Outpatient Physiotherapy Services Research Articles

Impact of the Comprehensive Care for Joint Replacement bundled payment model on postoperative utilization of home health and outpatient physical therapy services

ObjectiveTo study the impact of the Comprehensive Care for Joint Replacement (CJR) bundled payment program on postoperative home health and outpatient physical therapy (PT) for total hip or knee arthroplasty (THA/TKA). DesignRetrospective cohort with national Medicare data (5% claims) using a difference-in-differences analysis comparing January 2013-September 2015 (before) versus October 2016-September 2019 (after). SettingAdministrative claims from hospitals in 34 metropolitan statistical areas with mandatory CJR participation as of 2018 and 42 control metropolitan statistical areas. ParticipantsEpisodes in fee-for-service Medicare beneficiaries (5% claims) undergoing elective THA (n=6,327) or TKA (n=10,764) with community discharge. InterventionsImplementation of CJR bundled payment program. Main Outcome Measure(s)Home health and outpatient PT, including any use and number of visits. ResultsProgram implementation was associated with an increased percentage of THA episodes using home health PT (+8.0 percentage-point change, 95% CI +3.5 to +12.6, P=0.001) but a decreased per-episode number of home health PT visits for THA (-1.1, 95% CI -1.6 to -0.6, P<0.001) and TKA (-1.1, 95% CI -1.4 to -0.07, P<0.001). The program was also associated with an increased per-episode number of outpatient PT visits for TKA in the primary but not sensitivity analyses (+0.8, 95% CI +0.1 to +1.4, P=0.02). ConclusionsFindings of increased home health PT may reflect an intentional shift in care from the inpatient post-acute setting to the community to decrease costs. Alternatively, the limited impact of CJR, particularly on outpatient PT, could reflect challenges with care coordination in a retrospective bundle spanning multiple care settings.

Examining rehabilitation access disparities: an integrated analysis of electronic health record data and population characteristics through bivariate choropleth mapping.

Despite efforts to view electronic health records (EHR) data through an equity lens, crucial contextual information regarding patients' social environments remains limited. Integrating EHR data and Geographic Information Systems (GIS) technology can give deeper insights into the relationships between patients' social environments, health outcomes, and geographic factors. This study aims to identify regions with the fastest and slowest access to outpatient physical therapy services using bivariate choropleth maps to provide contextual insights that may contribute to health disparity in access. This was a retrospective cohort study of patients' access timelines for the first visit to outpatient physical therapy services (n = 10,363). The three timelines evaluated were (1) referral-to-scheduled appointment time, (2) scheduled appointment to first visit time, and (3) referral to first visit time. Hot and coldspot analyses (CI 95%) determined the fastest and slowest access times with patient-level characteristics and bivariate choropleth maps that were developed to visualize associations between access patterns and disadvantaged areas using Area Deprivation Index scores. Data were collected between January 1, 2016 and January 1, 2020. EHR data were geocoded via GIS technology to calculate geospatial statistics (Gi∗ statistic from ArcGIS Pro) in an urban area. Statistically significant differences were found for all three access timelines between coldspot (i.e., fast access group) and hotspot (i.e., slow access group) comparisons (p < .05). The hotspot regions had higher deprivation scores; higher proportions of residents who were older, privately insured, female, lived further from clinics; and a higher proportion of Black patients with orthopaedic diagnoses compared to the coldspot regions. Our study identified and described local areas with higher densities of patients that experienced longer access times to outpatient physical therapy services. Integration of EHR and GIS data is a more robust method to identify health disparities in access to care. With this approach, we can better understand the intricate interplay between social, economic, and environmental factors contributing to health disparities in access to care.

