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Development of critical care rehabilitation guidelines in clinical practice: a quality improvement project
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
namely their gender, their manner and their professional competence; the provision of information, namely about the problem, the treatment plan, what they could do to help themselves, and prognosis; service provision, and decisionmaking. Most of our participants preferred to be treated by a therapist from the same gender and wanted to delegate all clinical decision making to the therapist. These findings differ from those of western studies which may relate to cultural differences that frown upon opposite gender proximity and value expert opinion more than patient opinions respectively. Discussion and conclusions: The therapeutic encounter between patients and therapists in an episode of back care is complex and reflects the multidimensional nature of patient satisfaction. Participants had several criteria according to which they evaluated the quality of care and were able to determine when these criteria were met or not during physiotherapy. Impact and implications: Accordingly, redirecting LBP management to include patient satisfaction outcome measures is recommended to give Egyptian patients the chance to evaluate and improve the quality of back care. Funding acknowledgement: All expense related to the research were covered by the main researcher, Nancy Ali, who also wishes to extend gratitude to her supervisor, Dr. Stephen May, for his valuable feedback and guidance during the research process. http://dx.doi.org/10.1016/j.physio.2016.10.061 POS004 Current knowledge of scoliosis in physiotherapy students training in the UK D.A.J. Black 1,∗ , M. Bradley 1 , D. Shawn 2 , E. Maude 1 , D. Glynn 3 1 Scoliosis
SOS, London, United Kingdom State University, Jonesboro, United States 3 Independant, York, United Kingdom 2 Arkansas
Relevance: This study is designed to analyse and evaluate the knowledge gained by final and penultimate year physiotherapy students regarding the identification and management of scoliosis within universities in the UK. Purpose: It has previously been highlighted in both Poland and the United States that knowledge of Idiopathic Scoliosis (IS) among physiotherapy students is limited with respect to the SOSORT Guidelines. Early detection of scoliosis and correct initial management is essential in effective scoliosis care, and thus physiotherapists should be aware of the basic criteria for diagnosis and indications for treatment. The aim of this study was to evaluate the basic knowledge of Idiopathic Scoliosis in physiotherapy students trained in the UK. Methods/analysis: A previously designed and tested 10question survey, including knowledge of 2011 SOSORT
eS69
Guidelines was transcribed onto an online-survey platform. Questions were designed to analyse knowledge of: definition, cause, development, prevalence, diagnosis, treatment and bracing of scoliosis. All physiotherapy-based UK universities were invited to participate, with the programme lead of each institution asked to distribute the questionnaire among the target population of final and penultimate year physiotherapy students (Master’s and Bachelor’s Degrees). The final number of students who received the study invitation is unknown. The survey link closed after 8 weeks of data collection. Results: A total of 206 students, split over 12 institutions successfully completed the questionnaire. Analysis showed that 79% of students recognised when Idiopathic Scoliosis (IS) is likely to develop, yet only 52% recognised that Idiopathic Scoliosis’ aetiology is unknown. 88% of students incorrectly defined IS as a 2-dimensional deformity, with only 24% of students successful in recognising the prevalence of IS within the scoliosis population. 12% of students could recognise the criteria for diagnosis and 93% were unable to recognise the appropriate treatment approach through therapeutic exercise. Finally 54% students managed to correctly identify when bracing is recommended for IS. In comparison to previous studies within the US, UK students performed worse in relation to all questions except treatment (7% answered correctly vs 3% in the US). Discussion and conclusions: With only 7% of students able to answer >50% of the survey questions correctly, there is a clear lack of knowledge of appropriate Idiopathic Scoliosis diagnosis and care which could directly impact the information these patients are given within first contact primary care in the UK. Impact and implications: A lack of knowledge at firstcontact in primary care within the UK can cause to a delay in diagnosis, referral and correct management of Idiopathic Scoliosis which is a particularly time sensitive and progressive condition. Funding acknowledgement: Unfunded. http://dx.doi.org/10.1016/j.physio.2016.10.062 POS005 Development of critical care rehabilitation guidelines in clinical practice: a quality improvement project S. Elliott Medway NHS Foundation Trust, Physiotherapy Dept, Gillingham, United Kingdom Relevance: Rehabilitation in critical care has the potential to restore lost function and improve quality of life on discharge, but patients are often viewed as too unstable to participate in physical rehabilitation. Following a physiotherapy service evaluation of the provision of critical care rehabil-
