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Prevention is better than falling

When thinking about the contribution made to society by health professionals it can be all too easy to view their work as reactive; diagnosing and helping people to recover from illness or injury. But to do so would be to ignore the increasing movement towards proactive health care; enabling individuals to live healthy lives either through prevention or early intervention.

One such success story comes thanks to the Chartered Society of Physiotherapy (CSP). Their research in conjunction with Agile, a professional network for physiotherapists working with older people, has identified that a multifactorial approach can lead to a 24% reduction in falls amongst older people. When coupled with an evidence based exercise programme that increases to 34%. That is a significant reduction, particularly when taking into account the cost of falls in terms of mobility and longevity, not to mention resource allocation.

As the CSP paper highlights, falls which result in injury are the leading cause of mortality in older people. So much so that following a fall there is a 10% probability of older people dying within a year and half will experience serious mobility impairments. With an estimated 500,000 fragility fractures each year and an overall cost of falls to the NHS of £2.3b per year, any measures which can result in a reduction in fall outcomes can only benefit individuals and the wider society.

By undertaking a multifactorial risk assessment, physiotherapists are not only able to detect early difficulties with mobility, strength and balance; they can also identify other environmental factors which could contribute to the chance of falls. These include the physical environment as well as behavioural and cognitive factors. With early identification comes the chance of early intervention; providing a range of strength and balance exercises to reduce the risk of falls. Providing holistic support such as recommending home modifications or referrals to other agencies can also help individuals to be mobile and play an active role within the community for longer. And of course, the more active someone is the better their chance of managing other health conditions such as obesity.

Interestingly, although half of those who have experienced a fall are afraid of falling again, up to half of those who have not fallen also have the same fear. This can lead to a modification of behaviour which in itself can lead to negative outcomes. For example, if an individual is afraid of falling whilst out walking then they may isolate themselves in their home. Helping people to understand and manage risk, including showing them how to get up safely after a fall, can help to overcome these fears.

In outlining the case for early intervention the CSP makes the case for effective service provision and the beneficial use of physiotherapy services. More importantly it also demonstrates the value of supporting preventative health services and the long term benefit which such support can deliver. Each successful intervention can lead to a significant improvement in the long term quality of life for the individual as well as a reduction in long term costs for the health service as a whole.

A major breakthrough for physiotherapy

The Chartered Society of Physiotherapy (CSP) has hailed the NHS’s new long term plan as “a major breakthrough for physiotherapy.” The ten year plan which was launched on 7 January 2019 aims to improve the quality of patient care and health outcomes by focusing not only on treatment and ongoing management of conditions but also on prevention. There is also a renewed emphasis on developing digital solutions in order to speed up access to health services and treatments.


With this in mind the core of the new plan aims to enable everyone to get the best start in life, to help communities to live well and to help people to age well. This includes a focus on treatment of major conditions such as cancer, heart and respiratory disease as well as a renewed emphasis on mental wellbeing.


Key to implementation is a move towards an integrated service which will provide both in-patient and home care as required. Treatments are to be patient-focused and will look towards providing an integrated solution. For example, breathlessness can be caused by both pulmonary and cardiac problems so collaboration between those two disciplines could lead to a combined treatment programme.


In terms of physiotherapy specifically, deployment of the new plan will lead to an increase in the number of physiotherapists in primary care alongside the use of first contact physiotherapists. In addition the new emphasis on whole person rehabilitation will require increased levels of physiotherapy contact in a number of disciplines.


But it is not just physiotherapists who will be positively impacted by this new plan. The fresh emphasis on whole patient care will impact a range of health professions from podiatrists to dentists and hair care professionals. The challenge will be to ensure that not only is the right support identified for an individual, the resources are in place to provide that support. Whether that leads to increased training requirements is perhaps a discussion for another time. What is certainly true is that existing health professionals are going to have to work smarter in order to optimise patient care.


The What Happens Next section of the NHS site dedicated to the ten year plan says that “From publication until the summer of 2019 staff, patients and the public will have the opportunity to help their local NHS work out what NHS Long Term Plan means for their area and how to meet our national ambitions in their community.”  This could also be an opportune time for health practices to review their own practices, perhaps looking for time savings in areas such as appointment booking, diary management and the electronic filing of patient records.


Announcing the new plan the Health and Social Care Secretary, Matt Hancock, said the plan “marks an important moment not just for the health service but for the lives of millions of patients and hardworking NHS staff across the country.” But its ambition to deliver integrated care will require it to also draw in professionals from outside the NHS, helping people to manage their conditions in their own homes and communities and to lead independent lives.


A revolution in health care

According to the World Economic Forum we are standing on the brink of change, a time in which the Fourth Industrial Revolution is taking hold of the world. Looking back into the past, the first industrial revolution ushered in an era of mechanisation, process driven and with people merely seen as cogs in the industrial wheel. Then came electric power and mass production followed by the third industrial revolution which ushered in the use of information technology as a driver of automated production.