Analysis of Marketing Strategies in Outpatient Services, Inpatient and Physiotherapy Services by Method Mix Marketing at RSU Royal Prima Marelan Medan

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;The increasing number of hospitals every year causes competition between hospitals in providing health services to patients. Because that's the need to implement a marketing strategy. This study aims to analyze the marketing strategy of Royal Prima Marelan Hospital with the marketing mix strategy (4P), namely product, price, place/distribution, and promotion. This study used a qualitative approach, conducted by interviewing 14 informants, namely 1marketing and public relations management, 1 general practitioner, 1 head of administration, 1 head of inpatient room, 1 head of outpatient room, 1 physiotherapist, and 8 patients. From the research results it is known that a specialist urologist and neurosurgeon are needed, and the number of nurses needs to be increased. The advantage of this hospital in the field of service products is that even though it is a type C hospital, it has quite a lot of specialist doctors. This hospital focuses on excellent trauma services, but still requires specialists in neurosurgery and urology. Royal Prima Marelan Hospital is also located on the side of the road which is very quickly accessible, but it needs to expand or expand the entrance and exit. In the field of promotion quite a lot and often done by the management and employees. However, more promotion is needed in the physiotherapy service product section&lt;/em&gt;&lt;em&gt;.&lt;/em&gt;&lt;strong&gt;&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keyword: Hospital manangement, Marketing mix&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

Reported Experience of Women Who Received a New Self-management Physical Therapy Instruction before Breast Cancer Surgery - A Case Series

Objective: The need to provide information and instruction for patients post breast cancer (BC) surgery is highly supported. Several studies have shown pre-surgery instruction to be beneficial. However, as information about the experience of patients receiving pre-surgery instruction is limited, this case series aims to describe the experience of nine individual women who received newly developed, updated, self-management physical therapy (PT) instruction before BC surgery. Methods: Participant interviews were conducted by telephone using a list of questions prepared in advance about their personal experience. Medical files provided demographic and medical data. Interviews were performed by one physical therapist, transcribed, and analysed by two co-authors. Similarities and differences between transcripts were summarized. Results: Most participants found the instruction content to be easily understood and beneficial. They also expressed the value of receiving instruction before BC surgery. Nine felt that the instruction should be routinely provided. Criticism was mainly for lack of instruction regarding pain control, dealing with exercise fear avoidance, and that women unfamiliar with self-management and independent exercise may benefit less. Conclusion: Most participants found the new instruction understandable and beneficial when provided pre-surgery. However, this may not be suitable practice for all women as some may need personalized post-surgery instruction. Therefore, in addition to pre-surgical instruction provision, a post BC surgery PT visit would identify those requiring individualized instruction. Information about outpatient PT services should be added to pre-surgery instruction. Future studies should examine content and provision timing in a large sample of participants.

P99 Barriers to outpatient physical therapy services and the role of these services in patients with neuromuscular diseases

P99 Barriers to outpatient physical therapy services and the role of these services in patients with neuromuscular diseases

Goal setting in physiotherapy-led adult musculoskeletal care: A scoping review.

Goal setting is a key part of rehabilitation across various fields of physiotherapy. It is less clear what evidence exists to underpin its effectiveness and to practically guide its use within musculoskeletal physiotherapy. This scoping review provides an overview of current research regarding goal setting in adult physiotherapy-led musculoskeletal care with three aims: 1) to identify and analyse any gaps in the literature, 2) to identify relevant features of goal setting theory and 3) to make recommendations for future research. The principal research question was what does the literature tell us about the role of goal setting for adults over the age of 18 with musculoskeletal pain accessing outpatient physiotherapy services? The population, concept and context framework was used to define the inclusion criteria. Key definitions were adults over the age of 18 with musculoskeletal conditions, goal setting, and physiotherapy-led interventions. This scoping review followed the guidance set out by the Joanna Briggs Institute Manual for Evidence Synthesis. Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, MEDLINE, American Psychological Association PsycInfo and the Cochrane Database of Systematic Reviews, Protocols and Trials were searched using pre-defined search criteria. Data were extracted from screened full-text articles and presented in basic statistical and narrative form. 41 articles were included in the review. Several broad themes and research methods were identified. The nature of the studies suggested that the clinical application of goal setting is complex and the depth of understanding is limited. Most studies suggested that goal setting is feasible and has a positive impact on outcomes. A common finding was a lack of clear definitions regarding goal setting terminology and approaches. Study samples were generally defined by biomedical categories, suggesting a pathoanatomical approach to researching a cognitive construct. Theoretical underpinning was lacking in many studies. No frameworks guiding goal setting in physiotherapy-led musculoskeletal rehabilitation have been identified. Goal setting is a popular tool within musculoskeletal outpatient physiotherapy. Further research is required to clarify its efficacy and provide guidance on its role and application in clinical practice.

