Physiotherapy Input Research Articles

‘I Just Felt A Bit Faint’: The Role Of Physiotherapists In Older Adults Presenting With Transient Loss Of Consciousness (T-LOC)

Abstract Background Clinical presentation of transient loss of consciousness (T-LOC) in older adults presents significant diagnostic challenges, especially in those with frailty or multi-morbidity. This study analysed T-LOC presentations in individuals over the age of 75 and assess the impact of physiotherapy in this cohort. Methods A retrospective review was conducted on 56 older adults (>75 years), who presented with T-LOC to a large academic teaching hospital, over a six-month period in 2023. Data on demographics, presenting complaints, diagnostic tests, physiotherapy input and discharge diagnoses was collected and analysed. Results The analysis included 56 older adults, 57% (N=32) were male, with an average age of 81.6 years (75 – 94 years). The average length of stay was 9.1 days (1-64 days). Physiotherapy was provided to 59% (n=33) of the patients, with those in the physiotherapy group more likely to have a history of falls (55% compared to 4%) and a diagnosis of dementia (27% compared to 9%). Patients with T-LOC presentations were five-times more likely to be referred to physiotherapy if they had at least two diagnoses of recurrent falls, dementia or stroke (24% vs 4%). Of those who received physiotherapy, the number of sessions ranged from 1-25 (averaging 4.5 sessions per patient). Outcome measures were completed for 73% (n=24) of these patients, and 70% were discharged at their mobility baseline. Education on syncope, orthostatic hypotension or falls was documented for only 12% (N=4). 79% (N=26) were discharged directly home and 50% (N=13) were referred for community follow up. Conclusion Physiotherapy is often required for older adults with T-LOC, particularly those with a history of falls and dementia. Physiotherapy should be considered a fundamental component in the multi-disciplinary management strategy to improve healthcare efficiency and clinical outcome for this cohort.

Enhancing Physiotherapy Services within a Community Specialist Team for Older Adults: An Evaluation Study

Abstract Background An aim of Community Specialist Teams (CSTs) is to provide integrated multidisciplinary services to older people closer to home. Physiotherapy is a key component of this service. This evaluation aims to describe current physiotherapy practices within a specific CST and identify potential areas for improvement. The CST under examination maintains a physiotherapy staffing level of 1.2 Full-Time Equivalents. Methods An evaluation was completed of the physiotherapy input provided to 71 older adults who underwent a Comprehensive Geriatric Assessment (CGA) with the CST between July and December 2023. Data encompassing service user demographics and physiotherapy specific information were anonymised and analysed using Microsoft Excel. Results The median age of clients was 84 years (range 66-95), with 84.5% aged over 75 years. 70% were female. The median Clinical Frailty Scale (CFS) was 5 (range 3-7), with 75% being classified as frail. The reasons for referral were community rehabilitation (43%), admission avoidance (20%), early supported discharge (17%) and other (20%). Median time to CGA was 18 days (range 1-64 days). 64 (94%) patients were referred to physiotherapy and received an average of 4.4 sessions. Time to physiotherapy assessment following CGA ranged from 0-41 days with a median of 6 days. 83% of clients had physiotherapy intervention in their homes, 14% attended community hubs and 3% both. Analysis of delayed discharge revealed a range of 0-99 excess days beyond the estimated discharge date, with a median delay of 6 days. Conclusion This evaluation underscores the prevalent need for physiotherapy input among the service users engaged with this CST. Concerns arise regarding the breach of the of the National Integrated Care Programme for Older Persons (NICPOP) guideline for CGA timing (2 weeks) and target discharge date (6 weeks). The findings of this review will inform future service planning and the development of integrated physiotherapy pathways for older people.

