Passive is “OUT” …. Active is “IN”!
Re-evaluation of the physiotherapy services
Over the past year
We (Physiotherapists at BMSTC) have re-evaluated our practise and have strived to improve our services both for existing and new members. For instance, in collaboration with staff from the NHS, we have launched a fatigue management programme at the Centre and have completed our first successful course. We are proud to offer an FES assessment clinic and have invested in the essential equipment that allows members to trial the FES. In collaboration with the RBH wheelchair service we now host regular wheelchair clinics.
We have also been networking with physiotherapist in the community with the aim to promote our services and to share our knowledge, and we have built bridges with the Rivermead Leisure Centre in creating a pathway scheme that encourages people with MS to join the gym, use the swimming pool or join an exercise class under the supervision of a sports physiologist trained in dealing with MS. As a result there has been an increase of interest in the Centre both from people with MS, GPs and consultants, MS nurses and colleague physiotherapists and we have seen an increase in referrals.
Why did we re-evaluate our services?
As physiotherapists we are bound by “professional standards of care”, set out by our professional body (Chartered Society of Physiotherapists) and the HPC (Health Professions Council), which drives us to provide evidence based practise. There are NICE (National Institute for Clinical Excellence) guidelines, specifically drawn up to improve the care for people with MS which we, as professionals, are advised to follow. A legally binding paper (the white paper produced by the Department of Health 2005) states that our emphasis of therapy should be towards increasing levels of activity, participation and independence and increase general fitness in people with long term neurological conditions.
What does research say?
Research into passive movements and stretches shows that clients often report to have social and psychological benefits of having passive stretches applied to their limbs. However, it has been shown that there is no significant change in joint mobility and that there is no benefit over exercise alone. In fact, in order to prevent contractures, muscles need to be stretched for a minimum of six hours a day! It is however more important to manage a person’s position over 24 hours in a range of different postures and activities. Active exercises are proven to have a longer lasting and more beneficial effect to the client.
Active physiotherapy has been shown to have a positive impact on symptoms of fatigue, regulation of depression, impairment, disability and well-being. Participating in an active exercise programme is vitally important for clients with MS but research did not find any differences in clients performing a self-selected exercise programme and those following a rigid physiotherapy programme. The study concluded that to have long-term effects and to enable people to cope better at home and in a work environment, physiotherapy has to be geared towards increasing an individual’s ownership of their disease and help them to establish a self-management programme.
Implications for our current practise…..
Clients who are currently attending the Centre for physiotherapy will be re-assessed and goals and aims of treatment will need to be discussed. We will then help them to establish the best way of achieving these goals and, when appropriate, we will set up a tailor made exercise programme. In view of increasing independence and self-management, we will then encourage the member to either participate in an active exercise class aiming to improve or maintain flexibility, strength, balance, postural control, stamina and general fitness or we will encourage the client to participate in an exercise circuit following a tailor made exercise programme.
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One to one sessions will be reserved for new assessments, for people who do not have the ability to participate in active exercises, who are going through a remission or who have acute problems.
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Exercise classes will be restructured which means that each class will be allocated a level of ability from 1 to 5 and the physiotherapist will discuss with the client which level is most suitable. Participating in a class aimed at the client’s own specific ability level will not only be more encouraging and motivating but it will also challenge members at a level appropriate for them.
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Our classes are becoming more and more popular and with the new “self management approach” we will see an increase in members attending a class. We are planning to accommodate this by increasing the variety of classes and by adding new classes.
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In light of the 24 hour positioning management we will aim to address the client’s position in the chair, in bed, etc. and when necessary we will assess a client at home and make recommendations. We will also be committed to educating carers/family members on how to position the client and, if appropriate, make up a positioning photo booklet to assist the carers with the 24 hour positioning management.
This re-evaluation might mean that we need to agree changes to your current physiotherapy schedule. Be assured that the changes are the result of our commitment to provide the best possible physiotherapy care to all current and new members!
Ann Sezier
Physiotherapist