NIHR Highlight My Signals - Physiotherapy Collection
Published June 2018
In My Signals, health and social care staff and service users tell us what research is important to them and why they feel others need to know about it. Join the conversation on Twitter and tell us which Signals have interested, excited or surprised you, using #MySignals. You can find the latest NIHR Signals here.
In this collection, we asked four physiotherapists to tell us which Signals have interested them most and explain why they feel the findings are worth sharing.
Doreen is a Professor of Pelvic Floor Physiotherapy at the Nursing, Midwifery and Allied Health Professions, Research Unit, Glasgow Caledonian University. The unit is internationally renowned for conducting high quality research in the area of continence and prolapse; Doreen has a special interest in those who also have neurological conditions.
“I was drawn to this Signal as many of the patients we see as pelvic floor specialist physiotherapists are women whose pelvic floor disorders (e.g. continence/prolapse) tend to become worse during the menopause.
“For some women, menopausal symptoms can be very troublesome and they often feel isolated and unsupported. It is important that women have the most relevant information to make an informed decisions should they require an intervention. However, the lack of evidence on the short and long term adverse events highlighted in the Signal is striking.”
“I found this Signal important as it offers evidence on some physiotherapy interventions which have been discontinued or are under threat due to service cuts. Having worked in a gynae/cancer unit for many years, it was routine to provide pre and post-operative advice on breathing exercises and early mobilisation.
“Prevention is better than cure, with patients often being receptive to such advice before their operation, giving time for consolidation and indeed practice to get them into optimum condition for surgery and recovery. Further research within the NHS is required to look at cost-effectiveness and efficacy.”
“As more people are surviving cancer, there are more and more people living with the consequences of treatment who are now seen as living with a long-term condition. Fatigue is a common feature and it is important that physical and functional decline is limited as much as possible. In addition, physical activity has been shown to improve mood and quality of life.
“Although the settings and interventions identified were varied, community based groups appear to be optimal and although participants were primarily breast cancer survivors, there is also evidence in other cancers, such as gynaecological cancers. This Signal highlights the need for physios to develop such programs and potentially online resources or apps.”
Fran is a falls specialist physiotherapist working in a variety of community settings in Nottinghamshire including patients’ homes, care homes and a primary care centre. She provides evidence-based assessment and treatment methods for service users mainly over 55 at risk of falls and frailty.
Fran also links with Public Health and voluntary sector organisations to establish new approaches to promoting physical activity and empowerment of older adults.
Free entry for leisure centres may increase physical activity across all social groups &
Exercise referral schemes increase physical activity for some
“These Signals caught my eye as we have recently established an integrated pathway, linking our falls prevention exercise programme with a new balance group delivered at local leisure centres by exercise referral scheme instructors. This has supported patients to continue with their strength and balance rehabilitation, to self-manage their risk of falls and to combat issues of social isolation.
“These Signals mirror the benefits I’ve seen in practice in my area and highlight the role the leisure sector could play in supporting people from all backgrounds with multiple co-morbidities to self-manage and prevent long-term conditions.”
“I found this Signal interesting because, as a falls specialist physiotherapist, balance and strength are the cornerstones of my rehabilitation approach, in accordance with NICE guidance. It is not surprising that Pilates is beneficial in improving these components of physical fitness. It could be offered as an alternative to Tai Chi and I liked the discussion around accessibility as Pilates classes are abundant across the country. This may make it an appealing option when motivating people to stay active and age well.
“While most of my patients would be not be suitable for Mat Pilates, due to mobility issues or high levels of frailty, it may be useful in a health promotion setting. As always clinical reasoning should be used when applying this Signal in practice.”
“Patients accessing falls prevention services are often frail and can also be obese. Previous studies have demonstrated that the risk of frailty increases with obesity, in part due to unhealthy behaviours such as inactivity, poor diet and smoking.
“This randomised control trial highlights the value of promoting strength training alongside aerobic exercise to reduce the risk of sarcopenia. It demonstrates the importance of not solely focusing exercise recommendations around weight loss and has helped me facilitate conversations when advising patients who are aiming for a healthy target weight.”
“This study was of interest to me as our team provide falls prevention training to care home staff. We frequently see patients following a fall in care homes who have a diagnosis of dementia and demonstrate behavioural symptoms, such as agitation and aggression. The anti-psychotics used to manage these symptoms often have many side effects which can often further increase an individual’s falls risk
“This large randomised control trial found that training care home staff to deliver personalised activities and positive social interactions for residents with dementia led to small improvements in quality of life, reduced agitation and is likely to be cost-effective long term. This builds on a previous study which showed this approach reduced antipsychotic use and mortality in care home residents with dementia. It is a useful example to show the value of tailoring interactions and making a meaningful connection with residents with dementia.”