Establishing a Specialist Physiotherapy service with a Regional Specialist Memory Clinic

Abstract Background Patients with complex motor-cognitive syndromes (E.g. Dementia with Lewy Bodies, Corticobasal syndrome, Progressive Supranuclear Palsy and Huntington’s disease) present with a wide variety of symptoms. Accordingly, these patients have traditionally been managed under different services from Neurology-led movement disorder clinics to age-related services, without dedicated access to specialist physiotherapy input. Recognising this, the Model of Care for Dementia in Ireland recommended that all regional specialist memory services (RSMC) should have a dedicated Clinical Specialist Physiotherapist. The aim of this study was to provide an overview of clinic activity in the first six months of operation. Methods Physiotherapy referrals were collected from September 2023 to March 2024. Referral details were captured using Microsoft Excel and included patient demographics, reason for referral, diagnosis and previous physiotherapy input. Following triage of referrals, patients were placed in one of the following three care pathways: Results 63 referrals were generated. Of these, 15 patients were referred for pre-diagnostic assessment, 46 were referred for rehabilitation, and 2 were referred for secondary prevention. Of those referred for rehabilitation; 18 patients had a diagnosis of DLB, 27 had another form of atypical Parkinsonism, 1 patient had HD. 22 patients had previous physiotherapy input. Conclusion This is the first specialist physiotherapy service in Ireland within a RSMC. This presents a challenge as there is no specific physiotherapy care pathway established for this service elsewhere, but also opportunity for service development and innovation. This overview will help with strategic and service planning and enables KPIs to be established to ensure patients receive a quality service.

Evaluating diagnostic and management agreement between physiotherapists and ear, nose and throat specialist in a primary contact physiotherapy-led vestibular clinic: A prospective blinded inter-rater agreement pilot study

BackgroundDizziness and vertigo are common referrals to Ear Nose Throat (ENT) outpatient services however these services have long waitlists for assessment. Primary contact physiotherapy-led vestibular clinics are recognized as improving access to care. This pilot study investigated agreement between physiotherapists and an ENT medical practitioner for diagnostic and management decisions in patients attending a primary contact physiotherapy-led vestibular clinic.MethodsProspective blinded inter-rater agreement study undertaken in an ENT primary contact physiotherapy-led vestibular clinic. Participants were adults referred to ENT from general practitioners, triaged (Category 2 or 3) to the primary contact physiotherapy-led vestibular clinic with clinical symptoms consistent with vestibular disorder. Primary outcome measures included agreement of diagnoses and management decisions made by an ENT medical practitioner and Physiotherapist based on a vestibular physiotherapy assessment. Adverse events were reviewed 11 months post data collection. Gwet’s first order agreement co-efficient (AC1) calculated inter-rater reliability between physiotherapy and ENT.ResultsFifty-one participants were recruited consecutively from the primary contact physiotherapy-led vestibular clinic. Physiotherapy and ENT had a substantial agreement (AC1 0.613) on diagnosis. AC1 between physiotherapy and ENT for recommending Magnetic resonance imaging (0.810) and computerized tomography (0.935) both indicated near perfect agreement. There was moderate to near-perfect agreement regarding management recommendations between physiotherapy and ENT. Substantial agreement (AC1 0.720) was found for recommendations for ENT input, near perfect agreement (AC1 0.933) for neurology input and moderate agreement (AC1 0.574) for physiotherapy input. There were no adverse events from physiotherapist’s management decision, based on final recommendations undertaken 11-months post data collection.ConclusionsPhysiotherapists and ENT medical practitioner made comparable diagnostic and management decisions, based on physiotherapy and audiology hearing assessment, for adults with signs of vestibular dysfunction, within an ENT primary contact physiotherapy-led vestibular clinic. This study provides support for this type of Physiotherapy-led service in managing patients referred to an ENT service with vestibular dysfunction.

