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One Step Too Far

In our last article we commented on the way in which exercise regimes have moved on; with the emphasis now being on providing exercise and mobility training which not only suits individual pursuits but also the individual athlete. With the Rugby World Cup being very much in evidence at the moment, it’s a theme which we thought we would return to.

Aside from the numerous injuries which seem to have befallen the Welsh team, opening skirmishes have led to injury worries for numerous players. Some will be rested before being brought back into the fray later on in the campaign whilst for others their World Cup dream is already at an end.

The neutral observer may question why there are so many injuries when it comes to the big tournaments. Admittedly rugby is a game which begets injuries but it has to be asked whether there is an underlying reason for so many key players to become injured at the same time. Again the neutral observer may wonder whether it is simply that in rugby injuries are rife, but we only hear about them thanks to the increased publicity which world cups bring.

But there has to be more to it than that and whilst some injuries are simply down to the run of the game or bad luck, it has to be wondered whether others may be as a result of a desire to field the best team possible. This can lead to circumstances such as players who are carrying a minor injury being selected in the hope that they will be fit in time for the tournament, players ignoring slight niggles as they don’t want to miss out on the tournament, or even a bit of overtraining in a bid to be as ready as possible for a key match.

Whatever the reason, players who entered the tournament in hope are leaving it in pain; being forced to swap the field of glory for the physiotherapy table. As they depart they bring a lesson for all of us. It’s one thing to push yourself to the limits of your ability but take one step too far, be unrealistic in your expectations, and you will run the risk of harm.  We all like to think we can cope under pressure, we all like to think that we can just do one bit more and one bit more again but even those at the top of their game have their limitations.

In other words, sooner or later we will reach the limits of our abilities and when that happens we have to call on others for help. And that is not an admission of failure; it is simply an acknowledgement that when we are open to calling others on to our team, we can stretch just that bit further and do just that bit more.

For injured players, it will be the help of physiotherapists and other health and fitness professionals. For those same health professionals, it may be the help of administrators or assistants in areas such as booking and keeping track of appointments, maintaining virtual client records or simply in answering the telephone to avoid interruptions to client treatments.

Sportsperson or not, sooner or later we all come up against our limits. Getting the right help at the right time might just prevent us taking one step too far.

Stretching Therapies

Looking back at old newsreels of athletes training it is striking how little variety there is in the exercises shown. Admittedly this may be down to the personal preference of those who made the films but whether looking at footballers in training or holidaymakers limbering up at summer camp, there seems to be little variation from the sit ups, press ups and touch your toes type of exercise.

But times have moved on and now the emphasis is very much upon providing bespoke exercise and mobility training which not only suits individual pursuits but also the individual athlete. The old favourites are still there but they are supplemented by other activities.

Cross-training is also very much in evidence. For example, athletes may look to yoga training to enhance posture and core control, or take up dance or gymnastics to improve overall mobility and rhythm. Swimmers too no longer spend 100% of their training time ploughing up and down a pool but look to other forms of strength and conditioning work to supplement their water work. And this idea of choosing the right type of exercise to help the individual is not simply confined to athletes. Mainstream healthcare too is exploring the way in which a range of different platforms can lead to faster recovery times and increased mobility.

For example, according to the Chartered Society of Physiotherapy website a group of physiotherapists from Edinburgh are exploring the benefits of tai chi. More than 50 physiotherapists have signed up to the event and it is hoped that more will be planned in future. Commenting on the event occupational  health physiotherapist Jo Gordon said that they were  “interested in options for exercise to recommend to our patients and contacted the centre to ask if they would consider hosting a class or introductory session so we could find out more.”

This idea of moving away from the traditional and exploring other options is not just confined to physiotherapy. Right across the health service we are seeing practices embrace new treatments and new ways of operation in a bid to maximise the service which is being provided to patients. So tai chi and reflexology are coming in but so too are a raft of simple exercises which people can carry out in their own homes. This health professional/patient partnership in which the patient is responsible for some of their rehabilitation not only provides a more consistent recovery regime, patients also take more of a stake in the success of their care plan.