The fourth Industrial Revolution is one step further on, driven by a ‘fusion of technologies that is blurring the lines between the physical, digital, and biological spheres.’ Put simply, technology has gone so far and is so interconnected that people have stopped becoming cogs in the wheel and instead are the prime drivers of service delivery.


In other words, what differentiates businesses nowadays is user excellence. As a result technological developments are increasingly being focused towards delivering great customer outcomes rather than simply as a way of reaching a mass audience or delivering cost savings.


What’s that got to do with delivering healthcare? Well in this regard there is no difference between the way in which we look to deliver customer or patient outcomes. So much so that there is an increasing recognition that targeting healthcare delivery towards an individual patient can significantly improve recovery. For example, we look to gene mapping as a means of best identifying cancer treatments, or we look to devise treatment plans which fit in with a patient’s lifestyle.


One prime example of this has been highlighted on the Chartered Society of Physiotherapy website. The Western Isles Hospital in Stornoway has linked up with a Glasgow orthopaedic surgeon who specialises in hand injuries. Initial assessments take place via a video-conferencing link with x-rays viewed over the National PACS system. Not only does this save patients the cost and time of a trip to Glasgow for initial assessment, it also speeds up decision-making. If there then is an identified need for surgery, preoperative procedures can be carried out in Stornoway; thereby minimising the time which patients have to spend away from their home base.


This is a perfect example of the way in which integrated technology can not only improve the patient experience but also treatment outcomes. It also illustrates the way in which digitising patient records can help to improve consultation options with patient information being rapidly shared over secure systems. Of course, electronically storing patient records also helps the practitioner; enabling them to call up records quickly and easily as well as saving the time taken in manual filing and retrieval.


Setting people outcomes at the heart of process may require a re-evaluation of the way in which we work. It may also cause us to question the reason behind certain processes, and to evaluate whether there may be alternative approaches which would improve delivery. The fourth Industrial Revolution isn’t simply a revolution in the way in which we use technology, it is also a revolution in attitudes and approaches which truly sets people first.

Too cold for snow: An Olympic lesson

If you are a fan of winter sports then there is a fair chance that the Winter Olympic Games may deliver a pinnacle of sporting viewing. However, as all sports fans know only too well, truly memorable contests come about when athletes are able to perform to the best of their ability. And that requires optimum conditions.

With that in mind it was somewhat concerning to see the weather reports ahead of the 2018 Winter Olympic Games which predicted wind chill factors as low as -25°. Some of the teams were reporting skis warping thanks to the effect of extreme cold on snow crystals and concerns abounded over the effect of unusually low temperatures on athletes. Ironically; despite the cold, or perhaps because of it, there was also concern over snow levels with machines being brought into supplement natural precipitation.

At the time of writing, a few days in to the games, high winds have also proved hazardous with some athletes unhappy at having to compete in what they considered were dangerous conditions. Under such extremes, successfully completing courses is more a lottery than a game of skill; something which no athlete wishes to encounter at the end of four years hard training.

From the safety of our sofas it is hard to imagine the physical and mental effect of extreme cold on the body. Low temperatures can sap brainpower, slowing down decision-making and reducing coordination; not something you want when faced with the challenge of extreme downhill skiing through slalom gates or over jumps. Preparation and training, inbuilt muscle awareness allied to physiotherapy and other physical and health support can go some way towards helping athletes to overcome conditions; but at the end of the day when the weather becomes so extreme inevitably accidents and injuries will occur.

And when breaks, fractures and ligament damage occur, our Olympic athletes are put in the same position as any recreational skier. There is an imperative to heal as quickly as possible in order to return to the normal routine. The only difference is that whilst for most of us that everyday routine will be away from the slopes, for Winter Olympians the slopes are their way of life.

This is where physiotherapists and other health professionals truly come into their own. For whilst naturally there is a core treatment plan in order to rehabilitate the injured limb, at the same time athletes have to undergo a programme of training which helps their whole body stay as strong and supple as possible. One leg may be broken but that’s no excuse not to continue to exercise appropriately in order to ensure that core and arm strength and tone are not lost.

It’s a lesson which we can all benefit from; the fact that one injury should not be allowed to affect the entire body. No matter whether we’ve followed our Olympic heroes on to the slopes or injured ourselves in some other fashion, the more we work with health professionals to ensure rehabilitation across the entire body, the better chance we have of regaining full strength and mobility as swiftly as possible.



A pain in the back….

There’s no escaping back pain. A sore back can not only affect neck and limbs as attempts to get comfy result in collateral pain elsewhere, it can also lead to headaches and depression as painful movement hampers and frustrates efforts to get on with daily life.