WHAT DO BOFAS MEMBERS PERCEIVE TO BE THE BARRIERS AND FACILITATORS OF DAY-CASE SURGERY FOR MAJOR FOOT AND ANKLE PROCEDURES? A SCOPING SURVEY OF SURGEONS

IntroductionRecent advances in minimally invasive surgery and improved post-operative pain management make it possible to perform major foot/ankle operations as day-case. This could have significant impact on length of stay, saving resources and is in keeping with government policy. However, there are theoretical concerns about complications and low patient satisfaction due to pain.MethodsThe survey was developed following review of the literature and was approved for distribution by the BOFAS (British Orthopaedic Foot & Ankle Society) scientific committee. An online survey (19 questions) was sent to UK foot and ankle surgeons via the BOFAS membership list. Major foot/ ankle procedures were defined as surgery that is usually performed as an inpatient in majority of centres and day-case as same day discharge, with day surgery as the intended pathway.ResultsA total of 132 surgeons responded, 80% from Acute NHS Trusts. The majority (78%) thought that more procedures could be performed as day-case at their centre. Currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures. Despite post-operative pain and patient satisfaction being theoretical concerns for day-case surgery in this population; these outcomes were only measured by 34% and 10% of respondents respectively. The top perceived barriers to performing more major foot and ankle procedures as day-case were: Lack of physiotherapy input pre/post-operatively (23%), Lack of out of hours support (21%).ConclusionsThere is consensus among surgeons to do more major foot/ ankle procedures as day-case. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. Out of hours support and physiotherapy input pre/ post-op were perceived as the main barriers. There is a need to scope the provision of physiotherapy pre/post-operatively and out of hours support at sites where this is a perceived barrier.

Outcomes of a consultant physiotherapy upper limb clinic: reducing the patient journey through early access to specialist care

Background: Many patients referred into secondary care for a ‘surgical opinion’ do not have a surgical target. Aims: An intermediate care consultant physiotherapy upper limb clinic was set up to reduce the patient journey and deliver the right advice/treatment at the first point of assessment. Method: A clinic was set up to: enable an expert clinical assessment; deliver education to the patient regarding diagnosis, treatment options and likely outcomes; arrange appropriate imaging; and deliver care on the day (advice, specialist physiotherapy, injection or splinting). This creates a proactive approach to waiting list management and ensures early management for patients. Results: Complete data from the first 173 patients seen are presented. A total of 99.5% had treatment delivered on the day. Waiting times were reduced by a mean of 3.5 months for appointment, and 27 weeks for physiotherapy input. All received on-the-day expert physiotherapy advice, exercise programmes and progression advice. Oxford Shoulder Score improved by 17.5 (mean). QuickDASH scores improved by 34.72 (mean). Patient satisfaction was extremely positive. Conclusion: The clinic has been successful at shortening the patient journey, reducing the burden on secondary care and delivering best care in a timely manner.

Awareness and Utilization of Public Physiotherapy Health Care Services to Support People With Multiple Sclerosis: A Health Care Service Audit.

To maximize functioning and well-being in people with multiple sclerosis (MS), physiotherapy consultation is recommended at the point of diagnosis and throughout the disease course. We wanted to determine whether patients with MS being managed through a large metropolitan hospital in Australia accessed physiotherapy input as part of their MS management consistent with evidence-based recommendations and to identify patients' self-reported physiotherapy requirements, including symptom management, information needs, and service delivery preferences. Surveys were sent to 597 MS clinic patients, and 160 responded. Data were analyzed using descriptive methods to derive frequencies and percentages. The survey consisted of 16 questions plus 2 optional questions related to sociodemographics (age and postcode). Of 160 respondents, 142 completed all 14 nonoptional questions. One-third of participants (n = 53) were aware of the hospital MS clinic physiotherapy services, with 21.3% (n = 34) saying that they had accessed these services. Conversely, 40.1% of respondents (n = 61) reported having consulted a private physiotherapist. Combined, 52% of respondents reported seeing a physiotherapist. There was a clear preference (94.7%; n = 144) for access to the MS clinic physiotherapy service. The presence of at least 1 current MS-related physiotherapy problem was reported by 82.2 2% of respondents (n = 125). The top ways to access MS-related information were via a specialist MS website (57.6%) and a mobile app (55.6%). There is an unmet need for physiotherapy, and many participants may have foregone services due to unawareness. Improved awareness and uptake of physiotherapy at the point of diagnosis is needed to maximize functioning and well-being in people with MS.

