1,721,159 research outputs found
First impressions: an information leaflet for patients attending a musculoskeletal outpatient department
No full textObjective: The purpose of this work was to design and evaluate an information leaflet for new patients attending a physiotherapy outpatient department. This formed part of a wider agenda of improving the patients’ experience and increasing adherence to the Chartered Society of Physiotherapy's core standards.Design: A needs analysis was undertaken with existing patients to determine the content of the new leaflet. This was then tested for readability, reviewed by physiotherapy staff and evaluated by patients via a questionnaire.Setting: The musculoskeletal outpatient physiotherapy department at Southampton General Hospital.Participants: Patients referred to the outpatient physiotherapy service, plus all clinical and support staff employed in the musculoskeletal outpatient team.Main outcome measures: Numerical Rating Scale and Gunning's Fog Index.Results: Thirty-seven of 50 patients completed the needs analysis (74%), generating 42 ideas for the leaflet content. The definitive leaflet addressed one core standard and 16 specific criteria, and had a readability of grade 8.3, which is below the recommended maximum limit of grade 9 for health education leaflets. Using an 11-point Numerical Rating Scale, where 0 = of no benefit and 10 = extremely helpful, the mean rating for the leaflet from 29 of 100 patients was 8.6.Conclusions: This work has produced a patient information leaflet for physiotherapy outpatients, a copy of which is freely available (electronically) from the author. The leaflet forms part of an ongoing commitment to improving the patients’ experience
Demystifying research – how to make it happen
No full textIn the current climate, there is an unprecedented need to demonstrate the clinical effectiveness and value of healthcare interventions. Health professionals need to ensure that their decisions are evidence-based, and able to withstand financial and clinical scrutiny. When planning a piece of work to evaluate an aspect of clinical practice, the first step is to identify whether the intention is to undertake research, a service evaluation, a quality improvement project or an audit. It is also important to be clear about when an ethical review is necessary for governance and insurance purposes, and to ensure that the final paper will be publishable. There are multiple ways to engage with research, including undertaking a project in practice, completing a higher degree, seeking external funding or pursuing a clinical academic career. Research is not something that can be done alone – it requires teamwork. Having completed a piece of research, there is then a professional and moral duty to disseminate the findings appropriately, not only at conferences, but also in peer-reviewed publications. Given that engaging in evidence-based practice is a regulatory standard of proficiency, the challenge is for all health professionals to produce at least one high-quality piece of evidence during their career, and disseminate their work in a peer-reviewed academic journal in order to help develop and protect the future of their profession
Improving quality, service delivery and patient experience in a musculoskeletal service
No full textThe purpose of this quality improvement initiative was to enhance service delivery and patient experience in a musculoskeletal out-patient setting. A cross-sectional survey, with 6 annual stages, evaluated the musculoskeletal outpatient physiotherapy service in a large National Health Service hospital in Southern England. The population comprised 1095 patients, referred by medical staff to the service from rheumatology, orthopaedics, pain clinic and occupational health departments. The individual clinician-initiated strategies for quality improvement included: cue cards; reminders; reflections and training. The systems-changes comprised revised documentation and booking systems. The primary outcome was patient experience, measured with the Chartered Society of Physiotherapy's standardised ‘Patients feedback’ questionnaire. Attendance data was a secondary outcome. This initiative showed that strategies to motivate individual clinicians to change their behaviour were unsuccessful, whereas system-changes resulted in 32/37 improvements (8 statistically significant) in patient experience. Furthermore, the revised systems resulted in a 6% decrease in wasted appointments. It is essential that clinical services are evaluated through the eyes of their users. This initiative demonstrates the value of service evaluations (alongside research) and the importance of patient feedback to show how it can drive change and positively impact upon health-care experiences. Furthermore, this work has shown that active implementation strategies with systems-level changes produced greater improvements in service quality and patient experience, than simply encouraging and supporting clinicians to change their behaviour
2009 annual evidence update on osteoarthritis - commentary on the role of exercise and physical therapies in osteoarthritis
No full textThe bibliography presents the results of searching systematic reviews relating to exercise and physical therapies in osteoarthritis during the last year, however it is recognised that 4 reviews from the Centre for Reviews and Dissemination summarise papers published in 2007 and January 2008.It has previously been suggested that the most important concept emerging from current research is that joint failure is the problem in osteoarthritis. In assisting patients to manage the resultant symptoms, a range of non-pharmacological therapies is recommended in clinical guidelines (education, exercise and lifestyle changes, including weight loss). As these interventions are rarely given in isolation, research evidence is needed to determine their efficacy and optimal application in clinical practice. Some aspects are addressed in this update; however many questions remain unanswered
Control issues and low back pain
No full textAcute low back pain (LBP) is a commonly occurring symptom that can impact considerably upon a person’s life. This thesis is concerned with perceptions of control in people with acute LBP, how they respond to this symptom and the way it impacts upon their lives
Clinical conundrums in a case of upper quadrant dysfunction
