient Understanding - The Effectiveness of an Educational and Exercise Programme for Persistent Lower Back Pain

Lower back pain (LBP) is one of the ten leading causes of disease burden globally. It is widely recognised that LBP produces significant detrimental effects on physical and emotional wellbeing whilst having a substantial economic burden for society. There is an inverse relationship between socio-economic status and the prevalence of pain. Increasing patients understanding of non-specific lower back pain including pain physiology, combined with completing exercises can provide optimal management. Therefore, the effectiveness of a locally run 'Back to Fitness Programme' (education and exercises) in the most deprived local authority area in England was evaluated.

The purpose was to evaluate the effectiveness of the Back to Fitness programme upon patients' understanding of pain, ability to function, symptom-report and physical outcomes.

Evaluation of the optimal physiotherapy-led mobilisation on critical care following the implementation of a mobility guideline.

Every patient on critical care should be assessed daily for the potential to begin functional rehabilitation including mobilisation.

Levels of agitation and sedation, as measured by the Richmond Agitation and Sedation Score (RASS) and consciousness measured by the Glasgow Coma Scale (GCS), can impact on the type of activity delivered by physiotherapy. A new mobility guideline was initiated on the general intensive care unit (ICU) to maximise patient rehabilitation within the limitations of their RASS score.

The purpose of this evaluation is to establish that the maximum level of rehabilitation/mobility was safely performed within each patient's physical, medical and cognitive abilities.  

Replacing a Retiring Consultant Rheumatologist with an Appropriately Skilled Consultant Physiotherapist.

The role of the Advanced Practice Physiotherapist (APP) has been well established in our Rheumatology team for more than 10 years. However, following the semi-retirement of one of the medical consultants there has been an option to pilot Consultant-level Physiotherapy input to the Rheumatology team. This process of using allied health professionals to replace medics has been called “Practitioner Substitution” and is seen as an important part of improving care and patient outcomes whilst delivering the efficiencies the NHS needs. The aims of the pilot Consultant post were: to independently manage and streamline the pathway for the non-inflammatory / pain service in Rheumatology, to reduce wait times and to ensure a more inflammatory-heavy caseload for the remaining Rheumatology medical team.

Hemiarthroplasty for hip fracture: Are post-operative hip precautions necessary?

The purpose of patients being asked to follow post-operative 'hip precautions' is to restrict range of movement at the hip joint in order to reduce the risk of dislocation.

There has been increasing recent evidence in literature to suggest that these hip precautions may not be required following hip surgery.

Following discussion and consideration of the evidence available, all orthopaedic surgeons at our Orthopaedic Trauma unit agreed to discontinue the implementation of these hip precautions for all patients undergoing trauma hip hemiarthroplasty; and jointly signed a paper informing of this decision.

The aim of this study was therefore to assess any effects of this change upon the post-operative dislocation rate for this patient group.

Does delay to theatre influence patients' ability to achieve early mobilisation following surgical fixation of a hip fracture?

The National Hip Fracture Database (NHFD) publishes performance data which includes achievement of early post-operative mobility - defined as 'Mobilised on day of, or day following, surgery'.

It had been anecdotally noted on our Orthopaedic trauma unit that patients who experience a delay to surgery find it more difficult to achieve this early mobility target (with 'delay' to surgery defined here as failure to meet the NICE clinical guideline for hip fracture: 'Perform surgery on the day of, or the day after, admission').

This study therefore aimed to objectively investigate this supposition.

Early detection of post-operative pulmonary complications such as pneumonia using physiotherapy-led lung ultrasound: A case study

Lung ultrasound (LUS) has been shown to have higher diagnostic accuracy (95% sensitivity and 95% specificity) in the detection of pneumonia in patients with respiratory symptoms when compared to chest radiograph (CXR) (49% sensitivity and 92% specificity). Physiotherapists trained in LUS could use this diagnostic technique to monitor patients for pneumonia especially when they begin to show signs of post-operative pulmonary complications (PPC).

Lung ultrasound in the management of patients with cystic fibrosis: A literature review

Adults and children diagnosed with cystic fibrosis (CF) are regularly exposed to ionising radiation, from chest radiographs (CXR) and computed tomography (CT). This poses an issue as life expectancy has increased into the fifth decade of life.

Lung ultrasound (LUS) has the ability to assess many lung pathologies experienced in CF with accuracy close to CT but without the exposure to ionising radiation. The purpose of this review is to explore the literature to establish if LUS is being used to aid the management of patients with CF.

Exploring hospital and physiotherapy length of stay following thoracic surgery

The number of thoracic surgical procedures performed in the United Kingdom continues to increase annually putting pressure on thoracic surgical bed capacity. Reducing hospital length of stay (LOS) following thoracic surgery can help to reduce pressure on hospital beds. The purpose of this service evaluation is to explore hospital and physiotherapy LOS for individuals following thoracic surgery at our hospital and identify whether any factors influence hospital and Physiotherapy LOS. The findings could potentially allow the identification of individuals at risk of longer LOS and help direct physiotherapy rehabilitation provision to these individuals.

Implementation of a new goal-planning process in an intermediate neuro-rehabilitation unit

It was recognised that the neuro-rehabilitation unit had a length of stay above the national average of 80 days. A new multidisciplinary goal planning process was implemented on the unit with the following aims; reduce length of stay to the national average; reduce the waiting list to 1 week; to consistently achieve greater than 70% patient and family/carer satisfaction.  The impact on the FIM/FAM outcome measure was monitored to ensure there were no adverse effects on patient outcome as a result of implementing the new process.

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