Improving the Physiotherapy Pathway for children under 16 years of age who present to A+E with a patella dislocation

Purpose

At Present all children being referred to the physiotherapy MSK department at Southampton have to be seen by the Orthopaedic consultants in their clinics and then referred to physiotherapy. This includes GP referrals and the Emergency Department (ED). Looking at the literature the average annual incidence of primary patella dislocation is 5.8 per 100 000 in the general population, with the highest incidence in the 10 to 17 year age group (29 per 100 000) (Neel et al sports health 2011 Mar:3(2) 170-174) A study by Maenpaa and Lehto suggested limiting the period of immobilization to 3 weeks to avoid muscle atrophy and knee joint restrictions, Typical rehabilitation protocols show return to full activity 8-12 weeks from the time of injury ( Dennis et al Chirpr Med Sept 2015 14(3): 212-219 Following the literature above I reviewed and evaluated our MSK service for patella dislocations with a view to improving the pathway they are currently following.

Approach

- Pareto analysis of the referrals to the Paediatric Physiotherapy department over a 3 month period

- Reviewed the current pathway for patella dislocations

- Discussion with current Orthopaedic leads

- Focus group with current members of the paediatric physiotherapy MSK team

- Patient stories

- PDSA cycles

Outcomes

Results: - In a 3 month period there were 18 patella dislocations who presented to ED, referred to the trauma orthopaedic clinic and then referred to physiotherapy. These children were placed in a cricket pad splint and not progressed until physiotherapy contact. - The current pathway is causing a delay in physiotherapy treatment for these children. - This delay leads to longer treatment times, increase in chronicity of the problem, anxiety and decreased patient satisfaction. - Pareto analysis showed the main referrals coming to physiotherapy are patella dislocations, ankle sprains, and knee injuries all of which come through the ED department, see consultant and then are referred to therapy. This shows that a large co-hort could be seen either in ED by our team or ED can refer directly to physiotherapy.

Conclusion(s): There is a need for an improved paediatric physiotherapy MSK pathway for children who sustain a patella dislocation.

Cost and savings

No further data. 

Implications

The potential impact of a new pathway will:- - Decrease the referral time from injury to physiotherapy to less than 2 weeks post injury in order to decrease chronicity, increase recovery therefore enhancing the patients’ rehabilitation experience and satisfaction. How will I measure success? - Percentage of patients on the new pathway. - Length of time from injury to physiotherapy referral and discharge - Treatment outcomes - The Knee injury and Osteoarthritis Outcome Score (KOOS) - Patient feedback/ satisfaction on the new pathway/process/ service.

Top three learning points

No further data.

Funding acknowledgements

Not funded.