P24 TB or not TB? A case of severe multi-organ erosive rheumatoid arthritis in a Ukrainian refugee

P24 TB or not TB? A case of severe multi-organ erosive rheumatoid arthritis in a Ukrainian refugee

OA01 Tennis shoulder? A rare case of brachial neuritis

OA01 Tennis shoulder? A rare case of brachial neuritis

43 Nursing Home Residents presenting to the Emergency Department; what can multidisciplinary, integrated frailty teams offer?

Abstract Background Comprehensive Geriatric Assessment (CGA) in the Emergency Department (ED) may provide opportunities to improve care of Nursing Home Residents (NHR). The aim was to develop an abbreviated CGA (aCGA) for NHRs presenting to the ED and identify their multidisciplinary care needs. Methods The existing Frailty at the Front Door (FFD) CGA was simplified. Over a three-month period, consecutive patients over the age of 75 years in an age friendly hospital accredited emergency department, were selected by address from iPMS and underwent an aCGA. Age, gender, Clinical Frailty Score (CFS), 4AT, excessive polypharmacy, high risk medications usage, 4QT swallow screen, MST nutrition screen, need for physiotherapy and/or occupational therapy input, use of intravenous (IV) antibiotic therapy and the number of those experiencing their last 1,000 days was entered prospectively onto an Excel database. Data was analysed using descriptive statistics. Results 104 NHR presented to the ED, 59 of which (57%) underwent an ‘a-CGA’. Co-ordinated care was then delivered through the FFD. The mean (SD) age was 85 years (+/−6.5). Male to female ratio was 2:1. The mean CFS was 6.6(+/−0.5) 0.39% (n = 23) were at risk of delirium (4AT ≥ 2), 80% (n = 47) had excessive poly-pharmacy or were prescribed high risk medications, 63% (n = 37) presented with dysphagia, 50% (n = 30) were at risk for malnutrition (MST ≥ 2), 39% (n = 23) required trans-disciplinary assessment of function/mobility, 52% (n = 31) required IV antibiotics and 20% (n = 12) were experiencing their last 1,000 days. Conclusion The aCGA effectively identified frailty syndromes, triggering early input from the ED based interdisciplinary team. A significant number of NHRs were in their last 1,000 days. Administering IV antibiotics in nursing homes with on-site access to the wider multi-disciplinary team would address the needs of many NHRs who currently have no option other than admission to hospital. For those in their last 1,000 days particularly, this would represent a more person-centred approach.

Older Hospitalised Patients' Reported Confidence in Managing Discharge Needs: A Retrospective Observational Study.

To evaluate the introduction of a patient-reported outcome measure (PROM) of self-confidence in managing discharge needs in an acutely hospitalised older adult population. A retrospective service evaluation in an English hospital. The PROM measure consisted of a visual analogue scale asking patients to rate their confidence with managing the things that they would need to do at home. This was collected on admission and discharge. Of 923 patients, 461 had both admission and discharge confidence scores. Median confidence was higher at discharge (8.00, IQR: 6.20-9.80) than on admission (7.20, 5.00-9.00) (P<0.001). Predictors of high confidence with managing discharge needs at admission were: being male; having a lower number of morbidities; self-reporting fewer falls over the last year; and a higher level of functional mobility. Low confidence score on admission, being from one's own home, and a higher number of physiotherapy contacts were associated with improvement in PROM scores. Self-confidence in managing discharge needs at discharge was not associated with readmission within 30 days. Measuring patient-reported confidence to manage discharge needs is feasible in an older inpatient population. Confidence improved from admission to discharge, and more frequent physiotherapy input was associated with improved confidence.

