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Patients’ expectations of physiotherapy treatment for musculoskeletal conditions
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The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS1–eS42
centres’; as increasing numbers of people are being treated in such centres after cardiac arrest. Methods/analysis: A cross-sectional survey design was chosen, to provide quantitative data. A postal questionnaire was chosen as it would have the advantage of a known denominator population. A questionnaire was sent to each of the 144 acute NHS hospital Trusts in England. One physiotherapist from each trust was invited to respond. Individual guidelines were considered met if they were reported as being met ‘always’ or ‘almost always’ by respondents. Results: 52 questionnaires were included in the analysis; an overall response rate of 36% was achieved. A number of areas for improvement were identified, where levels of adherence were low; from initial screening and assessment – to appropriate onward referrals. No significant difference was found between responding trusts – with and without heart attack centres – in terms of guideline adherence. Discussion and conclusions: This survey has provided a ‘snap shot’ of the provision of acute rehabilitation for patients with brain injury after cardiac arrest, in a number of hospital trusts across England. The results question the equity of acute rehabilitation for patients with brain injury after cardiac arrest; as adherence to guidelines varied between responding trusts, and individual trusts reported adhering to some guidelines only ‘sometimes’. Further research into areas where adherence was low or varied is warranted. Added responses suggested that patient location within the trust was a factor influencing adherence to many of the guidelines, and as such it may be appropriate to review the patient pathway, with a view to improve consistency and quality of care. Impact and implications: This study highlights the need for further guidance towards appropriate acute rehabilitation after cardiac arrest; particularly as more people are surviving cardiac arrest, and understanding how brain injury can impact on the lives of these patients and their families. Organisational support is needed to either further adopt the existing brain injury guidelines or to produce more specific guidelines for survivors of cardiac arrest. Funding acknowledgement: Unfunded research. MSc Rehabilitation supported through CPPD contract, and staff at St George’s University Foundation Health Trust and Kingston University and St George’s University, London, Faculty of Health, Social Care and Education. http://dx.doi.org/10.1016/j.physio.2016.10.031
OA029 Patients’ expectations of physiotherapy treatment for musculoskeletal conditions C. McCrum 1 , E. Bryant 2,∗ , S. Murtagh 2 , L. Hodgson 2 , G. Canby 3 , L. Finucane 4 , C. Mercer 5 , T. Smith 6 , A. Moore 2 1 East
Sussex Healthcare NHS Trust, Physiotherapy, Eastbourne, United Kingdom 2 University of Brighton, Centre for Health Research, Eastbourne, United Kingdom 3 University of Brighton, School of Health Sciences, Eastbourne, United Kingdom 4 Surrey and Sussex Healthcare NHS Trust, First Community Health & Care, Redhill, United Kingdom 5 Western Sussex Hospitals NHS Trust, Physiotherapy, Worthing, United Kingdom 6 Brighton and Sussex Hospitals NHS Trust, Physiotherapy, Haywards Heath, United Kingdom Relevance: Research shows that the expectations a patient brings to treatment have important influences on the clinical relationship, experiences of treatment, the treatment process, outcomes and satisfaction with care. This influence means that patients’ expectations are important for physiotherapists, service providers and researchers to take into account in approaches to care and treatment evaluations. Research highlights the need for a better understanding of expectations of physiotherapy treatment for musculoskeletal problems to enable more effective, high quality and cost-beneficial care. Purpose: The aim of this qualitative study was to explore prospective responses to an open comment item on patients’ expectations of their physiotherapy treatment that was nested within a larger research project developing and validating the Brighton musculoskeletal Patient Reported Outcome Measure (BmPROM). Methods/analysis: The BmPROM is a generic patient self-report outcome measure developed to evaluate the effectiveness of physiotherapy treatment for musculoskeletal conditions. A validity and reliability study was undertaken with patients newly referred into five NHS physiotherapy outpatient departments in SE England. The outcome tool has open-comment items, which included a pre-treatment invitation to provide expectations of their physiotherapy treatment. A thematic analysis was undertaken of the expectations expressed to gain insights for physiotherapy practice and patient care. Results: Analysis was undertaken of 563 expectations of physiotherapy treatment expressed from 224 participants (mean 50.7 yrs [17–88 yrs]; 60% female) experiencing a range of musculoskeletal conditions (Lower limb: 30%, Upper limb: 25%, Spine: 28%, Other/multiple sites: 17%). Five key themes were identified. Three themes were outcome-related and desired effects of treatment; Reliev-