The Prevalence of Cognitive Impairment Among Medicare Beneficiaries Who Use Outpatient Physical Therapy.

The objective of this study was to estimate the prevalence of cognitive impairment (including cognitive impairment no dementia [CIND] and dementia) among Medicare fee-for-service beneficiaries who used outpatient physical therapy and to estimate the prevalence of cognitive impairment by measures that are relevant to rehabilitation practice. This cross-sectional analysis included 730 Medicare fee-for-service beneficiaries in the 2016 wave of the Health and Retirement Study with claims for outpatient physical therapy. Cognitive status, our primary variable of interest, was categorized as normal, CIND, or dementia using a validated approach, and population prevalence of cognitive impairment (CIND and dementia) was estimated by sociodemographic variables and Charlson comorbidity index score. Age-, gender- (man/woman), race-/ethnicity-adjusted population prevalence of CIND and dementia were also calculated for walking difficulty severity, presence of significant pain, self-reported fall history, moderate-vigorous physical activity (MVPA) ≤1×/week, and sleep disturbance frequency using multinomial logistic regression. Among Medicare beneficiaries with outpatient physical therapist claims, the prevalence of any cognitive impairment was 20.3% (CIND:15.2%, dementia:5.1%). Cognitive impairment was more prevalent among those who were older, Black, had lower education attainment, or higher Charlson comorbidity index scores. The adjusted population prevalence of cognitive impairment among those who reported difficulty walking across the room was 29.8%, difficulty walking 1 block was 25.9%, difficulty walking several blocks was 20.8%, and no difficulty walking was 16.3%. Additionally, prevalence of cognitive impairment among those with MVPA ≤1×/week was 27.1% and MVPA >1×/week was 14.1%. Cognitive impairment prevalence did not vary by significant pain, self-reported fall history, or sleep disturbance. One in 5 older adults who use outpatient physical therapist services have cognitive impairment. Furthermore, cognitive impairment is more common in older physical therapist patients who report worse physical function and less physical activity. Physical therapists should consider cognitive screening for vulnerable older adults to inform tailoring of clinical practice toward a patient's ability to remember and process rehabilitation recommendations.

Longitudinal Patterns of Postfracture Outpatient Physical Therapy and Occupational Therapy Use and Its Association With 3-Year Mortality Among Adults With Cerebral Palsy.

Fragility fractures are common among adults with cerebral palsy (CP), but clinical rehabilitation use after fracture and its effect on long-term health outcomes have not been sufficiently studied. The objectives of this study were to identify patterns of the use of physical therapy, occupational therapy, or both in the 6-month postfracture period and the association with 3-year mortality in adults with CP. This retrospective cohort study included adults who were ≥18years old, had CP, and had sustained an incident fragility fracture between January 1, 2014, and December 31, 2016, as identified from a random 20% Medicare fee-for-service dataset. Six-month outpatient physical therapy or occupational therapy use patterns after fracture were identified using group-based trajectory modeling. Cox regression determined the association between physical therapy or occupational therapy use trajectory patterns and mortality from 6months to 3years after fracture, adjusting for confounders. Effect modification by key characteristics was tested, including age, sex, and the modified Whitney Comorbidity Index (mWCI), which is a CP-specific comorbidity index that better captures overall medical complexity. Of the 2429 participants included, the majority (73.2%) were characterized as having little to no probability of physical therapy or occupational therapy use, whereas 16.0 and 10.7% were characterized as having early initiation and later initiation, respectively. Compared to the mortality rate for the little to no physical therapy or occupational therapy group, the mortality rates were 26% lower for the early physical therapy or occupational therapy initiation group (hazard ratio [HR] = 0.74; 95% CI = 0.55-1.00) and were 20% lower for the later initiation group (HR = 0.80; 95% CI = 0.57-1.12). There was effect modification by the mWCI. The mortality rate was lower when the early initiation and later initiation groups were compared to the little to no initiation group across all mWCI values examined (median and interquartile range), but the effect was stronger (ie, lower mortality rate) for lower mWCI values for both early initiation and later initiation groups. Most adults with CP underutilize outpatient physical therapy or occupational therapy services within 6months postfracture. Early or later initiation versus little to no physical therapy or occupational therapy use was associated with a lower HR of mortality, although the effect was stronger and statistically significant among those with less medical complexity. Throughout their lives, the use of rehabilitation services in individuals with CP, including physical therapy and occupational therapy, dramatically declines despite the need for continued rehabilitation across their lifespans. This study characterized longitudinal physical therapy or occupational therapy use patterns in the 6months following a fragility fracture among adults with CP and found that nearly 3 in 4 adults with CP had little to no physical therapy or occupational therapy use during this critical window to optimize postfracture health and function. Further, those who more regularly used physical therapy or occupational therapy services, regardless of the timing of initiation (early vs later), had significantly improved survival up to 3years after fracture, suggesting the need for greater access to and delivery of clinical rehabilitation services.