eS70
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
itation, a number of concerns were raised in our practice. It was identified that there was a need to standardise pathways for clinical decision making in early rehabilitation so interventions are safe, timely and consistent. Purpose: The publication of NICE Guidelines (CG83) Rehabilitation after Critical Illness in 2009 advocates the need for a structured rehabilitation programme to commence as early as clinically possible. This should include an individualised, structured rehabilitation programme that addresses both physical and psychological needs of the patient. This is further supported by the recently published Guidelines for the Provision of Intensive Care Services (GPICS) (2015) which recommends critical care units provide rehabilitation encompassing physical, functional, communication, social, spiritual, nutritional and psychological aspects of care using nationally agreed assessments and outcome measures. Approach/evaluation: PDSA cycles were used as a method for quality improvement within this setting. Following a literature review, participants trialled an existing protocol but felt it did not fully meet the needs of clinicians and patients. At Medway NHS Foundation trust we developed our own, local evidence based critical care rehabilitation guidelines which incorporate core components from existing literature. Outcomes: The participants took the key ideas from all the authors and research reviewed as part of this study to devise our own rehabilitation guidelines, which included: Must be patient centred. Must include a system based assessment. Must consider other factors such as time, staffing and safety. Must include a risk assessment. Considers type and duration of exercise. Assists therapists in identifying suitable progression. Assists therapists in identifying adverse events. Assists therapists to review intervention and set plans/goals with patient for ongoing care. Must be in a clear, easy to read flow chart format. Must be relevant to our clinical practice. Discussion and conclusions: Following this project the participants surmised that in our clinical setting we were seeking to create Trust critical care rehabilitation guidelines that can act as a reference or teaching aid for all members of the MDT and that they will guide: • clinical decision making in assessing a patient’s suitability for commencing/progressing rehabilitation with an critical care patient. • an appropriate risk assessment, • a comprehensive physical and non-physical assessment, • options of rehabilitation interventions and approaches, • the identification of adverse events and potential cessation of the intervention, • time points of certain actions during the patient pathway, standards that should be met,
• promotion of increased adherence to rehabilitation programs by all members of the critical care team, • patient centred care, • promotion to include families within the rehabilitation pathway, • promote adherence to NICE Guidelines CG83. Impact and implications: These guidelines may assist physiotherapists and other members of the MDT with evidenced based decisions and clinical reasoning to ensure safe and timely interventions when rehabilitating the critically ill. Funding acknowledgement: Nil funding received. http://dx.doi.org/10.1016/j.physio.2016.10.063 POS006 Functional analysis through ultrasound of the suprahyoid muscles during pharyngeal exercises performance L. González 1,2 , S. Francisco 1 , S. Souto 1,2,∗ 1 University
of A Coru˜na, Physiotherapy, A Coru˜na, Spain 2 Psycosocial Intervention and Functional Rehabilitation Research Group, Physiotherapy, A Coru˜na, Spain Relevance: Therapeutic exercise programs used for the treatment of different conditions (obstructive sleep apnoea syndrome, swallowing disorders, etc.) usually include pharyngeal exercises that could be grouped into sucking exercises, swallowing exercises and soft palate exercises. However, it is unclear how the recruitment of the mouth floor muscles happens during the exercise performance. Purpose: To describe and compare changes in geniohyoid and mylohyoid muscles thickness during the performance of three pharyngeal exercises (sucking, swallowing and soft palate). Methods/analysis: Contraction of the geniohyoid and mylohyoid muscles during three pharyngeal exercises was investigated using ultrasound (6 to 13 MHz 6 cm linear probe) in 10 healthy subjects (5 men, mean age 18.8 ± 1.87 years). Images were taken in the transversal plane with the probe placed under the mandible. The thickness of the muscles was studied at rest and during the exercises performance. Three measurements were taken for each exercise (at rest and in contraction). The mean value of these measures was taken. Descriptive analysis was performed. The quantitative data is presented as mean and standard deviation (±SD). One sample t-test was used for analyze the changes in the muscles thickness. Paired two-sample t-test was used for comparing the changes between the exercises. A P value of <0.05 was considered to be statically significant. Results: Ultrasound measurements showed a significant (P < 0.000) increase in muscle diameter during all the pharyn-