1223 Physiotherapy’s Crucial Role in Early Elective Post-Operative Orthopaedic Discharge - One More Night?

Abstract Aim Physiotherapy (PT) is essential post operatively in optimizing patient mobility. However, patients admitted to the wards in the evening may not benefit from same day post-operative mobilization. Subsequent overnight hospital stays are common. We aimed to investigate whether same day mobilization with physiotherapy reduced length of hospital stay. We hypothesized that failure to reach mobility milestones delayed discharge and earlier physiotherapy intervention could reduce overnight stay/hospital duration. Method We retrospectively evaluated patient records and operating notes for all patients undergoing elective lower limb arthroplasty procedures under one operating hospital team, during April 2022. 38 patient records were analysed. Results Medical complications (particularly fatigue, wound issues, pain, and blood pressure control) commonly delayed discharge (31.6%) and affected engagement with physiotherapy. 55.3% experienced post operative pain affecting engagement with physiotherapy, blood pressure and fatigue being other factors. 92.1% of patients had same-day physiotherapy input of some form (such as pre-operative assessment), whilst 76.3% had same day post-operative PT assessment. Most patients required further PT assessments (92.1%) - of the patients who stayed overnight (92.1%), only 17.1% had same day post-operative physio assessment. Conclusions Optimising commonly encountered post operative complications is vital as medical complications often delayed discharge and affected engagement with physiotherapy. Notably, the majority of patients (68.4%) were discharged from hospital less than a day after being discharged from inpatient PT, suggesting that patient mobility/PT engagement may be the limiting factor affecting discharge.

ThTP5.3 Outcome of weekend physiotherapy input post emergency laparotomy

Abstract Aims Early ambulatory has been shown to reduce risk of morbidity and length of stay. It is evident in elective laparotomy patients but there is limited data on emergency laparotomy patients. We aim to explore the outcome of morbidity and physiotherapy input over weekend. Methods Patients ≥18 years old underwent emergency laparotomy (EmLap) as per NELA criteria from July 2021 to Dec 2021 in a busy district hospital were reviewed. Data on demographics, physiotherapy input and morbidity (post-operative ileus and pneumonia) were analysed. P-value of &amp;lt;0.05 was considered significant. Results A total of 81 patients were included with 56% female and median age 69 years. Ratio of smoker: Non-smoker: Ex-smoker was 1:4:1. 74% were seen by physiotherapist over the weekend (POW) and 48% had chest physiotherapy post-operative day 1. The overall rate of post-operative ileus was 18.5% (19% no-POW vs 18.3% POW; p= 0.942) while the rate of post-operative pneumonia was 11.1% with 2/3 non-smoker (9.5% non-POW vs 11.7% POW; p= 0.855). Median post-operative length of stay was 10 days (8 days No-POW vs 11 days POW). Conclusion Physiotherapy input post EmLap over the weekend did not significantly improve morbidity. Weekend input is provided by the oncall physiotherapist and the requirement of the service could reflect the high risk status of patients. Besides physiotherapists, ward nurses play an important role in continuous encouragement of mobilisation post-operative to reduce morbidity rate.

P446 Physiotherapy input to cystic fibrosis screen positive indeterminate diagnosis patients at a regional paediatric cystic fibrosis unit

Since the advent of newborn screening in the UK, Cystic Fibrosis Screen Positive Indeterminate Diagnosis (CFSPID) infants have been identified. Many are asymptomatic and long term outcomes are uncertain. Within the UK there is a wide variation in physiotherapy input for these children, ranging from routine reviews to referral only and there is ongoing uncertainty regarding the optimal approach.

Perceived barriers and facilitators of day-case surgery for major foot and ankle procedures? A cross-sectional survey of United Kingdom surgeons.

