Improving postural care of the people with learning disabilities through implementing postural care clinic

Purpose

The purpose of this project is to increase the number of postural assessments of people with learning disabilities in Cheshire west and Chester. This may prevent future complications along with help in the management of long-term conditions along with reducing the mortality rate of the people with learning disabilities due to lack of postural care.


The project outline was scoped using the quality improvement strategy of Cheshire and Wirral Partnership NHS foundation trust considering the Trusts organizational objective of Zero Harm.

Approach

Quality improvement methodologies were used to provide a structure to manage this project. Used fishbone diagram to understand the reasons of lack of postural assessments. Driver diagram was used in understanding the drivers and change ideas influencing secondary drivers to achieve the primary objective.


Quantitative and qualitative data was collected as first PDSA (Plan, Do, Study, Act) cycle to do pilot clinic.


Quantitative data included following measures: Number of service users had postural assessment, thoracic depth / width ratio, angle between leg and pelvis (ABLAP), wind sweeping deformity using anatomical measurement instrument, and number of chest infection in last one year


Qualitative data included the experience of the family carers and staff about the clinic and new process of conducting postural assessments through five question questionnaires. Questionnaire were used instead of interview as it would be anonymous and less time consuming along with giving an opportunity to staff / family carers to convey their honest feedback.

Outcomes

Successfully completed three postural assessments as the first PDSA cycle and had following findings as a result of assessment clinic.

Able to identify

  1. Rotation of the trachea in first service user and starting of its movement to right side which in long term if left unmanaged could be life threatening.
  2. Starting of anti-clockwise thoracic rotation in second service user after doing objective measurements using anatomical measurement instrument.
  3. Significant changes in depth width ratio of the thorax of the third service user which is a sign of flat chest caused by the long-term impact of gravity in supine lying.


Support staff and family carers reported that they have found postural assessment clinic very informative and helpful.


Postural assessment clinic does help in the early identification of the postural changes which helps in putting the strategies to prevent further deterioration with an aim to maintain functional movements and physiological thoracic capacity. Including service users, carers and family in the assessment process raised awareness about the postural care.

Implications

This would lead to increase the number of postural assessments of people with learning disabilities in Cheshire West and Chester.


This may prevent future complications along with help in the management of long term conditions reducing morbidity and mortality.

Funding acknowledgements

Did not seek any separate funding for this service evaluation as done as part of quality improvement initiative of the trust and work based project as part of PG certificate in Professional practice from CETAD, Lancaster University.

The PG certificate course was jointly funded by Innovation agency and Connected Health Cities.

Additional notes

This work was presented at Physiotherapy UK 2019