Developing a best practice framework for musculoskeletal outpatient physiotherapy delegation: the MOPeD mixed-methods research study protocol

IntroductionPhysiotherapy assistants/support workers are an important part of the physiotherapy workforce in the UK. Many of them work in National Health Service (NHS) physiotherapy outpatient services treating patients with musculoskeletal...

Patients' Perceptions of Physical Therapists Addressing Opioid Misuse.

In the US, rising numbers of patients who misuse illicit or prescribed opioids provides opportunities for physical therapists (PTs) to be engaged in their care. Prior to this engagement, it is necessary to understand the perceptions of patients who access physical therapy services about their PTs playing such a role. This project examined patients' perceptions of PTs addressing opioid misuse. We surveyed patients, newly encountering outpatient physical therapy services in a large University-based healthcare setting, via anonymous, web-based survey. Within the survey, questions were rated on a Likert scale (1 = completely disagree to 7 = completely agree) and we evaluated responses of patients who were prescribed opioids versus those who were not. Among 839 respondents, the highest mean score was 6.2 (SD = 1.5) for "It is OK for physical therapists to refer their patients with prescription opioid misuse to a specialist to address the opioid misuse." The lowest mean score was 5.6 (SD = 1.9) for "It is OK for physical therapists to ask their patient why they are misusing prescription opioids." Compared to those with no prescription opioid exposure while attending physical therapy, patients with prescription opioid exposure had lower agreement that it was OK for the physical therapist to refer their patients with opioid misuse to a specialist (β = -.33, 95% CI = -0.63 to -0.03). Patients attending outpatient physical therapy seem to support PTs addressing opioid misuse and there are differences in support based on whether the patients had exposure to opioids.

A service evaluation of the management of patients with suspected cauda equina syndrome from an outpatient physiotherapy service in the United Kingdom

BackgroundThe expanding scope of physiotherapists worldwide has come with an increased responsibility to identify serious pathologies such as fracture, infection, tumour and cauda equina syndrome (CES). Guidelines recommend a low threshold for emergency MRI to avoid the potentially devastating consequences of CES, but a balanced approach is required to prevent excessive strain on emergency resources. AimTo evaluate the management of patients presenting to an outpatient physiotherapy service with suspected cauda equina syndrome. DesignService evaluation with an embedded case series of patients with radiological CES. MethodThe records of patients who were identified by their outpatient physiotherapists as having suspected CES (n-231) over a 27-month period were included. Data was extracted from patients’ medical records by a team of Advanced Clinical Practitioners (ACPs). The lead author further analysed the records of patients with clinical and radiological CES, in order to present the embedded case series. ResultsIn 79% of cases, it was decided that emergency referral was not required. The remaining 21% of patients were referred to the emergency department and 49% of these had an emergency MRI. In the case series of seven patients with cauda equina compression on MRI, four patients had a disc bulge and underwent emergency surgery. One patient had non-emergency surgery for a disc bulge combined with anterolisthesis and scoliosis. Two patients had stenosis and decided against surgical intervention. ConclusionsFindings from this service evaluation suggest support for the use of safety netting and an effective communication chain to facilitate effective management of patients with suspected CES.

