Community rehabilitation: student-made resources

Want to understand more about community rehabilitation? This page brings together resources and information for students new to this area of physiotherapy. 

    Physiotherapy students, Natalie Chan and Chris Parton, created this page to showcase their learning during their six-week placement with the CSP.

    To develop an understanding of students' perspectives on community rehabilitation, they began by devising a questionnaire. They then created social media and video resources based on the results to raise awareness of this area of physiotherapy.

    Chris Natalie
    Chris Parton and Natalie Chan

    From Natalie and Chris:

    Our journey with the CSP has been a huge learning curve! Before starting this community rehabilitation project, we were not aware of the diverse reach of community rehabilitation and how important it is for people living in the community. But now after 6 weeks of background research, joining related CSP meetings and developing student resources, we have become so enthusiastic and passionate about this area. Hence, we hope the student resources show our dedication to this project and changes the way you feel about community rehabilitation.

    One of the biggest motivations of making these resources was from the data collected. 83% of students mentioned they would like to have a placement opportunity in community rehabilitation, whereas only 48%had the opportunity to do so. 

    This shows that few students get the exposure they desire, and raising awareness can give students insight to what is available to them in a career in community rehabilitation.


    Busting myths about community rehabilitation 

    Myth Reality

    “Slow paced, lots of waiting around.”

    “Lots of driving, long travelling time.”

    • Getting to invest time and build a good rapport with the person
    • More time to develop clinical reasoning and self-study on common pathologies
    • Some areas in community rehabilitation, such as admission prevention, are fast-paced environments
    • Being in control of your diary, having flexibility in your work
    “Repetitive cases – less complex, all treatments were very similar.”
    • Unpredictability of a visit – not always completing assessments but referral to relevant services
    • Being challenged to adapt treatment to each environment, their goals and social situations
    • Wide variety of conditions, requires constant adaptation of assessments to each person

    “Working as an individual.”

    “Feels isolated.”

    “Reduced MDT working.”
    • A holistic, personalisedapproach involves a variety of health careprofessionals and agencies working as a dynamic team
    • Joint therapysessions with colleagues such as occupational therapists and nurses
    • Always having support from colleagues, senior physiotherapists and a person's  family members

    “Visiting the individual’s own environment.”

    “Visiting private homes makes me uncomfortable.”

    • Physiotherapists work in many community settings such as a community hospitals, special schools and care homes
    • Natural and realisticenvironment to assess the person's needs

     

    Watch Natalie and Chris' community rehabilitation video

     

    And check out their Instagram highlights @thecspstudents.


    Community rehabilitation in more detail

    On analysis of the questionnaire results, Natalie and Chris selected the following eight areas of community rehabilitation to explore in detail because it was evident that these were the least understood.

    1. Discharge to assess (D2A)

    • This is for people whose care and assessment can be safely continued in a non-acute setting and do not require an acute hospital bed, but may still require care services are provided with short term, funded support to be discharged to their own home (where appropriate) or another community setting.
    • Taking someone out of the hospital setting and moving them to a place where they will be safe and supported, building a rehabilitation package within the person’s natural environment.
    • Creating a smooth transition for patients to go from an acute setting to community setting.
    • It reduces the length of stay in an acute hospital setting, opens more space for medically unwell people and reduces bed shortages.
    • Read more: Discharge to Assess: Quick Guide  

    2. Paediatrics

    • Physiotherapists working within the community with patients from birth to 18 (or up to 19 years if the young person attends a special school).
    • Essential collaboration with MDT (Speech and language, Occupational Therapist and more), which aims to restore movement, function, cognition and reduce and manage pain.
    • Comprehensive assessment conducted, treatment needs established and care plan put in place.  More specialist areas available if needed such as musculoskeletal, neurological, respiratory, developmental and learning difficulties.
    • Some treatments include improving balance, motor coordination, mobility, normalising tone, reduction and management of pain, participating in physical activities in the community
    • Occurs in children's homes, schools, and community settings such as clinics.