Advances in minimally invasive surgery and improved post-operative pain management make it possible to consider performing even major foot/ankle operations as day-case. This could have significant benefits for patients and the health service. However there are theoretical concerns about post-operative complications and patient satisfaction due to pain. To scope the current practice of foot and ankle surgeons on day-case surgery for major foot and ankle procedures in the United Kingdom (UK). An online survey (19 questions) was sent to UK foot and ankle surgeons via the British Orthopaedic Foot & Ankle Society membership list in August 2021. Major foot and ankle procedures were defined as surgery that is usually performed as an inpatient in majority of centres and day-case as same day discharge, with day surgery as the intended treatment pathway. 132 people responded to the survey invitation with 80% working in Acute NHS Trusts. Currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures. 78% felt that there was scope to perform more procedures as day-case at their centre. Post-operative pain (34%) and patient satisfaction (10%) was not highly measured within their centres. Lack of adequate physiotherapy input pre/post-operatively (23%) and lack of out of hours support (21%) were the top perceived barriers to performing more major foot and ankle procedures as day-case. There is consensus among UK surgeons to do more major foot/ankle procedures as day-case. Out of hours support and physiotherapy input pre/ post-op were perceived as the main barriers. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. There is a need for nationally agreed protocols to optimise the delivery of and measurement of outcomes in this type of surgery. At a local level, the provision of physiotherapy and out of hours support should be explored at sites where this is a perceived barrier.

272 PHYSIOTHERAPISTS' EXPERIENCES OF WORKING IN RESIDENTIAL CARE IN THE REPUBLIC OF IRELAND DURING COVID-19

Abstract Background COVID-19 was officially declared a pandemic in March 2020. Social distancing and visiting restrictions were introduced in Irish residential care units in March 2020. The impact of COVID-19 and associated restrictions on physiotherapists working in residential care in the Republic of Ireland (ROI) is unknown. This study aimed to explore the experience of physiotherapists working in residential care units in the ROI during the COVID-19 pandemic. Methods A qualitative phenomenological study design was used. Physiotherapists working in residential care units were invited to participate in one-to-one semi-structured interviews from December 2021 to March 2022. Participants were recruited via purposive and snowball sampling. Data were analysed using reflexive thematic analysis by two independent reviewers. Results Seven one-to-one semi-structured interviews were conducted among five female and two male physiotherapists. Four major themes emerged: (i) service adaptation (ii) communication (iii) physical and emotional impact of COVID-19 pandemic on staff and (iv) physical and emotional impact of COVID-19 pandemic on residents. A number of subthemes were identified under each theme. Participants experienced changes in service delivery including redeployment, reduced resident contact and social distancing. These changes resulted in innovation, mainly through telehealth. Participants felt communication from managers could be improved through clarity regarding protocol changes. The pandemic stimulated enhanced inter-professional communication among physiotherapists. Some participants contracted COVID-19 resulting in residual physical impairments. Participants were affected emotionally through the increased stress experienced due to COVID-19 restrictions. Residents experienced isolation due to visiting restrictions. Due to reduced physiotherapy input participants observed reduced physical functioning among residents. Conclusion COVID-19 and its associated restrictions had a profound impact on physiotherapists working in residential care units as well as on residents. The extent of this impact is only beginning to emerge. Planning for future pandemics should consider the long-term physical and emotional consequences of restrictions on both physiotherapists and residents.

A Scoping Survey of BOFAS Membership: What are the Perceived Barriers and Facilitators of Day- Case Surgery for Major Foot and Ankle Procedures in the UK?