Jenny Van Maurik
Jenny is a Musculoskeletal Physiotherapy Specialist and Clinical Lead in Dynamic Health, Cambridgeshire Community Services NHS trust. She works in outpatient clinics and assesses patients with complex musculoskeletal (MSK) symptoms.
Jenny also links with the orthopaedic elective care and pain sustainability and transformation partnerships in the Cambridgeshire and Peterborough region providing clinical expertise for the development of streamlined patient pathways for MSK, pain and rheumatology services.
“I found this Signal really interesting because, as an MSK physiotherapy specialist, I can refer patients who have not responded to physiotherapy and a steroid injection, for subacrominal decompression surgery. The study, however, found that these patients had only a slightly more effective response to shoulder surgery than to no treatment.
“This was not the outcome I was expecting and is certainly something I now discuss with patients early on in their treatment pathway; that shoulder surgery may not be the ultimate answer to the resolution of their pain and that this is backed up by recent evidence.
“It is also worth while noting that patients who underwent subacrominal decompression surgery, arthroscopy only or had no treatment improved slightly over 12 months, with minimal differences between groups.
“For me, this study has raised further questions on the mechanism by which this surgery may work and whether we need to be more selective in the use of surgery for patients by reviewing the criteria for patient selection.”
“This Signal was of interest to me as I have introduced a cognitive behavioral intervention for patients with persistent low back pain in six physiotherapy departments across Cambridgeshire and the Peterborough area. This intervention is called the UP class (Understanding Pain and improving fitness). The Signal reports a long term benefit in patient reported pain and disability from low back pain.
“Low back pain is very common and can persist causing great suffering to patients. It is useful to know that this Signal mirrors the benefits seen in clinical practice in my area and highlights the need for a cognitive behavioral approach in the management of this patient group.
“Delivering this intervention in a group setting reduces cost to allow more patients to benefit from this important treatment, helping to reduce the disabling impact of persistent low back pain.”
“As a clinician who uses injection therapy I was very interested in this review. The review reports that corticosteroid injections provide moderate pain relief for adults with rotator cuff disorders up to two months after injection. There is no evidence of any effect after this time. It also reports that multiple injections are no more beneficial than a single injection.
“In the clinical setting, corticosteroid injections are used to reduce shoulder pain to enable patient to regain shoulder function. This shoulder condition is normally very painful, and whilst we know that keeping the shoulder and arm exercised is very beneficial, patients can often find exercising the shoulder too painful - even when pain medication is used. A corticosteroid injection offered at this time can often reduce a patient’s shoulder pain to enable exercise to take place.
“This Signal has further confirmed my belief that it is important to make the patient aware that exercises along with physiotherapy should be considered two weeks after the injection to maximise on the temporary pain relief provided by the corticosteroid injection. It is also important to consider when to perform this intervention, as multiple injections are no better than a single injection. I now give this information to patients to make them aware of the temporary effects of this treatment.”
Rónán Mac Cann
Rónán is a final year MSc. Physiotherapy (Pre-Registration) student at Queen Margaret University, Edinburgh. He is currently an active MSc. Chartered Society of Physiotherapy (CSP) representative with a keen interest in neurological rehabilitation.
“I found this Signal important on a recent community physiotherapy placement which had a newly developed early supported discharge pilot programme for stroke survivors.
“With the number of stroke survivors in the UK increasing due to the advances in medical care, there has also been a parallel rise in the number of people who find themselves caring for loved ones. This Signal examined studies across ten countries with a combined sample of 452 carers to explore their views about involvement in care planning.
“Quite often, by putting the patient at the centre of our treatment, we can forget about the impact on family and carers. This Signal highlights the importance of recognising carers as ‘partners in care’. As the evidence for how to support carers of stroke survivors is relatively poor, this Signal offers an insight into this gap and should encourage all health professionals to consider the voice of carers and support them during the patient’s transition from hospital to the community. Families and carers of stroke survivors need a full understanding of the requirements of their future role which ultimately involves emotional, psychosocial and practical support.
“For me, this Signal has encouraged me to be more mindful of carers and family members and the stress that they may be hiding. In considering their need for support, signposting, information and training we can ultimately reduce some of the distress placed upon these carers.”
“This study was of particular interest to me during my paediatric placement, as many of the patients that I encountered had respiratory conditions that required constant management and monitoring. Quite often, due to the nature of their conditions, these patients are regularly presenting at emergency departments which creates an economic burden and puts the child at an increased risk of picking up infections or other serious diseases.
“This Signal explores the idea of self-care support which involves health professionals working together with families and patients with long-term conditions to empower the safe use of self-care support packages. Although the evidence is limited in this area, this Signal suggests that this approach could reduce the need for emergency treatment and increase the quality of life of children with long-term conditions, such as asthma.
“Considering the findings of this study I am now more aware of the need to keep these children out of hospital by providing them and/or their families with the right resources, information and support to manage these conditions at home.”