namely their gender, their manner and their professional competence; the provision of information, namely about the problem, the treatment plan, what they could do to help themselves, and prognosis; service provision, and decisionmaking. Most of our participants preferred to be treated by a therapist from the same gender and wanted to delegate all clinical decision making to the therapist. These findings differ from those of western studies which may relate to cultural differences that frown upon opposite gender proximity and value expert opinion more than patient opinions respectively. Discussion and conclusions: The therapeutic encounter between patients and therapists in an episode of back care is complex and reflects the multidimensional nature of patient satisfaction. Participants had several criteria according to which they evaluated the quality of care and were able to determine when these criteria were met or not during physiotherapy. Impact and implications: Accordingly, redirecting LBP management to include patient satisfaction outcome measures is recommended to give Egyptian patients the chance to evaluate and improve the quality of back care. Funding acknowledgement: All expense related to the research were covered by the main researcher, Nancy Ali, who also wishes to extend gratitude to her supervisor, Dr. Stephen May, for his valuable feedback and guidance during the research process. http://dx.doi.org/10.1016/j.physio.2016.10.061 POS004 Current knowledge of scoliosis in physiotherapy students training in the UK D.A.J. Black 1,∗ , M. Bradley 1 , D. Shawn 2 , E. Maude 1 , D. Glynn 3 1 Scoliosis
SOS, London, United Kingdom State University, Jonesboro, United States 3 Independant, York, United Kingdom 2 Arkansas
Relevance: This study is designed to analyse and evaluate the knowledge gained by final and penultimate year physiotherapy students regarding the identification and management of scoliosis within universities in the UK. Purpose: It has previously been highlighted in both Poland and the United States that knowledge of Idiopathic Scoliosis (IS) among physiotherapy students is limited with respect to the SOSORT Guidelines. Early detection of scoliosis and correct initial management is essential in effective scoliosis care, and thus physiotherapists should be aware of the basic criteria for diagnosis and indications for treatment. The aim of this study was to evaluate the basic knowledge of Idiopathic Scoliosis in physiotherapy students trained in the UK. Methods/analysis: A previously designed and tested 10question survey, including knowledge of 2011 SOSORT
eS69
Guidelines was transcribed onto an online-survey platform. Questions were designed to analyse knowledge of: definition, cause, development, prevalence, diagnosis, treatment and bracing of scoliosis. All physiotherapy-based UK universities were invited to participate, with the programme lead of each institution asked to distribute the questionnaire among the target population of final and penultimate year physiotherapy students (Master’s and Bachelor’s Degrees). The final number of students who received the study invitation is unknown. The survey link closed after 8 weeks of data collection. Results: A total of 206 students, split over 12 institutions successfully completed the questionnaire. Analysis showed that 79% of students recognised when Idiopathic Scoliosis (IS) is likely to develop, yet only 52% recognised that Idiopathic Scoliosis’ aetiology is unknown. 88% of students incorrectly defined IS as a 2-dimensional deformity, with only 24% of students successful in recognising the prevalence of IS within the scoliosis population. 12% of students could recognise the criteria for diagnosis and 93% were unable to recognise the appropriate treatment approach through therapeutic exercise. Finally 54% students managed to correctly identify when bracing is recommended for IS. In comparison to previous studies within the US, UK students performed worse in relation to all questions except treatment (7% answered correctly vs 3% in the US). Discussion and conclusions: With only 7% of students able to answer >50% of the survey questions correctly, there is a clear lack of knowledge of appropriate Idiopathic Scoliosis diagnosis and care which could directly impact the information these patients are given within first contact primary care in the UK. Impact and implications: A lack of knowledge at firstcontact in primary care within the UK can cause to a delay in diagnosis, referral and correct management of Idiopathic Scoliosis which is a particularly time sensitive and progressive condition. Funding acknowledgement: Unfunded. http://dx.doi.org/10.1016/j.physio.2016.10.062 POS005 Development of critical care rehabilitation guidelines in clinical practice: a quality improvement project S. Elliott Medway NHS Foundation Trust, Physiotherapy Dept, Gillingham, United Kingdom Relevance: Rehabilitation in critical care has the potential to restore lost function and improve quality of life on discharge, but patients are often viewed as too unstable to participate in physical rehabilitation. Following a physiotherapy service evaluation of the provision of critical care rehabil-