And for health professionals themselves, technology has brought a new range of options including electronic diary management, automated SMS appointment reminders and electronic storage of patient information.  In fact anything which can cut down on day-to-day administration and maximise patient focus is being looked at in a bid to increase the time spent with patients and provide as swift a response service as possible.

Today’s health service is looking towards having a relationship with patients which optimises treatment on an individual basis whilst maximising efficiencies. Sit-ups and old-fashioned courtesy may still be part of the package but those who look to maximise patient care are constantly broadening their horizons, looking for alternative treatments and operational efficiencies.

Suffering from Compartment Syndrome

Sometimes it is amazing to see just what people will go through simply to look good. We are used to seeing stories in the papers on a virtually daily basis about how this foodstuff or that drink will completely transform our energy, complexion, body shape or mood; but similar stories about what we wear are not as prevalent.

It was interesting therefore this week to see two stories about clothing hit the headlines. The first story was from a journalist in Los Angeles who set out to wear high heels for an entire day. By early evening, he had called off the experiment as he was in so much pain.

The second story related to the wearing of skinny jeans. Researchers in Australia reported that a 35-year-old woman had suffered from bleeding and swelling of her leg muscles, caused by spending an extensive period squatting to clean out cupboards whilst wearing skinny jeans. The condition experienced by the Australian woman has been named as compartment syndrome but tight fitting trousers have also been blamed for a number of conditions including heartburn and twisted testicles.

Whilst these examples may seem isolated, the fact is that physiotherapists and other health practitioners are regularly called on to relieve the symptoms of those who have damaged muscles and ligaments thanks to their choice of clothing. The Los Angeles journalist may have been in so much pain because he had come to high heel wearing without proper preparations but according to the American Osteopathic Association high heels are one of the biggest factors leading to foot problems in women, with one in three high heel wearers suffering permanent damage. If skinny jeans are now to be added to the list of potentially harmful clothing, particularly if compartment syndrome starts to become a regular problem for fashion-conscious home cleaners, then osteopaths physiotherapists and others are in for a busy time.

And that’s just the start of the clothing-damage story.  In recent times we’ve also heard tales of people setting out to climb steep hillsides whilst wearing flip flops, tripping over long skirts, and even wrenching necks whilst putting on tight tops. It seems as though when it comes to looking good, practicality goes out of the window. Perhaps it’s not surprising therefore that our health professionals, particularly physiotherapists and chiropractors, are increasingly under time pressure.

As a result, whilst health practitioners are relieving the symptoms of clothing related injuries including compartment syndrome, they need to do something to ensure that their time is spent as productively as possible.  So they in turn looking towards virtual assistant services to relieve the time pressure caused by full client books. Even something as simple as a call answering and appointment booking service can make a measurable difference to daily pressures

With calls being answered in a prompt and professional manner in the name of the health practice, clients are reassured that they are dealing with a professional practice. Other benefits include never having to miss a call or interrupt a consultation to take a call. With unwanted sales calls also being screened, health practitioners can concentrate on patient treatments.

Osteoarthritis Quality Standards

The National Institute for Health and Care Excellence (NICE) has released new quality standards for the diagnosis and treatment of osteoarthritis. The standards have been drawn up after consultation and are supported by bodies including The Primary Care Rheumatology Society and the British Association of Prosthetists and Orthotists.

Osteoarthritis affects some seven million people in the UK and can be a life-limiting condition. Although its prevalence increases with age, osteoarthritis can be caused by a mix of genetic, environmental and lifestyle factors. This new quality standard covers the management of the condition from initial diagnosis and assessment through to ongoing management and support including the consideration of remedial joint surgery.

In recognition of the fact that extensive investigations, including x-rays and MRI scans, add little to the treatment plan, NICE recommends that a more practical and simple test should be enough to deliver an initial diagnosis. The standards therefore recommend that a simple test of having activity-related joint pain and any morning joint stiffness lasting no longer than 30 minutes should suffice.

