Long term conditions

Around 15 million people in England have a long-term condition who require early diagnosis and assessment, high quality information support and individualised care plans. Much of this can be provided by physiotherapists and other AHPs. One such long term condition is stroke.

Stroke is the single largest cause of disability in England, with some 300,000 people living with moderate to severe disability. Physiotherapy can contribute to health promotion particularly in the areas of exercise prescription, activity management and smoking cessation, impacting across all age groups. By working within and across health, social care and leisure sectors, physiotherapy can make a substantial contribution to the health and well being of all population groups.

10,000 people under 55 suffer a stroke every year, 1000 of who are under 30 years of age. These younger age groups have specific and complex needs with respect to discharge into the community e.g. with support for return to work, employers providing reasonable adjustment in the working environment. Longer term survivors with stroke are likely to encounter problems with weakness, spasticity, contracture, incontinence, pain, sensory loss and reduced function; there are estimates that 40-60% of stroke survivors will have problems with spasticity, providing further evidence for specialist physiotherapy services to be available at all stages of the patient pathway to maximise and maintain potential for independent functional recovery.

Case study (1) - Self-management support scheme

A physiotherapy led scheme is helping people with long-term conditions. This scheme has already been shown to be effective for service users with multiple sclerosis, and is now being rolled out for those with chronic obstructive pulmonary diseases (COPD) and in the management of chronic pain. The guiding principle for this scheme is that the services are designed around the patient and reflect what the patient wants. People are able to access the multi-disciplinary team when they feel their condition is changing. It is well known that people with long-term conditions mostly face a confusing maze in order to access statutory services. Accessing the right service at the right time in their situation means that further problems will most likely be prevented. This is most especially true in the prevention of re-admission for conditions such as COPD, or indeed the flare up of a joint in a person with rheumatoid arthritis.

Ensuring the focus of service is on what the service user identifies as their need, maximising the effectiveness of the service, for example a service user with obvious physical need may say their need is with housing or benefits, or getting into the bath. The physiotherapy led condition management pathway acts as a sign-posting route to services rather than as a gate-keeper. It is therefore facilitative, engaging and empowering the service user, enhancing the patient experience.

Case study (2) - Comment of a stroke survivor in response to ‘A New Ambition for Stroke. A consultation on national strategy’

"Without physiotherapy, instead of walking and driving my car I would still be in a wheelchair. Thanks to my physios I have been able to become a school governor of a primary school where I do voluntary work half a day a week. I am a street leader and report any environmental problems to the council. I am a resident member of the [XX] Partnership Board which tries to improve the area. I am a member of the Stroke Peer Support Group and go to visit people who are recovering from a stroke. All of these things are voluntary but give me a lot of satisfaction. I can only do these things because I had physiotherapy."

Case study (3) - Diabetes control programme

This is a small scale physiotherapy run exercise programme helping people with diabetes keep their condition under control and reducing the risk of cardiac and respiratory problems. There are currently over 2 million people with diabetes in the UK and there are up to another 750,000 people with diabetes who have the condition and don’t know it. Under this scheme, people newly diagnosed with Type II diabetes are referred for a six week structured exercise programme, tailored to meet their individual needs - for example for people with existing disabilities. Last year 52 of the 63 patients showed a significant improvement in their walking and more than half showed improved health, with reductions in anxiety and depression.

Case study (4) - Home support service for long standing rheumatoid arthritis

An AHP led multi-disciplinary community service to meet the needs of patients with long standing rheumatoid arthritis was set up meet the complex needs of these individuals with a member of the multi-disciplinary team visiting a patient in their own home. On such visits the service user is assessed against agreed service and clinical criteria and a care package agreed that can be delivered at home. The benefits of such a service are that some 68% of problems are solved during the visit, 32% of problems requiring further investigation are usually solved within 2 weeks and 100% of visits are deemed appropriate by both service users and staff.