Staying healthy

Physiotherapy makes a vital contribution to promoting health and maintaining wellness - within every physiotherapy interaction there is an element of patient education, prevention of injury or exercise prescription to maintain and improve functional outcome. Advice around lifestyle change and management of self are fundamental to these encounters. Activity - based rehabilitation and early return to work, or remaining in work are therapeutic and beneficial for health and well-being.

Central to many public health initiatives is activity and exercise. Regular exercise has been shown to cut heart disease by one-third, strokes and Type II diabetes by one quarter and hip fractures in older people by half. Physiotherapy services are developing and running services to meet these growing needs. Physiotherapy is also integral to cardiac rehabilitation, using exercise training, education and counselling, to cut cardiac mortality by 27 percent. However, a British Heart Foundation survey found that only a tiny fraction of the 66,000 people newly diagnosed with heart failure each year will receive rehabilitation and practically none of the 345,000 new cases of angina. Similarly the people with acute coronary syndrome, ie. people with acute symptoms but not yet resulting in a heart attack are mostly excluded despite the huge potential to prevent them going on to have a heart attack.

The average cost of a cardiac rehabilitation programme is £550; compare this with the cost for a single day in a cardiac care unit of £1,400. The reduction in health service utilisation as a result of cardiac rehabilitation is approximately £100 per patient per year. Furthermore there are savings from the earlier cessation of other care and support services and the benefit of an earlier return to work.

Case study (1) - Home-based cardiac rehabilitation service

The service was prompted by the failure of approximately one third of patients to attend the hospital based cardiac rehabilitation service. Evidence has shown that a home-based service can be as effective as an institution based one. By using a physiotherapist to provide the service, exercises could be modified to take account of any existing other problems the patient might have, such as osteoarthritis or peripheral vascular disease, as well as the constraints of a home setting.

Case study (2) - Pulmonary rehabilitation

Physiotherapists play a key role in pulmonary rehabilitation which can significantly improve the quality of life of people with chronic obstructive pulmonary disease (COPD). This scheme has capacity to see around 430 patients per annum, but there are approximately 5,000 people in the area with COPD and potentially up to another 5,000 who remain undiagnosed.