As osteoarthritis is a condition which generally develops over time, the quality standard recommends the use of a self-managed plan wherever possible. This will include a multi-level approach including pain control, a weight management plan if required together with an exercise plan. This last should include a mix of muscle strengthening and aerobic exercise.

Although the plan is primarily written for the benefit of patients and the NHS; it is likely that physiotherapists, osteopaths and other health professionals may be called upon to help with treatment plans. Commenting on the Chartered Society of Physiotherapy website, Professor Krysia Dziedzic who helped to develop the standards said “We know that patients want access to non-pharmacological therapies and physios should be leading the way in the delivery of these.”

As people increasingly look for blended solutions, which include ongoing non-pharmaceutical management of conditions, the demand for physiotherapists and other health professionals can only grow; even if the incidence of osteoarthritis were to remain unchanged. However an Arthritis Research UK project has predicted that between 2010 and 2020 the number of people with osteoarthritis of the knee will increase from 4.7 to 6.5 million. It is little wonder therefore that NICE comments that the majority of hip and knee replacements in the UK are due to osteoarthritis and that currently treatment varies across the country.

This places an increasing demand on physiotherapists and others, both in the ongoing management of conditions and in assisting patients to recover from joint replacement surgery.  Whilst some of the burden may be taken up by new entrants to the profession, the challenge is still to find ways of working which will maximise treatment time.

Quoting a cliché, that means learning to work smarter not harder; taking full advantage of technological solutions in order to reduce time spent on the non-treatment elements of patient management.  These solutions include opening up the diary to enable patients to directly book online appointments, the electronic filing of patient records or taking card payment details at the time of booking. To borrow from the NICE standard, the more the health profession can take practical and simple measures to reduce the administrative burden, the more time can be spent on helping patients to manage their condition and get on with their lives.


Bank Holiday Toil

Don’t hold your breath but it seems as though we may be in for some spells of sunshine this bank holiday weekend.  Of course it is nearly the end of May so we are due some sun time but the forecast does open up additional possibilities for bank holiday activities.

Whilst some of us will be heading towards the beach or the park, others may have a full sporting calendar, either taking part or cheering on our favourite team.  Those with children who are taking GCSE or A ‘level exams this year may be facing a more sedentary time as the final chance for revision looms large over the household.

But  for many, this bank holiday weekend is traditionally a time for DIY or for gardening, for clearing out and tidying up, for moving plants and revamping flowerbeds in a bid to get our homes and gardens in top shape for the summer.   This is the weekend when despite our best intentions we do just that bit too much and our bodies let us know in no uncertain terms.  In fact in 2006 some 87,000 people were treated in hospital in the UK as a direct result of gardening accidents with lawn mowers and flower pots topping the list of causes.

Whilst trips and falls may require urgent attention, back and other muscle strains can take a few days to come through but when they do they can require ongoing therapy.  So much so that the Physiotherapy website comments that at this time of year physiotherapists, osteopaths and chiropractors all see an upswing in demand due to gardening injuries.  That site offers a list of eleven handy hints to reduce the occurrence of problems including warming up, using good lifting techniques and taking planned breaks

With the best will in the world even if everyone followed the suggestions there would still be an increase in demand as muscles and ligaments creak under the strain of unaccustomed exercise. This in turn places an increased demand on health professionals such as physiotherapists, chiropractors and osteopaths; all of whom may well see a significant increase in demand for their services in the period after bank holidays. So what can health professionals do in turn to reduce the strain on their own resources.  Our handy hints would include:

  • Offer an online booking facility.
  • Opt for secure card processing.
  • Manage your diary online.

…and of course, call in a virtual assistant service to answer routine calls when you are busy. These measures will all help to cut down on the volume of calls to the practice, thus freeing up time which can be spent in treating those bank holiday injuries. Online booking and diary management allied to a virtual assistant service enable prospective patients to book appointments quickly and easily without impinging on ongoing treatments. Adding secure card processing to the mix not only helps to speed up payment collection times and reduce paperwork, prospective patients who hand over card details at the time of booking are less likely to miss their appointments.

Let’s hope that the forecasters have got it right this weekend and that we can all enjoy some time in the sun without paying too dear a price afterwards in terms of painful joints or in too great a call on our services.