In the past treatments for back pain were largely along the lines of taking to bed with a few painkillers in the hope that the pain would ease. Nowadays the thinking is very much more along the lines of staying active; with the NHS choices website recommending a series of stretching exercises alongside gentle activities such as walking, cycling or water-based activities.

As with any other pain the temptation for those suffering from a bad back has still been to head for the pill box in a bid to feel more comfortable. However, a peer review has thrown up questions about the efficacy of taking non-steroidal anti-inflammatory drugs (NSAIDs) for back pain. The review concluded that taking NSAIDs was little better than taking a placebo with only one in six patients receiving any benefit from NSAID treatment. In addition, those patients who took the anti-inflammatory drugs were at a higher risk of gastrointestinal upset; perhaps the last thing which someone would want when already suffering from back pain!

The researchers concluded that there was an urgent need to develop analgesics which were more effective in treating back pain. However it would appear that more research is required as the peer review did not examine the efficacy or otherwise of exercise or direct interventions such as physiotherapy or chiropractic treatments. Certainly these are options to consider when looking to treat back pain as musculoskeletal professionals may be able to identify the root cause and suggest changes to posture or lifestyle which may help to speed up treatment and prevent re-occurrence.

Within the workplace too occupational therapists may also be able to suggest the best way for using equipment, or even sitting at a desk, which will optimise back health. For employers this is one area which should not be ignored as statistics from the health and safety executive indicate that in 2015/16 an estimated 8.8 million working days were lost due to work-related musculoskeletal disorders.

Work-related or not there is no doubt that back pain is something we can all do without, putting a strain not only on individuals and their families but also the health service as a whole. It’s one reason why health professionals are increasingly looking to find remedies which will help to relieve the strain on their own practices and maximise treatment times. For some, gentle remedies such as instituting online booking forms allied to automated appointment reminders have proved effective. Others have resorted to more intensive measures such as appointing virtual assistants or electronically filing patient records in a bid to reduce the strain on resources.

Whatever the remedy chosen, the more that health professionals are able to focus on working with patients to identify and treat the causes of back pain, the better it is not only for individuals but the country as a whole. With the study largely ruling NSAIDs out of the picture, the more we can focus on developing effective treatments, the quicker people will be able to get back to a pain-free lifestyle.



Post-Olympic preparedness

Let’s start with the uncomfortable truth; even for highly trained Olympic athletes sport can be dangerous. Anyone who doubts that only look at some of the horrific crashes in the cycling road races, or the broken leg suffered by the unfortunate gymnast in the opening days of the Rio Olympics.

But because sport can be dangerous, the better the preparation the more that injuries can be avoided or at least reduced. So whilst pictures of bored lifeguards sitting at the side of the Olympic pool may have given rise to some comment, competitors who inadvertently inhale water or suffer from a sudden cramp may be very glad that there is someone on hand to haul them out.

No matter what the sport; whilst talent plays its part, the secret to success is in the preparation. So those participating in sport have to ensure that their training is carefully balanced and this includes managing the pre-and post training warm up and warm down phases. Coaches too play their part in ensuring safety, as do those who manage sports venues. And this is before we bring in the ancillary support team which may include physiotherapists and chiropractors, sports nutritionists and psychologists.

However, whilst our Olympians may have a significant retinue to call upon, everyday athletes may find that the responsibility for safe training and performance falls very much more on their shoulders. This is not to say that support staff aren’t available if required; it is just that for the majority of athletes, health professionals such as physiotherapists are far more likely to become involved once an injury has occurred rather than at the preparation and training stage.

This of itself can cause something of a problem for health professionals. Following every Olympic Games there is a resurgence in interest in sports participation, and it is expected that the Rio Olympics will be no different. Whilst this is great news for sports clubs and for the overall level of fitness within the country, with a revival of interest in sport comes an inevitable increase in injuries. This can result in a significant increase in demand for health professionals to provide physiotherapy or other treatments.

Coping with this sudden increase in demand requires preparation. From a societal point of view, health professionals may feel that it is beneficial to work with local sports clubs, helping them to help their athletes to understand the importance of preparation in reducing the chances of injury.

But whilst this may play some part in helping sportspeople to look after their bodies, health professionals also need to work to streamline their practice in order to reduce strain on their time. Yet, as with fitness training, simple steps can make a measurable difference. For example, switching telephones to a virtual assistant service instantly frees up time which would otherwise be taken in simply talking to people and booking appointments. Similarly, offering an online booking service can help clients to book appointments at a time which is convenient to them without the need for a long discussion.

And when appointments have been made, SMS text reminders help to ensure that people turn up on time today treatments, helping the day to run smoothly and reducing the incidence of missed appointments. Similarly, online filing patient notes means that patient details are available at the click of a button rather than following a lengthy search through filing cabinets.