Analysis of Patient Satisfaction on the Quality of Physiotherapy Services in the Pandemic Era at the SHC

The present study about Satisfaction is the perception of a product or service that has metexpectations. The customer satisfaction is the result of the accumulation of consumers or customers in using products or services. The quality of health services is the degree to which the needs of the community or individuals are meet for healthcare in accordance with good professional standardswith the use of resources fairly, efficiently, effectively within the limited capacity of the government and the community, and is carried out safely and satisfies customers in accordance with accepted good norms and ethics. Based on observations made by distributing customer feedback questionnaires at the Sasana Husada Clinic (SHC), Jakarta Indonesia patient satisfaction in outpatient physiotherapy services from January to March 2021. Result for patient satisfactionobtained 76%, of which there were about 24% who were dissatisfied with the physiotherapy servicesprovided at the SHC Jakarta Indonesia. The purpose of this study was to determine the analysis of patientsatisfaction with the quality of physiotherapy services in the covid-19 pandemic era at the SHC. Thestudy used a descriptive observational method with a cross sectional research design. The sample in this study was 62 people with sampling technique using simple random sampling. This research was conducted by filling out a questionnaire by the patient. Data analysis was performed by univariate test analysis. The results of the study indicate that patient satisfaction inside pandemic and based on thequality dimension of reliability 79.61%, patient satisfaction based on the assurance dimension 80.06%, patient satisfaction based on the tangibility quality dimension 81.67%, patient satisfaction based on the empathy quality dimension 78.12%, satisfaction patients based on responsiveness 77.80% and general patient satisfaction 78.06%.

Strategies to Increase Access to Outpatient Physiotherapy Services: A Scoping Review.

Purpose: Multiple Canadian jurisdictions have curtailed public funding for outpatient physiotherapy services, impacting access and potentially creating or worsening inequities in access. We sought to identify evaluated organizational strategies that aimed to improve access to physiotherapy services for community-dwelling persons. Method: We used Arksey and O'Malley's scoping review methods, including a systematic search of CINAHL, MEDLINE, and Embase for relevant peer-reviewed texts published in English, French, or German, and we performed a qualitative content analysis of included articles. Results: Fifty-one peer-reviewed articles met inclusion criteria. Most studies of interventions or system changes to improve access took place in the United Kingdom (17), the United States (12), Australia (9), and Canada (8). Twenty-nine studies aimed to improve access for patients with musculoskeletal conditions; only five studies examined interventions to improve equitable access for underserved populations. The most common interventions and system changes studied were expanded physiotherapy roles, direct access, rapid access systems, telerehabilitation, and new community settings. Conclusions: Studies evaluating interventions and health system changes to improve access to physiotherapy services have been limited in focus, and most have neglected to address inequities in access. To improve equitable access to physiotherapy services in Canada, physiotherapy providers in local settings can implement and evaluate transferable patient-centred access strategies, particularly telerehabilitation and primary care integration.

A survey of patient opinions on long-term implementation of virtual physiotherapy consultations in the assessment and management of rheumatology conditions