From Sun Up to Sun Down

By the time that you read this article, the chances are that the US Masters golf tournament will be over and all of the speculation about whether Rory Mcllroy or one of the other front runners will triumph will have been answered. In the run-up to the tournament, apart from spotting potential winners, one of the main stories revolved around Tiger Woods and his return to the competition trail following treatment for injury from physiotherapists and other health professionals.

Commenting on his comeback Tiger Woods said “People would never understand how much work I put into it to come back and do this again, it was sun up to sun down.” His comments are hardly surprising, given the champion he once was.

Getting to the top in any walk of life requires a measure of determination and hard work and getting back to ones best after a set-back requires an extra measure of grit and courage.  But such courage is not simply confined to top sportspeople. The determination to improve, to get better, to overcome injury or other setbacks comes from within and can be found in all walks of life. It’s something which physiotherapists and other health professionals see on a daily basis. Octogenarians recovering from a hip replacement, children regaining the use of broken limbs following a fall, the middle aged recovering from a rather too strenuous gardening session in the spring weather; whatever the reason, when we set our minds to a task it is surprising how the results will follow.

It is one of the key motivators and rewards of being in the health profession; seeing others improve, watching them stretching themselves to the limit in a bid to return to fitness. It also can be one of the prime challenges; balancing people’s desire to return to ‘business as usual’ against their ability to recuperate. Get the balance wrong one way and overwork could lead to a setback. Swing the pendulum too far towards caution and the ability to return to maximum mobility could be lost forever.

Getting the balance right, deploying your professional skills to the benefit of patients is challenging but success can be personally rewarding. Discharging an individual from your care as they step out renewed to live as full a life as possible marks a success point in a busy profession. Sadly the procession of those in need is never-ending and physiotherapists, osteopaths, chiropractors and others could easily find themselves working from sun up to sun down in a bid to meet the ongoing demand.

Taking full advantage of time saving devices is one way to keep administration time down to a more manageable level. Electronic appointment booking, card payments, SMS text reminders, virtual assistant services; whatever the mix, finding ways to free up time will help busy health professionals to manage their day effectively. Who will win the Masters? We just don’t know but what we do know is that winning those everyday battles for fitness, fought by ordinary people of all ages, is for them every bit as important as any trophy could be.

Business Spring Cleaning

The second week in March has sadly not lived up to the promise of the first with cold, wet and dull weather taking the place of sunshine. Nevertheless spring is well on the way and with it our thoughts turn to the annual challenge of spring cleaning.

No-one knows where the tradition of spring cleaning started. The practice has been shown to have roots in several ancient cultures but it is almost tempting to speculate that even back in cave dwelling times, ancient people stepped out from the crevices in the rocks which had given them winter shelter, sniffed the fresh air of spring and started to clean.

But there is a darker side to spring cleaning. As we vacuum and scrub, mop dusty floors and persuade over-wintering spiders to leave the home, the emergency services are poised waiting for the call. Every year, casualty departments are called on to treat those of us who thought that balancing on a rickety chair or table would be a good idea when cleaning windows or reaching high ceilings. Others will have to call on the services of physiotherapists or osteopaths to help sort out sprains and strains caused by repetitive movements such as overenthusiastic dusting or polishing.

With health professionals such as physiotherapists being stretched by all of these seasonal injuries, it may be time for them to carry out a little spring cleaning of their own. When we start out in business we tend to adopt coping mechanisms, working through processes which may cost us in time but save cash flow. With more mature businesses it may be time to spring clean some of these practices, bringing processes up to date.

For example, in the early days with few clients it can be a simple matter either to hope that they will turn up for appointments or phone them with a reminder.  Growing businesses which try to continue this practice may well be spending time on client reminders which would be better spent on treating a growing client base.  And in truth, what business nowadays can afford to operate under a model which allows for gaps in appointment times when clients fail to turn up. Simple remedies such as SMS text reminders, the availability of online booking and switching phones in busy times can free up a significant amount of time.

