CSP held its annual congress in liverpool from 15-16 October.
Frontline reporters bring you the SECOND of two reports from the event
‘Battle back’ says MoD
Images of military amputees skydiving out of planes and competing in para-cycling championships set the backdrop for an inspiring session outlining the military’s ‘Battle back’ rehabilitation programme. Based at the Ministry of Defence centre at Headley Court, Major Martin Colcough manages the programme for amputees, using sport and adventure to challenge body and mind. He told delegates the approach was based on the biopsychosocial model. Launched in 2008, Battle back encourages injured military personnel to get active early into their rehabilitation. Exercise ‘snow warrior ‘was the forerunner of the scheme, with skiing used as a motivational exercise. But soldiers can now participate in athletics; wheelchair sports; watersports, including rowing and canoeing, and archery and shooting. And as a further motivational push, the programme offers more adventurous activities such as skydiving and channel swimming endurance events. ‘It’s all about using sport to be active and independent,’ Major Colcough said. Among many inspirational case studies were those of two soldiers who had recently been picked for the GB para-cycling team and were competing at international championships in Germany. One had lost a leg only 18 months ago. And reaching such sporting heights is not unusual for participants, Major Colcough said.
Research findings are not translated into practice
There has been a consistent failure to transfer knowledge acquired in the laboratory and through clinical research into physiotherapists’ practice, according to Professor Janice Eng. Professor Eng, of the department of physical therapy, University of British Columbia and scientist at the GF Strong rehab centre in Vancouver, said there was generally a time lag of 10 to 20 years between evidence gained through research and its use in a clinical setting. US research showed that around 45 per cent of patients were missing out on treatment that had proven effectiveness because it had not transferred into clinicians’ practice. Professor Eng identified a lack of clinicians’ time, a lack of computing resources, absence of any incentive, the fact that the relevant literature was not easily accessible or in one place, and language difficulties, as barriers to efficient knowledge transfer. Improving the implementation of evidence would not be easy, she said, but the introduction of two-way exchange between research and end users would help knowledge transfer. Professor Eng’s university employs a part-time member of staff who is specifically responsible for liaising between researchers and clinicians, and she said the Canadian government provided grants to researchers in all subjects that could be used to improve access to their work. She warned that the speedy implementation of evidence was important, but clinicians needed to know how to use that evidence. ‘Individual studies rarely provide enough evidence for changing practice, and sometimes the evidence can be conflicting,’ she said. ‘Around one third of highly positive early results are contradicted or found to be less effective in later studies. We still need clinical judgement, but it should be used with the evidence.’
Low activity is factor in heart patients’ exercise tolerance
Congenital heart patients often have reduced exercise tolerance for anatomical reasons, but their low level of physical activity could also be a major factor, according to Lynne Kendall, clinical specialist physiotherapist in congenital cardiology at Leeds teaching hospitals trust. Lynne Kendall said low expectations of congenital heart patients’ physical abilities and a desire to over-protect them from exercise contributed to many patients’ sedentary lifestyles. Some congenital heart patients were actively discouraged from taking exercise as children, and many had unfounded fears of the risks from exercise, she said. Congenital heart patients displayed a huge variation in their exercise tolerance levels, but the benefits of exercise that reduced the risk of acquired heart disease and improved psychological well-being applied to congenital heart patients as well as the rest of the population. If patients were fitter, they might spot their symptoms earlier and allow speedier treatment, she said. Lynne Kendall said good communication between primary and specialist care, and the use of patient held records could increase exercise levels in this group.
Nebuliser use differs from claims
Advances in nebuliser technology are opening up ways of monitoring patient adherence to their drug regime – and revealing some surprising results, said Tracey Daniels, senior physiotherapist at Leeds regional adults cystic fibrosis unit. The new small devices on the market not only made it easier for the patient to be more compliant in their own homes but also recorded patients’ use of the device. However, the results showed that patients were not using the devices as often as physios thought. And in some cases the patients were overdosing. ‘There was a significant number of patients in our group who were taking more than 100 per cent of their treatment dose,’ she said. This could mean toxicity problems.