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS1–eS42
ing symptoms, predominately pain relief; Regaining and maintaining physical abilities and function; and Improving psychological well-being by enabling coping, confidence and control. Theme four was process-related; Explanation, advice and education, where physiotherapy was seen as a resource to acquire better knowledge, skills and strategies to support resolution, management or prevention. The final theme involved recovery expectations conveyed within responses; Problem resolution and responsibility, where responses implied an expectation of a cure or one of problem management and control. Discussion and conclusions: The findings provide an understanding of domains considered important or appropriate by patients when seeking care for musculoskeletal problems. The themes show overlap with studies using retrospective explorations and surveys of treatment expectations, and research on outcomes considered important to evaluate within musculoskeletal PROMs. The study has also shown that a written method of eliciting expectations can be a valuable clinical tool for use to support discussions concerning treatment aims, strategies, desired outcomes and responsibilities. These communication processes are also likely to be integral to achieving the qualities in the therapist and clinical encounters considered important to patients, of feeling listened to, consulted with and respected, and associated with satisfaction with physiotherapy and features of patientcentred care. Impact and implications: Healthcare is changing as evidence-informed practice and cost-benefit drivers influence what and how care is provided. Shifts from traditional understandings about musculoskeletal problems and their management makes exploring and addressing patients’ expectations particularly important. Developing ways to support appropriate expectations of physiotherapy treatment remains an important endeavour that is integral to its effectiveness and demonstrating its value. Funding acknowledgement: This study was supported by the University of Brighton, Centre for Health Research. http://dx.doi.org/10.1016/j.physio.2016.10.032 OA030 The effect of rehabilitation interventions on long term upper limb function in chronic stroke patients: a meta-analysis I.O. Sorinola ∗ , M. Fergusson, L. Skevington-Postles Division of Health and Social Care Research, King’s College London, Department of Physiotherapy, London, United Kingdom Relevance: Up to 66% of stroke survivors remain with persistent upper limb paresis and functional limitations for many years after stroke. Optimising upper limb functional
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ability is one of the focus of many research efforts and this has yielded many strategies. However, in spite of the proliferation of these interventions, there is still a lack of clarity on the long term benefits of these interventions in chronic stroke. Purpose: To systematically evaluate the effects of rehabilitation interventions on long term chronic upper limb stroke outcomes. Methods/analysis: A systematic strategy was utilised to search the following online databases: Medline, EMBASE, CINAHL, Cochrane, PEDro, Web of Science and Scopus. Randomised controlled trials examining the effects of rehabilitation interventions on upper limb related impairments, activity limitations and participation restrictions in chronic stroke patients with a follow-up of at least three months, were identified. Two independent reviewers extracted data using the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Methodological quality was assessed using the Physiotherapy Evidence Database checklist (PEDro); and the risk of bias was assessed using the Cochrane Collaboration tool. Effect sizes were calculated as mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals (95%CI) for upper limb motor function, activity limitations and participation restrictions. Results: Fourteen studies involving 704 participants and a mean PEDro score of 6.5 (range 4 to 8) were included. These comprised studies of: 1) 2) 3) 4) 5) 6) 7) 8) 9)
robotics; constraint-induced movement therapy (CIMT); electrical stimulation; repetitive transcranial magnetic stimulation (rTMS); mirror therapy; bilateral arm training; mirror therapy; virtual reality; and trunk restraint therapy.