SMS text reminders also help to cut down on no-shows, but it still leaves businesses open to the possibility of a reduction in income, should clients fail to turn up for their appointments. One practice which can help to alleviate this problem is the taking of credit or debit card details at the time the appointment is made. When clients turn up for their appointments the card payment can simply be confirmed, considerably smoothing out the invoice/administration process. However, should clients fail to attend appointments; a no-show fee can still be taken in accordance with the health practice’s publicised tariff.

As we are looking at spring cleaning for efficiency, ask yourself if it is really necessary to have all of those paper records cluttering up the office?  Electronic filing can not only help to clear away paperwork, with patient records available at the touch of a button it can also help to save time when clients come to call.  It doesn’t take much to spring clean business processes, but health professionals may find that taking a little time out to review the way the practice is set up now could make a measurable difference in the future

‘Snow Joke if You’re Injured’

At the time of writing this article, a stunning photo has hit the headlines showing a skier making the most of the snow in the peak district. Taken under a clear blue sky and with the benefit of once in 20 year snow conditions; the picturesque scene could easily rival that at any ski resort abroad.

Elsewhere across the country it is a mixed picture. Whilst some are having fun building snowmen and throwing snowballs, others are simply faced with cold winds and ice. But whatever the weather, there is no doubt that winter, long postponed, has arrived at last bringing with it the usual mix of delight and disaster.

Whilst snow and ice may be fun for some, it can be no joke for those who fall prey to its deadly embrace. As cars slide on treacherous roads and pedestrians slip on pavements the list of sprains, strains and fractures can add to the usual winter woes packing out our casualty departments. Some may be quickly bandaged up and sent on their way but for others a long slow road to rehabilitation awaits.

It is a sad fact that the older we get, the longer our bodies take to heal and injuries such as a strain or pulled muscle which we mostly ignored when young can be devastating now.  And the longer we take to heal, the more other joints and muscles in our bodies seize up; bringing problems further along the line. For the elderly this can mean that even minor falls lead on to life limiting conditions. For example, slip over and hurt your ankle and by the time that it is well on the way to healing, the forced period of inactivity may well have led to knee, hip and back problems. Whatever the age, one of the solutions is to stay as active as possible and that means enlisting the help of a physiotherapist or other health or sports professional.

The trouble is that with winter slip and fall injuries adding to a list of winter sports injuries, whether from playing rugby or hitting the slopes, health professionals such as physiotherapists, osteopaths and chiropractors find that winter is a very busy time. With only a set number of hours in the day, in order to try and meet winter demands health professionals are turning to the internet and digital devices to help them to reduce administration time and maximise treatment times.

Working smarter not harder may be a cliche but it is one which has a basis in truth. Online appointment booking, automated SMS text reminders and electronic patient records all help to free up time which can then be devoted to patient treatment.  For those who prefer to retain a personal touch, switching telephone calls to a virtual assistant service means that patient calls can be answered in a professional manner without interrupting ongoing consultations; with the virtual assistant service making bookings via an online system.

Even something as simple as taking card payment details at the time of booking can help to cut down on missed appointments whilst simultaneously making it easier for client payments to be collected. These are all small changes but taken together they can make a measurable difference to the working day.

Snow may be beautiful to look at but when we fall prey to its embraces it is good to know that our physiotherapy and health services are on hand to help us to quickly heal.

Advancing Recovery through Electronic Filing of Medical Records

Not so long ago a broken hip would result in weeks or even months of hospitalisation as the bones were left to slowly knit together. Nowadays the broken hip is simply replaced, leading in many cases to discharge in a matter of days followed by recuperation at home.

Admittedly that recuperation requires the help of support services with physiotherapy and exercise advice being supplemented by aids such as walking frames but the new regime is far more effective and far better for the long term health of the patient. The patient is spared the challenge of being confined to bed for weeks and scarce hospital beds are freed up quickly.

