Author Summary

On the 11^th of March 2020, the World Health Organisation (WHO) declared a global health pandemic because of rapid transmission of the Covid-19 virus. The impacts of Covid-19 on healthcare systems caused a prompt evaluation of healthcare service provision to supress transmission rates and optimise emergency treatment of Covid-19 patients. As a result of this, almost all non-essential physiotherapy consultations were cancelled, and guidance given for virtual remote consultation and triage. Telehealth consultations increased exponentially as a direct result of Covid-19 and telehealth has continued to form an integrated part of health care services. Both the Royal College of Physicians, and the Chartered Society of Physiotherapy have produced guidelines for this to be embedded into future service provision. The aim of this review is to understand the perceptions of both patients and clinicians towards telehealth.

Background

Delegation of clinical tasks from physiotherapists to physiotherapy support workers is common yet varies considerably in musculoskeletal outpatient physiotherapy services, leading to variation in patient care. This study aimed to explore patients’ preferences and estimate specific trade-offs patients are willing to make in treatment choices when treated in musculoskeletal outpatient physiotherapy services.

Methods

A discrete choice experiment was conducted using an efficient design with 16 choice scenarios, divided into two blocks. Adult patients with musculoskeletal conditions recruited from a physiotherapy service completed a cross-sectional, online questionnaire. Choice data analyses were conducted using a multinomial logit model. The marginal rate of substitution for waiting time to first follow-up physiotherapy appointment and distance from the physiotherapy clinic was calculated and a probability model was built to estimate the probability of choosing between two distinct physiotherapy service options under different scenarios.

Results

382 patient questionnaires were completed; 302 participants were treated by physiotherapists and 80 by physiotherapists and support workers. There was a significant preference to be seen by a physiotherapist, have more follow-up treatments, to wait less time for the first follow-up appointment, to be seen one-to-one, to see the same clinician, to travel a shorter distance to get to the clinic and to go to clinics with ample parking. Participants treated by support workers did not have a significant preference to be seen by a physiotherapist and it was more likely that they would choose to be seen by a support worker for clinic scenarios where the characteristics of the physiotherapy service were as good or better.

Conclusions

Findings highlight that patients treated by support workers are likely to choose to be treated by support workers again if the other service characteristics are as good or better compared to a service where treatment is provided only by physiotherapists. Findings have implications for the design of physiotherapy services to enhance patient experience when patients are treated by support workers. The findings will contribute to the development of “best practice” recommendations to guide physiotherapists in delegating clinical work to physiotherapy support workers for patients with musculoskeletal conditions.

Background

Nonattendance at women’s health physiotherapy sessions involves considerable cost in time and resources. Uncovering factors associated with nonattendance is a key priority, and the current research aimed to enhance understanding of this issue.

Methods

Two studies were conducted involving women referred for women’s health physiotherapy who were interviewed about their attendance.

• Study 1 (N = 80) compared participants who did and did not attend their appointments.

• Study 2 (N = 61) explored reasons for nonattendance among women with pelvic-floor muscle dysfunction and pelvic girdle pain.

Results

Findings corroborated several key issues previously associated with nonattendance, including administrative problems in scheduling and managing appointments. Results also indicated that improving the information provided by healthcare professionals at the time of referral may help reduce barriers to attendance. Transport difficulties were frequently cited, emphasizing the need for affordable, reliable, and possibly dedicated transport systems. Furthermore, psychological factors differed between attendees and nonattendees, suggesting these aspects should be addressed as part of patient care.

Conclusions

While implementing the recommended strategies may involve initial costs, these are likely to be offset by the savings resulting from reduced nonattendance rates.

Background

Prehabilitation is a multidisciplinary intervention aimed at optimising patients prior to surgery. Locally, integration of prehabilitation within the major oesophagogastric (OG) cancer preoperative clinical pathway is unclear.

Aim

To evaluate the prehabilitation service provision and preoperative clinical pathways for OG patients at a regional cancer centre.

Methods

A retrospective service evaluation of electronic patient records and staff survey was undertaken. Adults undergoing elective OG cancer resection surgery between October 2022 to October 2023 were included. Patient characteristics and details of preoperative interventions were collected, and a survey sent out to staff involved in the preoperative pathway. The findings were evaluated against the Macmillan prehabilitation guidance.

Results

Ninety-five patients were evaluated, of which 70 (73.7%) received physiotherapy as part of prehabilitation. Reasons for non-receipt included: no referral (n=12, 48%), clerical errors (n=5, 20%), and missed appointments (n=8, 32%). Patients not receiving physiotherapy were older (median 70 years, IQR 58-77 vs. 66, IQR 61-73), had a higher proportion of open surgeries (53% vs. 47%), heart disease (28% vs. 8.5%) and obesity (72% vs. 2.8%) compared to those who did. Only 29/95 (30%) received dietetics input and none received psychological support. The staff survey identified that there is no funded prehabilitation service for dietetics or psychological medicine. Potential areas of improvement to align with the Macmillan guidance included: starting interventions promptly, and to develop dietetics and psychological medicine services as part of the prehabilitation service.

Conclusion 

These findings will contribute to the development of the current prehabilitation service and inform future research.

Background

First Contact Practitioners (FCP) have developed as a more advanced physiotherapy clinical role delivering specialist MSK services in GP practice settings. They aim to support GPs in effectively managing increasing patient workloads. As FCPs are now a more established NHS role, it is important to understand how these clinicians perceive their roles to guide and support future service development.

Aims

To review the current evidence regarding the experience of FCPs in the UK. To understand how FCPs perceive their role. To gain an insight into FCP practice which can inform future primary research studies.

Method

A systematic review of FCP primary qualitative research studies. Multiple database and grey literature search with screening following PRISMA guidelines. Qualitative critical appraisal and analysis used tools and frameworks from the Joanna Briggs Institute.

Results

The review reports on 11 included studies which informed the creation of six key concepts impacting upon FCP role experience and perceptions. These were complexity, competency and role development, role understanding, job satisfaction, wellbeing and burnout and service delivery.

Conclusion

FCP clinicians feel broadly positive about their roles, although they report a clear risk of burnout and associated negative impact on their wellbeing. Job satisfaction is linked to adequate training and developing the competencies required to manage patients in an environment of clinical uncertainty. Having access to regular clinical mentorship is a key requirement and FCPs must adapt to the specific demands of work in a GP practice environment.

Message from the Author:

Global demographic shifts have led to a rising prevalence of depression within the population aged 65 and over, a mental health condition that substantially reduces their quality of life and places an escalating burden on healthcare systems. Standard treatment, which typically combines psychotherapy and medication, frequently presents limitations and adverse effects in older adults, such as drug interactions or adherence challenges, thus highlighting a critical need to explore viable non-pharmacological alternatives. Consequently, this systematic review evaluated the effectiveness of physiotherapy techniques as an adjunctive treatment for alleviating depressive symptoms in older patients. Adhering to the PRISMA guidelines, eight randomised controlled trials (RCTs), encompassing a total of 1,368 participants, were included in the analysis. The findings suggest a promising trend whereby physiotherapy interventions, particularly therapeutic exercise (including modalities such as aerobic exercise and strength training), when combined with conventional treatment, can contribute to the improvement of depressive symptoms. However, despite these positive observations, the authors conclude that further high-quality research is warranted to fully validate its clinical efficacy and to inform evidence-based treatment guidelines for depression in this population.