Meta-analyses showed a significant beneficial effect of these interventions on upper limb motor function at post intervention (MD = 1.32, 95% CI 0.65 to 1.99; P < 0.0001), three month follow up (MD = 1.10, 95% CI 0.48 to 1.72; P = 0.005), and greater than three month follow up (MD = 3.18, 95% CI 1.42 to 4.94; P = 0.0004). A significant effect was found in favour of the interventions on upper limb functional ability at post intervention (SMD = 0.42, 95% CI 0.11 to 0.72; P = 0.007). However, no beneficial long term effect was found for upper limb related activity limitations and participation restrictions. Discussion and conclusions: This review highlights the limited number of studies which assess long term impact of interventions in upper limb rehabilitation studies. The available evidence seems to indicate that rehabilitation interventions can induce small long term improvements in upper limb motor function in chronic stroke with negligible impact of on arm related activity and participation. This results suggest the need for alternative strategies to optimise functional
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS1–eS42
centres’; as increasing numbers of people are being treated in such centres after cardiac arrest. Methods/analysis: A cross-sectional survey design was chosen, to provide quantitative data. A postal questionnaire was chosen as it would have the advantage of a known denominator population. A questionnaire was sent to each of the 144 acute NHS hospital Trusts in England. One physiotherapist from each trust was invited to respond. Individual guidelines were considered met if they were reported as being met ‘always’ or ‘almost always’ by respondents. Results: 52 questionnaires were included in the analysis; an overall response rate of 36% was achieved. A number of areas for improvement were identified, where levels of adherence were low; from initial screening and assessment – to appropriate onward referrals. No significant difference was found between responding trusts – with and without heart attack centres – in terms of guideline adherence. Discussion and conclusions: This survey has provided a ‘snap shot’ of the provision of acute rehabilitation for patients with brain injury after cardiac arrest, in a number of hospital trusts across England. The results question the equity of acute rehabilitation for patients with brain injury after cardiac arrest; as adherence to guidelines varied between responding trusts, and individual trusts reported adhering to some guidelines only ‘sometimes’. Further research into areas where adherence was low or varied is warranted. Added responses suggested that patient location within the trust was a factor influencing adherence to many of the guidelines, and as such it may be appropriate to review the patient pathway, with a view to improve consistency and quality of care. Impact and implications: This study highlights the need for further guidance towards appropriate acute rehabilitation after cardiac arrest; particularly as more people are surviving cardiac arrest, and understanding how brain injury can impact on the lives of these patients and their families. Organisational support is needed to either further adopt the existing brain injury guidelines or to produce more specific guidelines for survivors of cardiac arrest. Funding acknowledgement: Unfunded research. MSc Rehabilitation supported through CPPD contract, and staff at St George’s University Foundation Health Trust and Kingston University and St George’s University, London, Faculty of Health, Social Care and Education. http://dx.doi.org/10.1016/j.physio.2016.10.031
OA029 Patients’ expectations of physiotherapy treatment for musculoskeletal conditions C. McCrum 1 , E. Bryant 2,∗ , S. Murtagh 2 , L. Hodgson 2 , G. Canby 3 , L. Finucane 4 , C. Mercer 5 , T. Smith 6 , A. Moore 2 1 East
Sussex Healthcare NHS Trust, Physiotherapy, Eastbourne, United Kingdom 2 University of Brighton, Centre for Health Research, Eastbourne, United Kingdom 3 University of Brighton, School of Health Sciences, Eastbourne, United Kingdom 4 Surrey and Sussex Healthcare NHS Trust, First Community Health & Care, Redhill, United Kingdom 5 Western Sussex Hospitals NHS Trust, Physiotherapy, Worthing, United Kingdom 6 Brighton and Sussex Hospitals NHS Trust, Physiotherapy, Haywards Heath, United Kingdom Relevance: Research shows that the expectations a patient brings to treatment have important influences on the clinical relationship, experiences of treatment, the treatment process, outcomes and satisfaction with care. This influence means that patients’ expectations are important for physiotherapists, service providers and researchers to take into account in approaches to care and treatment evaluations. Research highlights the need for a better understanding of expectations of physiotherapy treatment for musculoskeletal problems to enable more effective, high quality and cost-beneficial care. Purpose: The aim of this qualitative study was to explore prospective responses to an open comment item on patients’ expectations of their physiotherapy treatment that was nested within a larger research project developing and validating the Brighton musculoskeletal Patient Reported Outcome Measure (BmPROM). Methods/analysis: The BmPROM is a generic patient self-report outcome measure developed to evaluate the effectiveness of physiotherapy treatment for musculoskeletal conditions. A validity and reliability study was undertaken with patients newly referred into five NHS physiotherapy outpatient departments in SE England. The outcome tool has open-comment items, which included a pre-treatment invitation to provide expectations of their physiotherapy treatment. A thematic analysis was undertaken of the expectations expressed to gain insights for physiotherapy practice and patient care. Results: Analysis was undertaken of 563 expectations of physiotherapy treatment expressed from 224 participants (mean 50.7 yrs [17–88 yrs]; 60% female) experiencing a range of musculoskeletal conditions (Lower limb: 30%, Upper limb: 25%, Spine: 28%, Other/multiple sites: 17%). Five key themes were identified. Three themes were outcome-related and desired effects of treatment; Reliev-