No full textThis case study charts the progress of a 60-year-old angling coach presenting with a complex upper quadrant dysfunction. Following a brief summary of the history and physical examination, the main focus of the paper explores the mechanical and physiological rationale for adopting a neurodynamic approach for a proposed double crush condition. This case further highlights mismatches that arose between the clinical findings and traditional healing timescales, and the importance of considering pathomechanics of the whole quadrant in complex clinical circumstances
‘Life on hold’: the lived experience of radicular symptoms. A qualitative, interpretative inquiry
No full textBackground: Patients with radicular symptoms can experience high levels of pain and disability with at least a third experiencing on-going symptoms 12 months after onset. Aims: To explore ‘what matters’ about living with radicular symptoms at the point of seeing a spinal specialist and to consider how care can be aligned to best address need. Methods: In this qualitative study, based on the principles of interpretative phenomenological analysis, 14 participants with a clinical presentation of radicular symptoms were purposively recruited from an NHS, Musculoskeletal Service in the UK. Individual, semi-structured interviews were undertaken, audio-recorded and transcribed verbatim. Data were managed using a Framework approach and analysed thematically. Findings: Radicular symptoms were experienced as a protracted journey of acute exacerbations of symptoms that were difficult to make sense of. Adversely affecting almost all aspects of life, participants struggled to maintain their physical and functional independence; their important relationships; social networks and the roles and activities that provided joy and purpose. The impact of radicular symptoms was a ‘life on hold’ and an uncertain future, and 3/14 reported suicidal thoughts. Conclusions: This paper, the first to focus on the lived experience of radicular symptoms at the point of seeing a spinal specialist, reveals the severity and devastating impact of radicular symptoms. Important implications have been identified regarding the need for clinicians to legitimise the symptoms and impact of radicular symptoms; to identify early those patients who might benefit from injection/surgery; and to signpost appropriate patients to sources of psychological support.</p
Adolescent and parent experiences and perceived effectiveness of physical interventions for chronic musculoskeletal pain: a qualitative study
No full textIntroduction: there is a paucity of evidence on the effectiveness of physical interventions for chronic musculoskeletal pain affecting adolescents. This study explored adolescent and parent experiences and perceived effectiveness of physical intervention for chronic musculoskeletal pain in the UK. Methods: using semi-structured interviews, 21 young people receiving treatment for chronic musculoskeletal pain and 21 parents were interviewed regarding their healthcare experiences. Data regarding experiences of physical interventions were analysed in this secondary qualitative analysis using inductive reflexive thematic analysis. Results: three themes that captured why adolescents and parents perceived physical interventions to be effective or not were (1) feeling in control, (2) the right person and an explanation that makes sense and (3) make a difference to me not my foot. Discussion: core concepts that appeared to influence the perceived effectiveness of physical interventions from the perspectives of adolescents and parents included facilitating adolescent autonomy, establishing a therapeutic alliance on the basis of trust and focusing physiotherapy treatment on meaningful participation in life. Conclusion: there were no ideal physical interventions. The themes convey the importance of therapeutic alliance, intervention context and the need for personalised care.</p
Exploring the clinical decision making used by experienced cardiorespiratory physiotherapists: a mixed method qualitative design of simulation, video recording and think aloud techniques
No full textBackground: The ability of physiotherapists to make clinical decisions is a vital component of being an autonomous practitioner, yet this complex phenomenon has been under-researched in cardiorespiratory physiotherapy. The purpose of this study was to explore clinical decision-making (CDM) by experienced physiotherapists in a scenario of a simulated patient experiencing acute deterioration of their respiratory function.Objectives: The main objective of this observational study was to identify the actions, thoughts, and behaviours used by experienced cardiorespiratory physiotherapists in their clinical decision-making processes. Design: A multiple-methods (qualitative) design employing observation and think-aloud, was adopted using a computerised manikin in a simulated environment.Setting: The participants clinically assessed the manikin programmed with the same clinical signs, under standardised conditions in the clinical skills practice suite, which was set up as a ward environment. Participants: Experienced cardiorespiratory physiotherapists, recruited from clinical practice within a 50-mile radius of (*anon for review). Methods: Participants were video-recorded throughout the assessment and treatment and asked to verbalise their thought processes using the ‘think-aloud’ method. The recordings were transcribed verbatim and managed using a Framework approach. Results: Eight cardiorespiratory physiotherapists participated (mean 7 years clinical experience, range 3.5 -16 years). CDM was similar to the collaborative hypothetico-deductive model, five-rights nursing model, reasoning strategies, inductive reasoning and pattern recognition. However, the CDM demonstrated by the physiotherapists was complex, interactive and iterative. Information processing occurred continuously throughout the whole interaction with the patient, and the specific cognitive skills of recognition, matching, implying and predicting were identified as being used sequentially. Conclusions: The findings from this study were used to develop a new conceptual model of clinical decision making for cardiorespiratory physiotherapy. This conceptual model can be used to inform future educational strategies to prepare physiotherapists and nurses for working in acute respiratory care.<br/
- …