Category: Ankle Introduction/Purpose: Recent advances in minimally invasive surgery and improved post-operative pain management make it possible to perform major foot/ ankle operations as day-case. This could have significant impact on length of stay, saving resources and is in keeping with government policy. However there is no consensus of barriers reducing foot/ankle operations being performed as day-case.The aim of this survey was to scope the practice of UK foot and ankle surgeons in terms of perceived barriers and facilitators to performing day-case surgery for major foot/ankle procedures. Methods: An online survey (19 questions) was sent to UK foot and ankle surgeons via BOFAS (British Orthopaedic Foot &amp; Ankle Society) membership list in August 2021. Major foot/ankle procedures are defined as surgery that is usually performed as an inpatient and day-case as same day discharge, with day surgery as the intended treatment pathway. Results: A total of 132 respondents: 80% working in Acute NHS Trusts. 78% of respondents thought that more procedures could be performed as day-case at their centre (currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures). The top 2 perceived barriers to performing more major foot and ankle procedures as day-case were: no physiotherapy provision pre/ post-operatively 23%, no out of hours support for patients 21%. Conclusion: There is consensus among surgeons to do more major foot/ ankle procedures as day-case. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. Out of hours support and physiotherapy input pre/post-op were perceived as the main barriers to increasing the number day-case procedures. There is a need for nationally agreed protocols to optimise the delivery of care for this patient group and to scope the provision of physiotherapy pre/post-operatively at sites where this is a perceived barrier.

894 What Proportion of Acute Admissions for Urinary Tract Infection Under Urology Require Surgical Intervention Within 6 Months?

Abstract Introduction All male patients with urinary tract infections (UTI) at this large district general hospital are admitted under the care of the urology department. This audit aims to establish how many male patients over the age of 70 with a diagnosis of UTI required surgical intervention in the 6 months following admission. Method We performed a retrospective audit of all patients over 70 admitted with a UTI over a five-month period. Patients with recent instrumentation or other pathologies, including visible haematuria or ureteric stones confirmed on imaging in the accident and emergency department were excluded. Results Of the 30 patients included, five (16.7%) required invasive intervention. Three (10%) acutely, (two ureteric stents, one nephrostomy), two (6%) as an outpatient on an elective basis (flexible ureteroscopy and prostate artery embolisation). Conclusions Over 80% of patients included in this audit did not require surgical intervention within six months. Whilst UTI is a significant finding in younger men suggestive of structural or systemic abnormality, UTIs in incontinent, catheterised, or older men does not carry the same risks and rarely requires intervention. Elderly care wards were established to ensure older patients receive support to improve health functioning and prevent acute deterioration in physical and mental health during admission. Given that less than 20% of men required intervention, this cohort of patients would be better admitted to wards geared towards elderly care who are better able to manage their co-morbidities and have the resources for early physiotherapy and occupational therapy input.

Rehabilitation after critical illness (RaCI) enhanced physiotherapy input following critical care discharge: A quality improvement project

Background Early rehabilitation within the critical care setting is proven to have significant impact on functional ability, however the optimum model of care following critical care is unknown. Generally, a decrease in intensity of therapy seen on wards is linked with an initial plateau in a patient’s functional ability. Objective The primary objective of this study was to determine whether enhanced rehabilitation after discharge from critical care reduces patients’ hospital length of stay within a tertiary university hospital. The secondary outcomes include the effect on patient’s functional ability, frequency of physiotherapy activity and the need for support on discharge. Methodology Forty-four critical care participants were involved, over a four-month period, to receive daily physiotherapy provided by the critical care physiotherapy team in addition to existing ward-based therapy. Data was compared to a matched sample (based on risk of developing physical morbidity) from the previous year. Results Compared to before the quality improvement project, clinically significant reductions in patients’ hospital length of stay following critical care discharge were observed with a median saving of 11 hospital bed days. Conclusion In this small, local project, this quality improvement work has demonstrated potential reductions in length of stay because of enhanced physiotherapy input following discharge from critical care.

Early exercise in blunt chest wall trauma: protocol for a mixed-methods, multicentre, parallel randomised controlled trial (ELECT2 trial)

IntroductionChronic pain and disability are now well-recognised long-term complications of blunt chest wall trauma. Limited research exists regarding therapeutic interventions that can be used to address these complications. A recent...