United offer new approach to people with cancer
Two famous Manchester institutions have come together to provide a unique service for young people with cancer, staff from the Christie cancer hospital told delegates. In a session outlining the support allied health professionals can give cancer patients, delegates heard how Manchester United Football Club had helped the Christie with funding. Nicola Chesman, a senior physiotherapist, and Hannah Ballard, a senior occupational therapist, at the Christie’s young oncology unit, have been employed through the YOU – Man U partnership. National Institute for Health and Clinical Excellence guidelines, published in 2005, emphasised AHPs should provide rehabilitation for young people throughout all stages of their cancer journey. The Christie hospital built on this need and put in a bid to Manchester United foundation for help providing the service. The successful bid also provided money for specialist equipment and items to improve time on the ward, such as a Wii computer console. The AHP team works to prevent secondary complications, minimise side-effects of treatment, maximise independence and maximise symptom control, Hannah Ballard told delegates. She said positive outcomes included improved cardiofunction, increased strength and increased quality of life. ‘Results have been overwhelmingly positive, with patients reporting improved confidence, reduced anxiety and increased strength and fitness,’ she told delegates.
Physios have ethical duty to promote life
People can and should die well at the end of their life, and health professionals have an ethical duty to help if they have the means, the CSP’s president, Baroness Finlay, told Congress. It was a basic human right to be able to decide how our life ends, but assisted suicide was cutting off life deliberately before it was intended, she said. Fear of pain was the main driver causing patients to desire death, and physios should not underestimate their power to help to improve someone’s quality of life, and therefore desire to live. The message being sent out to patients should be ‘you are worth me working hard for’, rather than ‘you are right to think that you’d be better off dead’, she said. Improving the life of someone with a progressive disease was not easy, she warned, but symptom control and psychological support could help patients to set realistic hopes and aspirations. ‘Dignity is about having a sense of personal wealth,’ she said. ‘The way that care is given removes or confirms that dignity. As health professionals, our role is to help other people live.’ Robert Preston, clerk to the House of Lords select committee’s work on assisted dying for the terminally ill, said the central issue on assisted suicide was not morality or compassion but ‘is it safe to change the law to make this legal?’ ‘The current law has a stern face but a kind heart,’ he said.
Supporting knowledge in physiotherapy practice
Physiotherapists are being encouraged to share literature reviews and clinical protocols and evidence under an initiative from the CSP. The SKIPP programme, or supporting knowledge in physiotherapy practice, aims to make it quicker and easier for physios to collaborate with others. The programme will be managed and accessed online as part of the new CSP website, which is currently in its Beta, or trial, period. SKIPP administrator Ralph Hammond said it made sense to introduce a more methodical and strategic approach to evidence appraisal. Outlining the initiative at a Congress seminar, he said SKIPP would help avoid duplication of work. ‘It’s about planning and sharing the work we do in clinical practice to avoid lots of people all appraising the same evidence, and to make our effort reach further,’ Ralph Hammond said. ‘We need to get away from the idea that evidence can only come from a randomised controlled trial, that it can also be clinical experience, user views, standardised clinical data and learning from audit.’ All physios, including band 5’s and 6’s were encouraged to contribute as were postgraduates and PhD students. Ideas for submissions included evidence notes, clinical guidelines, technical assessments, position statements and cost-effectiveness briefings. Before being posted online work will be assessed by an endorsement panel. There will also be a liaison officer to advise on submission of work to the SKIPP project. For more information, members can email email@example.com CSP members can go the Society’s website for a number of policy documents including its response to the White Paper, the Physiotherapy Works campaign and resources on effective practice.
Reports by Julia Brandon, Graham Clews, Lynn Eaton, Robert Millett and Sally Priestley.
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