IMPROVING ACCESS TO ELECTIVE JOINT REPLACEMENT SURGERY: A WAITLIST COHORT Hackett D1, Andersen L2, Walker R3, Naylor J4, Jennings M5, Harris I6, Dietsch S7 Senior Physiotherapist, Musculoskeletal Coordinator, Whitlam Joint Replacement Centre, Fairfield Hospital, Prairiewood 1
Senior Physiotherapist, Musculoskeletal Coordinator, Bowral Hospital, Bowral 2
Orthopaedic Surgeon, Head of Department Fairfield/Liverpool Hospital Orthopaedic Department 3
Senior Research Fellow SWSLHD, Director, Whitlam Orthopaedic Research Centre, Liverpool Hospital, Liverpool 4
Physiotherapist, Allied Health Director, Liverpool Hospital, Liverpool
Orthopaedic Surgeon, Director of surgical specialties, SWSLHD, Director, Whitlam Orthopaedic Research Centre, Liverpool 6
Conclusion: This study shows that patients with severe MS experience a constant change in function, which may be presented by declined ability to move, changed perception of own body, increased spasticity, etc. This ever-changing state requires close supervision. Patients with severe MS also have potential for changes in a positive direction. The treatment given by physiotherapists contribute to reduce spasticity and tone, and also to increase joint range among the patients. The physiotherapists also contribute to maintenance of the patients’ respiratory function. Key Practice Points: • Patients with severe MS experience a constant change in function • T his ever-changing state requires close supervision by a skilled physiotherapist • M S patients in palliative care also have potential for changes in a positive direction • M S patients in palliative care requires a holistic and dynamic approach
Clinical Nurse Consultant Orthopaedics, Fairfield Hospital, Prairiewood
Question: Can changes made to the pre admission process improve clients’ access to elective total knee and hip replacement surgery? Design: Observational study. Participants: Patients with Knee or Hip Osteoarthritis waitlisted for primary elective joint replacement surgery. Outcome Measures: Number of clients waiting longer than elective joint replacement benchmark time (365 days), number of clients having surgery cancelled at pre admission appointment, number of clients escalated to surgery, client satisfaction and client complaints. Results: Implementation of changes to the preadmission process resulted in a reduction in people waiting longer than the benchmark period for joint replacement. This was reduced from 150 clients in June 2009 to 0 in June 2010. This improvement has been maintained throughout 2011 and 2012 data collection periods. The new process allows patients who require earlier intervention to be objectively identified, resulting in 205 clients escalated to earlier surgical intervention between January 2010 and December 2012. Preadmission cancellations were analysed for the period January – March 2011 and there was a 20% decrease in cancellations for the same period in 2012. Client complaints decreased from 16 to 5 from 2009 to 2012 and 98% of people surveyed were satisfied or very satisfied with their participation. Conclusion: Process changes to the pre operative management of clients awaiting elective primary total knee and hip replacement surgery at Fairfield Hospital was associated with improved access to surgery and enhanced patient satisfaction with the preoperative process. Key Practice Points: • N ew model of care; Osteoarthritis Chronic Care Program was developed in consultation with the Agency for Clinical Innovation • C hanging the pre admission process allows earlier identification and opportunity to assist clients. • C lient centred, holistic, multidisciplinary musculoskeletal chronic disease management improves clients’ access to elective joint replacement surgery and satisfaction with the preadmission process.
PHYSIOTHERAPY FOR MS-PATIENTS IN PALLIATIVE CARE Hagenes M Oppsalklinikken AS Questions: What do experienced physiotherapists emphasize during treatment of patients with multiple sclerosis (MS) in palliative care? Do any changes occur during treatment, and if so how is this reflected? Design: Open non-participating observation. Participants: Two physiotherapists who treated one patient each. Results: Patients with severe MS experience a constant change in function and the physiotherapists assesses among other things mobility, muscle quality (such as tone) and pain to evaluate the patients’ present condition. The physiotherapists are concerned with the patients’ total situation and the focus of treatment is set by which changes the patients have experienced since the last treatment. They emphasize maintenance of mobility and if possible to increase joint range, normalize muscle tone, as well as maintenance of lung function. The physiotherapists emphasize that the patients should pain free and they try to achieve a symmetric lying position. This study also shows that the patients experience reduced contact with own body. They have for instance a reduced or changed experience of how their own arms and legs feel like.
MULTIMODAL PHYSIOTHERAPY FUNCTIONAL RESTORATION VERSUS ADVICE FOR PEOPLE WITH SUBACUTE LUMBAR DISC HERNIATION AND ASSOCIATED RADICULOPATHY: A RANDOMISED CONTROLLED TRIAL Hahne AJ1, Ford JJ1, Surkitt LD1, Slater SL1, Richards MC1, Chan AYP1, Hinman RS2, Davidson M1, Taylor NF1 Department of Physiotherapy, La Trobe University, Melbourne
Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne 2
Question: For people with a clinical and radiological diagnosis of lumbar disc herniation and associated radiculopathy, is multimodal physiotherapy functional restoration more effective than guideline-recommended advice? Design: Multicenter, parallel group randomised controlled trial. Participants: Fifty-four participants with clinical features of radiculopathy (six-week to six-month duration) and imaging showing a lumbar disc herniation. Interventions: Participants were randomly allocated to receive either 10 sessions of multimodal physiotherapy functional restoration or two sessions of guideline-recommended advice over a 10-week period. Outcome Measures: Primary outcomes were activity limitation (Oswestry Disability Index), and separate 0-10 numerical pain rating scales for leg pain and back pain. Measures were taken at baseline and at 5, 10, 26 and 52 week follow-ups. Results: Linear mixed model analysis showed that activity limitation (Oswestry) improved more in the physiotherapy group than the advice group across the whole follow-up period (overall group x time interaction p = 0.049). Between-group differences for activity limitation favoured the physiotherapy group at 10-weeks (7.7; 95% CI 0.3 to 15.1) and 52-weeks (8.2; 95% CI 0.7 to 15.6). There was no overall group x time effect for pain scores, but back pain was significantly lower in the physiotherapy group relative to the advice group at 10-week follow-up (1.4; 95% CI 0.2 to 2.7). Conclusion: In people with lumbar disc herniation and associated radiucloapthy, a multimodal physiotherapy functional restoration program led to greater reduction in activity limitation across a 52-week follow-up period, and faster reduction in back pain, relative to guidelinerecommended advice. Trial registration: ANZCTR12609000205235. Key Practice Points: • For people with a clinical and radiological diagnosis of lumbar disc herniation and associated radiculopathy, multimodal physiotherapy functional restoration appears more effective than guideline-recommended advice. • T he effect of this physiotherapy program relative to surgery, injections, or in a chronic population, is yet to be investigated.