Data Analysis: Spasticity and neuropathic pain management provided for a community neuro rehab' team by an Independent Prescriber Physiotherapist.

Purpose

Access to specialised spasticity and neuropathic pain management was limited for patients who were receiving a maximum of 12 weeks rehabilitation in a community Neuro Rehab Team (CNRT). The referral to treatment time to the local spasticity service was 10-12 weeks .This meant spasticity and neuropathic pain could be inhibiting the patient and their rehab progression throughout their CNRT rehab period.

The project aimed to demonstrate if an Independent Prescriber (IP) Physiotherapist, highly experienced in spasticity and neuropathic pain management, would be of benefit on the service delivery CNRT. This would involve pharmacological and non-pharmacological intervention and follow up medicines optimisation as required. The project aimed to identify the number of patients referred, the waiting times and the time spent associated with patients. The project also aimed to evaluate the baseline confidence of CNRT Therapists in initial management of spasticity and neuropathic pain and therefore their need for support.

Approach

An IP Physiotherapist assessed all patients that were identified by the team as having problematic spasticity or neuropathic pain during a time limited pilot between May 2019-February 2020 (38 weeks).  Sample size at the end of this period was 46 contacts which equated to 21 patients. 

7 CNRT Physiotherapists and OT's completed a questionnaire rating their confidence 0-10 on 22 questions related to initial management of spasticity and neuropathic pain. They had opportunity to write comments and were asked if they thought the above role would be of benefit to the service. Data was collected on an excel spreadsheet.

Outcomes

Results: An average of 1.2 patient contacts were carried out per week. All of the patients were assessed within 2 weeks of referral. All referrals were appropriate as further management advice and intervention was given. 14 patients were appropriate for medication changes. All patients were followed up on time after medication changes were made. Patients required 2-5 appointments to optimise their medication.
On average time spent per new patient assessment was 60 minutes, reviews post medication change were 15-30 minutes. Admin time for new patients 60 minutes and reviews for were 30 minutes. Average confidence of CNRT Therapist’s in management of spasticity and neuropathic pain (over all questions) was 5.7 out of 10 (10 being completely confident). All therapists stated there would be benefit to having quick access to spasticity and neuropathic pain management.

Conclusion(s): Confidence of the CNRT Therapists indicated that support in managing patients with spasticity and neuropathic pain would be beneficial. An IP Physiotherapist with this extensive experience was able to offer quick access to management for all identified patients. All patients with medication changes had their medication optimised. 

Cost and savings

No additional information.

Implications

A band 7 Physiotherapy position was implemented from March 2020. This Physiotherapist is part of the Spasticity team and allocates approximately half a day a week to assess and review patients in CNRT. This input has also been extended to an Outpatient Brain Injury Rehab unit. Patients will continue to benefit from quick access to assessment and management, resulting in reduction of symptoms that could inhibit their rehab progression.

Top three learning points

N/A

Funding acknowledgements

Not funded.