eS70
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS67–eS282
itation, a number of concerns were raised in our practice. It was identified that there was a need to standardise pathways for clinical decision making in early rehabilitation so interventions are safe, timely and consistent. Purpose: The publication of NICE Guidelines (CG83) Rehabilitation after Critical Illness in 2009 advocates the need for a structured rehabilitation programme to commence as early as clinically possible. This should include an individualised, structured rehabilitation programme that addresses both physical and psychological needs of the patient. This is further supported by the recently published Guidelines for the Provision of Intensive Care Services (GPICS) (2015) which recommends critical care units provide rehabilitation encompassing physical, functional, communication, social, spiritual, nutritional and psychological aspects of care using nationally agreed assessments and outcome measures. Approach/evaluation: PDSA cycles were used as a method for quality improvement within this setting. Following a literature review, participants trialled an existing protocol but felt it did not fully meet the needs of clinicians and patients. At Medway NHS Foundation trust we developed our own, local evidence based critical care rehabilitation guidelines which incorporate core components from existing literature. Outcomes: The participants took the key ideas from all the authors and research reviewed as part of this study to devise our own rehabilitation guidelines, which included: Must be patient centred. Must include a system based assessment. Must consider other factors such as time, staffing and safety. Must include a risk assessment. Considers type and duration of exercise. Assists therapists in identifying suitable progression. Assists therapists in identifying adverse events. Assists therapists to review intervention and set plans/goals with patient for ongoing care. Must be in a clear, easy to read flow chart format. Must be relevant to our clinical practice. Discussion and conclusions: Following this project the participants surmised that in our clinical setting we were seeking to create Trust critical care rehabilitation guidelines that can act as a reference or teaching aid for all members of the MDT and that they will guide: • clinical decision making in assessing a patient’s suitability for commencing/progressing rehabilitation with an critical care patient. • an appropriate risk assessment, • a comprehensive physical and non-physical assessment, • options of rehabilitation interventions and approaches, • the identification of adverse events and potential cessation of the intervention, • time points of certain actions during the patient pathway, standards that should be met,
• promotion of increased adherence to rehabilitation programs by all members of the critical care team, • patient centred care, • promotion to include families within the rehabilitation pathway, • promote adherence to NICE Guidelines CG83. Impact and implications: These guidelines may assist physiotherapists and other members of the MDT with evidenced based decisions and clinical reasoning to ensure safe and timely interventions when rehabilitating the critically ill. Funding acknowledgement: Nil funding received. http://dx.doi.org/10.1016/j.physio.2016.10.063 POS006 Functional analysis through ultrasound of the suprahyoid muscles during pharyngeal exercises performance L. González 1,2 , S. Francisco 1 , S. Souto 1,2,∗ 1 University
of A Coru˜na, Physiotherapy, A Coru˜na, Spain 2 Psycosocial Intervention and Functional Rehabilitation Research Group, Physiotherapy, A Coru˜na, Spain Relevance: Therapeutic exercise programs used for the treatment of different conditions (obstructive sleep apnoea syndrome, swallowing disorders, etc.) usually include pharyngeal exercises that could be grouped into sucking exercises, swallowing exercises and soft palate exercises. However, it is unclear how the recruitment of the mouth floor muscles happens during the exercise performance. Purpose: To describe and compare changes in geniohyoid and mylohyoid muscles thickness during the performance of three pharyngeal exercises (sucking, swallowing and soft palate). Methods/analysis: Contraction of the geniohyoid and mylohyoid muscles during three pharyngeal exercises was investigated using ultrasound (6 to 13 MHz 6 cm linear probe) in 10 healthy subjects (5 men, mean age 18.8 ± 1.87 years). Images were taken in the transversal plane with the probe placed under the mandible. The thickness of the muscles was studied at rest and during the exercises performance. Three measurements were taken for each exercise (at rest and in contraction). The mean value of these measures was taken. Descriptive analysis was performed. The quantitative data is presented as mean and standard deviation (±SD). One sample t-test was used for analyze the changes in the muscles thickness. Paired two-sample t-test was used for comparing the changes between the exercises. A P value of <0.05 was considered to be statically significant. Results: Ultrasound measurements showed a significant (P < 0.000) increase in muscle diameter during all the pharyn-