    3. Bed-based rehabilitation

    • A community bed service offers rehabilitation in a safe environment for people who do not need to go into or remain in hospital but cannot be cared for safely at home due to rehabilitation needs.
    • Intensive short-term nursing, medical, therapy and social care support in the community.
    • Individuals situated in a community hospital or a step-down ward.
    • Believe in "rehab not rest" which encourages activeness to become independent
    • Promote confidence and independence so that the individual can continue or return to live in their own home.
    • To provide an integrated service to promote recovery from illness, prevent unnecessary admission to hospital, timely discharge from hospital and rehabilitation to maximise independent living.

    4. Anticipatory care

    • Anticipatory care is a proactive rather than a reactive approach to health care. It encourages people to make positive and proactive choices about their health and well-being. Physiotherapists can empower people to seek the right support to enable self-management, minimising deterioration and improve their quality of life.
    • Adopting a "thinking ahead" philosophy of care that allows practitioners and their teams to work with people. To set and achieve common goals that will ensure the right thing is being done at the right time by the right person(s) with the right outcome.
    • By establishing what matters most to the person, anticipatory care will be personalised and needs-led.
    • The concept of anticipatory care should be embedded into community rehabilitation services to support people to be with autonomous, independent and happy with the aim of well for longer.
    • A population health approach is used to identify those living with a long-term condition to plan for an expected change in health or social status.
    • Read more: Anticipatory care and crisis prevention

    5. Learning disabilities

    • Physiotherapy input is wide and varied due to the breadth of physical presentations of those with learning disabilities. The MDT is critical to learning disability management to aid early detection and treatment of health problems.
    • Assessing for appropriate day and night equipment for optimal positioning e.g. wheelchair, orthotic provision, sleep systems for postural support, complex physical needs, contractures and support at night.
    • Management involves education and collaboration with family members and carers to understand the person's health condition, social situation and preferences.
    • Promoting physical activity and healthy lifestyles to optimise function and prevent deterioration. 
    • Read more: About learning disabilities physiotherapy and about the Association of Chartered Physiotherapists for People with Learning Disabilities (ACPPLD)

    6. Disability management

    • Physiotherapists support people to adapt to long-term disability to facilitate a successful return to work and leisure, understanding the person’s social and occupational context.
    • Physiotherapists may work in occupational health settings to help improve the safety, comfort and performance of the working population.  
    • Understand the worker, formulate return to work strategy in collaboration with work-place representatives to inform rehabilitation plans, goals and clarifying or adjusting job demand
    • Read more: About the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE) 

    7. Admission prevention

    • Includes assessment only and urgent community response (UCR) services.
    • A two-hour response is typically required when a person is at risk of admission (or re-admission) to hospital due to an unexpected crisis that would result in inpatient care without rapid intervention in their own home; but can be within 48 hours depending on the urgency
    • For people who would be highly likely need a hospital admission in the absence of additional support being available.
    • The role of physiotherapist in this pathway includes physical examination such as mobility, balance and respiratory assessments. 
    • New opportunities such as the advanced clinical practitioner role is an exciting opportunity for physiotherapists to develop advanced skills in medical assessments, prescribing and investigations.
    • Read more: UCR learning collaborative 2-hour crisis response webinar recording 

    8. Social prescribing

    • Physiotherapists work collaboratively with local partners to connect general practices and voluntary, community and social enterprise organisations to allow the person to have quick access to appropriate services.
    • Building good relationships across the health and social care and leisure systems to work in a holistic and joined up way.
    • Community referral schemes enable people to continue their rehabilitation in their local communities when traditional rehabilitation interventions have finished. This can be local non-clinical services such as leisure centres and social groups.
    • Read more: About social prescribing and  Social prescribing in practice 

      For more information, visit the CSP's community rehabilitation section and watch the Rehab Matters video.

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