But this new regime does bring with it the challenge of moving support services away from the hospital and in to the wider community.  Local health practitioners including physiotherapists are now seeing an increase in demand from patients who previously would have relied on in-hospital services. Depending on the health authority, those requiring rehabilitation and physiotherapy treatments may be offered outpatient appointments at a central or local hospital, treatment in local specialised centres or even home visits from mobility specialists. Whilst this range of options is designed to improve patient outcomes, it does require an increased focus on effective patient treatment plans and the sharing of information.

Luckily, whilst technological improvements have enabled swifter treatment of patients, they have also enabled health practitioners to remove some of the burden of non-essential tasks as well as streamlining data and information sharing. Take patient records for example.  Paperwork has been a perennial challenge for the health profession.   Countless hours which should have been spent in patient treatments have been wasted as records are transferred from one treatment centre to another or are stacked up on administrator’s desks whilst skilled typists struggle to interpret scribbled notes.

Even simply filing and retrieving records can take up time which would be better spent in focusing on patient needs whilst the mobility of patients around treatment centres has increased the danger of patients being lost in the system. Now, thanks to the advent of electronic filing, much of the unproductive time is no longer wasted.  Electronic filing not only reduces instances of mis-filing, it also enables records to be transferred between treatment centres and then brought to hand swiftly as and when required.

With clinical notes organised and important test results and x-rays available on screen at the touch of a button, health practitioners can not only maximise patient treatment times, they can start treatment programmes in a timely manner without having to wait for records to be transferred by post or hand delivered.  Link in online diary management or on-line booking services and yet more time which was previously spent on administration is freed up.

Such is the pace of technological change that medical breakthroughs are coming thick and fast, transforming health services and enabling patients to recuperate at home where once they blocked beds.  With administration also reduced thanks to technology, the face of the health service in years to come will be a very different one from that which in the past was bedevilled by paperwork and the delays and frustrations occasioned by filing, retrieving and transporting patient records.

Redesigning Your Therapy Service

A discharge team working out of two West Midlands’ hospitals has been recognised with a national award for creating an integrated discharge process which includes a focus on early identification of appropriate therapy. The idea behind the scheme is simple but it has already reduced patient hospital stays by over 13% and saved the Trust around £2.5m.

Simply by giving therapists ‘trusted assessor’ status, patient assessments can start earlier, even before the patient has left hospital. Not only does this lead to the provision of a care plan which starts even before the patient has left the hospital, it also this means that seamless ongoing care can be provided.  With therapy plans already in place, patients can be discharged into home care far earlier than before. This in turn means that treatment is more focused, not only meeting the immediate needs of the patient but also their long term rehabilitation needs.

Prior to the inception of the integrated discharge process, patients would have to stay longer in hospital to ensure that they had recovered sufficiently well to enable them to be discharged into a home or other environment. Moreover, once they had been discharged they would have a period without treatment arguably at a time when treatment is most effective; having to wait for community assessment at home and potentially facing a relapse of their condition in the meantime. So not only do the new procedures save bed space they also help to speed up rehabilitation.

The idea of creating seamless and integrated processes is not just one which is confined to hospital discharge. When reports reveal that generally the health system is under some strain, anything which can speed up patient treatment and therefore recovery times is welcome. Health practitioners across the board are therefore looking for ways to cut down on administration and maximise treatment time.

Quite frankly, anything which can reduce the time spent on routine administration, and therefore non-treatment, time is to be welcomed. That is why practices such as SMS text messaging to remind patients of appointments, online booking and digitising patient records are becoming more widespread as health practitioners look to automate the non-treatment elements of their daily round.

For health practitioners who need to charge for their services secure card processing helps not only to smooth out cashflow but also saves time in sending invoices and chasing unpaid accounts.  And using the services of a virtual health receptionist means that patient treatments can run without interruption from multiple phone calls, leaving the health practitioner to provide therapy whilst others take the administration strain.

Thinking outside the box, thinking smart; whatever you call it the result is the same.  As health practitioners find new ways to leverage the advantages to be gained from technology and look anew at routine processes, they can make a measurable difference to ongoing patient treatments. As Physio Karen Lewis, one of the award winning West Midlands team said, receiving national recognition “really shows the value of physiotherapists leading innovative service redesign for the benefit of patients.”

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