Keywords: Remote consultation; Rheumatology; Choice Purpose: Due to the Coronavirus pandemic, outpatient physiotherapy services had no option but to cease face-to-face activity and implement virtual consultations for all. As infection rates decrease, and we come out of the pandemic, there is a need to see which changes to consultation in physiotherapy might be worth keeping longer-term. Rheumatology physiotherapy is a smaller area of practice and benefits from being considered as different from general musculoskeletal physiotherapy. The physiotherapy consultation method preferences of people living with long-term health conditions such as those managed by rheumatologists may be different to those with acute musculoskeletal issues. Methods: Throughout March and April 2021, forty follow up patients under the care of the rheumatology physiotherapy team at a large university teaching hospital were approached to complete a short phone call survey. Informed consent was sought and granted by all 40 participants. The following questions were asked:•How would you like the Rheumatology Physiotherapy service to look moving forwards beyond COVID?•Should it revert to face to face only, continue with virtual only or have a combination of both virtual and face to face?•What are the reasons behind your answers? Data were analysed for patterns and then considered in diagnostic groups to guide future set up of the rheumatology physiotherapy service. Results: 62.5% of participants preferred a virtual consultation. Ten per cent preferred face-to-face. 27.5% preferred a combined approach of virtual and face-to-face in their physiotherapy management. All respondents living with a diagnosis of Inflammatory Arthritis expressed a preference for virtual (6/6). There was a moderate preference for virtual in those living with a diagnosis of Fibromyalgia (10/17) and of Osteoarthritis (3/6). There was a preference for a face-to-face consultation amongst those living with a diagnosis of Hypermobility (4/5). Reasons for a preference for a virtual physiotherapy consultation included: not having to travel, saving time and money, easier to fit around work, medical appointment fatigue, and being happy with the progress over virtual consultations. Reasons for a preference for a face-to-face physiotherapy consultation included a chance to be told or shown that an exercise technique is correct and finding a face-to-face appointment more personal. Conclusion(s): Patient preference for the method of physiotherapy consultation is different for those living with different rheumatology conditions. Service provision should change to allow pathways for both virtual-first and face-to-face-first input. Each person referred for rheumatology physiotherapy should have a chance to express their own preference, but from this small survey there is some generalisation of preference according to diagnosis and potential treatment offered. There should not be a return to face-to-face only provision of physiotherapy for people living with long-term health conditions such as those managed in rheumatology. Impact: Pathways for access to and management in rheumatology physiotherapy will be altered to allow access to a virtual consultation as a long-term change to practice post-coronavirus pandemic. Whilst undertaken as a local project, the conclusions should be considered for wider implementation, particularly in departments where there may not be specific rheumatology physiotherapists to campaign for maintaining a virtual consultation option for some. Funding acknowledgements: This work was not funded.

Service users evaluation of outpatient NHS physiotherapy services. Using SERVPERF and IPA tools for transforming provision

Keywords: Service-quality; SERVPERF; Transformation

An evaluation of a neuro out-patient physiotherapy service: Are we helping our patients to self-manage?

An evaluation of a neuro out-patient physiotherapy service: Are we helping our patients to self-manage?

Physical therapists' knowledge and implementation of best practices in the outpatient physiotherapy department during the COVID-19 pandemic: A cross-sectional study.

Physiotherapists (PTs) play an important role in the well-being and physical rehabilitation of patients with long term health problems. It is important that PTs follow recommended practices that minimize the transmission of SARS-CoV-2 infection in providing Outpatient Physiotherapy services. The aim of this study was to assess the knowledge of COVID-19 among the PTs and evaluate the state of implementation of best practices in Outpatient Physiotherapy to prevent SARS-CoV-2 infections during the ongoing pandemic. A self-administered online questionnaire consisting of three sections, including section one on demographic information, section two on evaluating knowledge about SARS-CoV-2 and section three on implementing best practices as a survey tool for collecting data from PTs working in Lahore and Faisalabad in Punjab, Pakistan. A total of 216 completed surveys were received. Correct responses to different questions devised to test the participants' knowledge of SARS-CoV-2 varied from 58.3% to 99%. The implementation of best practices to prevent the infection transmission in the Outpatient Physiotherapy ranged from 22.7% to 92.1% for different domains. The age of the PTs and OPD setting were associated significantly with the PTs' knowledge of COVID-19 and also with the state of implementation of recommended practices to prevent SARS-CoV-2 infections in the Outpatient Physiotherapy (p < .05). The majority of the PTs, particularly those working in the clinic setting, possessed a good knowledge of COVID-19 and implemented best practices in their Outpatient Physiotherapy at a good level. However, efforts should be directed towards further improving the knowledge of PTs and ensuring implementation of best practices in Outpatient Physiotherapy, particularly in government and private hospitals.