The 4th European Congress of the ER-WCPT / Physiotherapy 102S (2016) eS1–eS42
ing symptoms, predominately pain relief; Regaining and maintaining physical abilities and function; and Improving psychological well-being by enabling coping, confidence and control. Theme four was process-related; Explanation, advice and education, where physiotherapy was seen as a resource to acquire better knowledge, skills and strategies to support resolution, management or prevention. The final theme involved recovery expectations conveyed within responses; Problem resolution and responsibility, where responses implied an expectation of a cure or one of problem management and control. Discussion and conclusions: The findings provide an understanding of domains considered important or appropriate by patients when seeking care for musculoskeletal problems. The themes show overlap with studies using retrospective explorations and surveys of treatment expectations, and research on outcomes considered important to evaluate within musculoskeletal PROMs. The study has also shown that a written method of eliciting expectations can be a valuable clinical tool for use to support discussions concerning treatment aims, strategies, desired outcomes and responsibilities. These communication processes are also likely to be integral to achieving the qualities in the therapist and clinical encounters considered important to patients, of feeling listened to, consulted with and respected, and associated with satisfaction with physiotherapy and features of patientcentred care. Impact and implications: Healthcare is changing as evidence-informed practice and cost-benefit drivers influence what and how care is provided. Shifts from traditional understandings about musculoskeletal problems and their management makes exploring and addressing patients’ expectations particularly important. Developing ways to support appropriate expectations of physiotherapy treatment remains an important endeavour that is integral to its effectiveness and demonstrating its value. Funding acknowledgement: This study was supported by the University of Brighton, Centre for Health Research. http://dx.doi.org/10.1016/j.physio.2016.10.032 OA030 The effect of rehabilitation interventions on long term upper limb function in chronic stroke patients: a meta-analysis I.O. Sorinola ∗ , M. Fergusson, L. Skevington-Postles Division of Health and Social Care Research, King’s College London, Department of Physiotherapy, London, United Kingdom Relevance: Up to 66% of stroke survivors remain with persistent upper limb paresis and functional limitations for many years after stroke. Optimising upper limb functional
eS23
ability is one of the focus of many research efforts and this has yielded many strategies. However, in spite of the proliferation of these interventions, there is still a lack of clarity on the long term benefits of these interventions in chronic stroke. Purpose: To systematically evaluate the effects of rehabilitation interventions on long term chronic upper limb stroke outcomes. Methods/analysis: A systematic strategy was utilised to search the following online databases: Medline, EMBASE, CINAHL, Cochrane, PEDro, Web of Science and Scopus. Randomised controlled trials examining the effects of rehabilitation interventions on upper limb related impairments, activity limitations and participation restrictions in chronic stroke patients with a follow-up of at least three months, were identified. Two independent reviewers extracted data using the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Methodological quality was assessed using the Physiotherapy Evidence Database checklist (PEDro); and the risk of bias was assessed using the Cochrane Collaboration tool. Effect sizes were calculated as mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals (95%CI) for upper limb motor function, activity limitations and participation restrictions. Results: Fourteen studies involving 704 participants and a mean PEDro score of 6.5 (range 4 to 8) were included. These comprised studies of: 1) 2) 3) 4) 5) 6) 7) 8) 9)
robotics; constraint-induced movement therapy (CIMT); electrical stimulation; repetitive transcranial magnetic stimulation (rTMS); mirror therapy; bilateral arm training; mirror therapy; virtual reality; and trunk restraint therapy.
Meta-analyses showed a significant beneficial effect of these interventions on upper limb motor function at post intervention (MD = 1.32, 95% CI 0.65 to 1.99; P < 0.0001), three month follow up (MD = 1.10, 95% CI 0.48 to 1.72; P = 0.005), and greater than three month follow up (MD = 3.18, 95% CI 1.42 to 4.94; P = 0.0004). A significant effect was found in favour of the interventions on upper limb functional ability at post intervention (SMD = 0.42, 95% CI 0.11 to 0.72; P = 0.007). However, no beneficial long term effect was found for upper limb related activity limitations and participation restrictions. Discussion and conclusions: This review highlights the limited number of studies which assess long term impact of interventions in upper limb rehabilitation studies. The available evidence seems to indicate that rehabilitation interventions can induce small long term improvements in upper limb motor function in chronic stroke with negligible impact of on arm related activity and participation. This results suggest the need for alternative strategies to optimise functional