With a little preparation comes the chance for success. The majority of sportspeople will never experience the Olympic Games as a competitor; but they still can push their own boundaries, challenging themselves to be the best that they can be. With health professionals on side, helping to keep people fit and to manage injuries, we all have chance to benefit from the Olympic legacy.


Avoiding Après Ski Physiotherapy

Christmas is well and truly over; but with summer still a far away promise it could be time to pack the bags and swap the damp coldness of the UK for the crisp clear coldness of a ski resort. We are now well and truly into the ski season with plenty of snow around to delight the skiing senses.

However, whilst most will return unscathed from their assaults on the mountain trails sadly some will return rather more bandaged up than when they left. There have been reports that overenthusiastic indulgence in après ski is partly to blame but French ski resort physiotherapists are pointing the finger in an entirely different direction.

According to a report on the Chartered Society of Physiotherapy website, skiers just aren’t getting fit enough before they hit the slopes. The report quotes Val D’Isere physiotherapist Louise Allison who highlighted the way in which differing ski conditions can cause a range of injuries. So, for example, hard-packed icy snow can lead to back injuries whilst deep snow is more likely to lead to knee ligament problems.

The essential message from the report though is that if people take the time before they go on holiday to really get themselves fit then their chances of injury are lessened. And we’re not talking here about the odd hour in the gym; people should be looking to carry out a combination of strength, endurance and overall fitness training in order to prepare themselves for the intense level of exercise at altitude which skiing requires.

It’s a lesson which doesn’t just apply to ski fitness. The more we look forward and plan to avoid problems, the fitter we can be in the long run. This applies in business as much as it does in our private lives. As we’ve been quoting from a physiotherapy website, let’s take a physiotherapy practice as an example.

In common with other types of health practice, there is a constant demand for physiotherapy time. However, there are certain times of year, such as in the winter when demand increases further. It’s not just the snow; slippery pavements and poor driving conditions can also lead to a whole variety of calls for physiotherapy help. But by planning and preparing, in effect increasing the fitness of the practice, it is possible to ensure that patient treatment times are maximised whilst admin is kept to a manageable minimum.

That doesn’t mean that procedures are skimped, rather the practice has become more efficient. Take the maintenance of patient records for example. Having large filing cabinets stuffed with patient notes may look impressive but it is hardly conducive to efficient working. It’s all too easy to miss file records, not to mention the fact that when a patient moves between treatment centres there is a delay while records are also transferred. Electronically filing patient records means that not only are they instantly accessible from any designated point (subject to secure access), the chances of misfiling are lessened.

Or how about payment management? When patients pay for their treatment it is all too easy to become bogged down in the appointment, issue invoice, chase invoice, receive check, pay into bank rigmarole. All this takes time, something which health practices rarely have in abundance. The solution is to take card payment details at the time of the booking and then confirm the payment as soon as the appointment has taken place. This is quick, simple and saves considerable administration time.

In a 24/7 always on world it is too tempting to simply react to the moment, to take each challenge as it arrives. Planning and preparation can make a measurable difference to the outcome whether we are off skiing or faced with treating the injuries of those who have been out on the slopes.

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.

Physiotherapy, an essential part of dementia care

The National Institute for Health and Care Excellence (NICE) have published a new quality standard which aims to support people to live well with dementia.  The aim behind the standard (QS30) is that “a person-centred and integrated approach to providing care and services is fundamental to delivering high-quality care for people with dementia.”

In addition to acknowledging the importance of carers in the treatment of those with dementia the standard also looks at every aspect of a dementia sufferer’s care including leisure, health and relationships.  The standard also highlights the need for individual choice and control to be at the forefront of any programme especially when planning and evaluating services.

One element of the standard also looks at the importance of those with dementia and their carers being able to access “services that help maintain their physical and mental health and wellbeing.”  Whilst some of these services naturally include access to general practices and nurses, the list also includes care services such as hearing therapists, chiropodists and physiotherapists.

The Chartered Society of Physiotherapy (CSP) contributed to the development of the dementia standard with particular advice being sought from the network of physiotherapists who work with older people (Agile)*.  In commenting on the standard Agile chair, Janet Thomas, said “The dementia guidance we saw certainly had a different feel to other NICE guidance, with the emphasis shifted to the day-to-day living aspect of dementia care, and this is very important.”

With a growing body of evidence supporting the theory that “a healthy mind in a healthy body” is not just a saying but a vital component of wellbeing in later life, there is certainly something to be said for helping dementia sufferers to stay as active as possible.  Hopefully this means that those involved in physiotherapy and other related services will see a greater call on their time as they work with carers and those with dementia to help to provide an integrated holistic management programme.

Taking steps to reduce administration time, such as by managing diaries and storing patient records electronically, will help to maximise treatment time and hopefully enable physiotherapists to take their place at the forefront of this new approach to care.


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