Evaluating the impact of a training program to support transitioning from the hospital to the community for people after stroke: a community case study

BackgroundThe transitions in care along the stroke recovery path are challenging, particularly in finding mechanisms to continue one’s recovery once at home. We aim to evaluate the impact of training physiotherapists and fitness instructors from one regional community together to deliver an evidence-based group exercise program starting in the hospital and transitioning to the community using an implementation approach.MethodsThe evidenced based exercise program Fitness and Mobility Exercise (FAME) for stroke was chosen as the intervention. Data from interviews with stakeholders (community centre and health authority hospital staff including a physiotherapy navigator) was transcribed and themes evaluated using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. These data were supplemented by information collected as a quality assurance project within the health authority.ResultsTwo programs were established; one in the community centre (run over 15 months by fitness instructors) and one in the regional hospital (run over 12 months by a rehabilitation assistant under the direction from a physiotherapist). Transitions in care were facilitated by implementing the same evidence-based group exercise class in both the hospital and community setting, so people living with stroke could seamlessly move from one to another. An existing physiotherapist navigator service also was valued as a support for the transitions between the two centres for people with stroke. The hospital group accessed group-based physiotherapy service on average 31 days earlier than they were able to in a one-to-one format.ConclusionsThis case study described the implementation of the Fitness and Mobility Exercise (FAME) program in one community and the use of a physiotherapist navigator to assist transition between them. After a community training workshop, FAME programs were established within the health authority and the community centre. FAME program participants within the health authority benefited from reduced wait times to access hospital outpatient physiotherapy service. Improvements in function were measured in and reported by the people after stroke attending either the health authority or community centre FAME groups.

Agendamento, tempo de espera, absenteísmo e demanda reprimida na atenção fisioterapêutica ambulatorial

Abstract Introduction: Access to physiotherapy services needs to be timely, avoiding the establishment of disabilities in users. Analyzing the demands in physiotherapy provides a basis for planning both the management of queues and preventive actions and the reorganization of services, directing them to the main needs of the public. Objective: To identify users who needed outpatient physiotherapy services in the Unified Health System (SUS) in Campo Grande/MS and to characterize those cared for and repressed demand, as well as analyzing absenteeism and the waiting time for access. Methods: We used secondary data from the Vacancy Regulation System and performed association and multivariate analyses, with a significance level of 5%. Results: Females were predominant and their number increased year by year; the largest number of requests was for adult motor disorders. The average waiting time in the period (2017-2019) was approximately 2.5 months. Absenteeism was 34% and increased yearly. Most appointments and absenteeism were from users from the region of greatest social exclusion. Most referrals of repressed demand were for primary care and for physical therapy treatment in adult motor disorders. Conclusion: The results showed excessive waiting time between the request and the scheduling, high rates of absenteeism and repressed demand. These aspects act synergistically as barriers to access to outpatient physical therapy care in the public network in the capital city studied, with significant negative impacts on users’ recovery.

Exploring the Impact and Acceptance of Wearable Sensor Technology for Pre- and Postoperative Rehabilitation in Knee Replacement Patients: A U.K.-Based Pilot Study.

Background:Knee replacement operations are common, highly successful procedures that are increasing in frequency. The COVID-19 pandemic has emphasized the need for innovative care pathways that reduce face-to-face appointments. We report on the impact of introducing a wearable sensor for pre- and postoperative rehabilitation of 21 knee replacement patients at 2 hospitals in the U.K.Methods:The sensor (BPMpathway; 270 Vision) was provided during joint school prior to knee replacement and stayed with the patient until a maximum of 9 weeks post-surgery. Participant progress and exercise were monitored remotely, with exercise regimens altered as required. Participants and clinicians could communicate remotely via the device.Results:The median range of motion during the first week post-surgery was 63° (interquartile range [IQR] = 21°) and increased to 136° (IQR = 16°) by week 7. The rate of participant compliance with exercises using the device was 32.3% for thrice-daily compliance and 52.4% for once-daily compliance. The 2-way communication channel was well utilized by both participants and clinicians. We report a 35.7% reduction in face-to-face physiotherapy appointments compared with standard practice. Finally, >80% of users who completed the feedback questionnaire reported a positive experience using the device, finding it easy to understand and reporting that it motivated them to perform their exercises.Conclusions:The use of BPMpathway was well received, effective, and reduced face-to-face physiotherapy appointments.Clinical Relevance:Remote monitoring can reduce the burden to the outpatient physiotherapy service by supporting the post-COVID-19 surgical service recovery plans of the National Health Service and allowing patients to recuperate at home.