Physiotherapy

Evaluation of inpatient physiotherapy groups on functional ability, self-reported psychological scales, and length of stay (LOS) in acute stroke patients: A service review of current provision at the Princess Royal Hospital (2026)

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Type of publication:

Service evaluation report

Author(s):

*Emily Farla

Citation:

Shrewsbury and Telford Hospital NHS Trust, January 2026

Abstract:

Purpose: The Shrewsbury and Telford NHS trust’s acute stroke rehabilitation therapy
team set up weekly circuit class therapy (CCT) groups in 2024, running alongside
individual therapy (IT) to improve stroke rehabilitation. Physiotherapists, occupational
therapists, speech and language therapists and therapy support workers delivered
both methods of rehabilitation. The service aimed to provide quality therapy to
improve motor and psychological outcomes in the acute stroke population, supported
by results reported in current literature. Anecdotal evidence was obtained from
attendees that suggested CCT to be a positive addition and so a formal review was
indicated. This service review aimed to answer; does attending additional inpatient
CCT groups up to three times per week in addition to standard therapy for inpatient
stroke patients at the Princess Royal Hospital (PRH), influence motor function,
psychological wellbeing scores and impact hospital length of stay (LOS)?
Methods: The service evaluation reviewed notes retrospectively between the months
of May and July 2025. All consenting adult patients diagnosed with a stroke in the
last 30 days and admitted on to the Stroke and Rehabilitation wards at PRH who
were receiving active treatment and referred to therapy were included. The review
aimed to collect 30-50 sets of data. Notes were screened to collect inpatient
demographics; including gender, age, height, weight, diagnosis, number of groups
attended, length of stay, and discharge destination and outcome measures; Modified
Rivermead Mobility Index, Distress Thermometer, and Stroke Recovery Perception
from baseline and discharge time points. Data was inputted into Excel and SPSS to
complete descriptive and inferential analysis. Patient identifiable data was removed
to ensure anonymity throughout analysis.
Results: 38/50 stroke inpatients admitted to the stroke rehabilitation ward were found
to have complete sets of data (n=38). Of the 38 inpatients nine received IT and 19
attended IT with additional CCT groups. Significant motor improvements were seen
in both the IT and additional CCT groups. Significant increases in psychological
outcomes and self-perceived improvement scores were seen in the additional CCT
group compared to the IT group. There appeared to be no relationship between CCT
attendance and LOS.
Conclusions: This service evaluation has shown additional CCT groups delivered
alongside IT on the stroke rehabilitation unit at the PRH is a significantly better
service in terms of patient perceived improvement and psychological outcomes with
an equivalent benefit to IT for motor outcomes. Though no impact of group
attendance on LOS was seen, it may be due to the external factors delaying
discharge. The findings from this service review support continuing provision of the
CCT service and has provided data for comparison with future service reviews.
Further research is needed to understand the relationship between CCT attendance
and becoming therapy fit for discharge and the impact of inpatient total treatment
time by adding CCT to IT for achievement of stroke therapy guidance.

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SaTH and CTH Therapy Weekend assessment and Discharge Model (2025)

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Type of publication:

Service improvement case study

Author(s):

*Mandy Taylor; *Sharon Huckerby; *Sarah Robinson.

Citation:

SaTH Improvement Hub, December 2025

SMART Aim:

To develop a streamlined therapy approach to support the discharge of the complex patient ensuring the patient is supported to leave the acute setting as soon as medically optimised by 20th November 2025 as
evidenced by complex discharge figures.

Link to PDF poster

To set up simulation sessions to assist with the confidence and competence of physiotherapists for on-call training (2023)

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Type of publication:
Service improvement case study

Author(s):
*Eleanor Giddings

Citation:
SaTH Improvement Hub, November 2023

SMART Aim:
To improve physiotherapy staff self perceived competency and confidence in line with the therapy on-call standards of practice by the end of March 2024.

Link to PDF poster

COACH: Challenging osteoarthritis and changing health (2021)

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Type of publication:Conference abstract

Author(s):*Haines-Eynon A.

Citation:Physiotherapy, 2021. Conference: Virtual Physiotherapy UK 2020 Conference. Virtual, Online. 113(Supplement 1) (pp e52-e53)

Abstract:Purpose: To develop, implement and evaluate an integrated rehabilitation programme for patients with hip and knee osteoarthritis (OA). To encourage behavioural changes by using social prescribing to facilitate longer-term management. Method(s): Patients with OA of the hip and/or knee were eligible for the class. An attempt was made to include as many patients as possible even with comorbidities. Any patients with any cardiac or respiratory conditions were still eligible provided they were able to manage any acute changes to their condition. Patients were assessed by a physiotherapist following a referral from a GP, ESP or consultant who completed an induction including 4 outcome measures; MSK-HQ, numeric rating scale (NRS), 30-s sit to stand and 4 x 10 m walk test. Patients took part in a 6-week programme consisting of 6 weekly 1 h sessions. Each session included a targeted strengthening circuit and a changing education presentation designed to help people improve their understanding of the condition. The final session which focused around longer term self management was attended by the Healthy Lifestyles Team to educate patients on available services within the local community. At the end of the final session all outcome measures were repeated and patients were given a patient satisfaction questionnaire. On completion of the class patients were given the opportunity to continue with their exercise programme in the hospital gym for a further period of time or encouraged to continue with their exercises in their local gym. They were referred back to their physiotherapist if they were still not able to manage their symptoms. Result(s): One hundred and twenty-three patients started the class, three of these were referred back to their physiotherapist as they were unable to engage in the class environment and a further 17 did not complete the course after the initial session. At least 75% of patients had repeat scores greater than or equal to their initial results on all outcome measures. The minimal clinically important improvement (MCII) value was achieved in 50.6% of patients in the MSK-HQ, 31.6% in the 4 x 10 m walk test, 36.7% in the NRS and 46.5% in the 30 s sit to stand test. Conclusion(s): The results demonstrate an important improvement to patient's pain and function following six exercise class and educational sessions. A wide inclusion criterion with patients who had multiple comorbidities meant these outcomes are more representative of the population and are more generalizable. Giving patients a starting point and a seamless approach from a hospital environment to self-management makes it more likely that patients will continue with a healthy lifestyle reducing the need for recurring visits to healthcare providers. Impact: The class had capacity for up to 12 patients allowing patients more treatment time compared to a routine 20 min follow up appointment. Also by avoiding 1:1 physiotherapy appointments the strain on acute services and its associated costs were reduced. This programme Identifies a further effective treatment option for patients with hip and knee OA. Funding acknowledgements: No funding was required for this study.

An evaluation of the current assessment methods used within a district general NHS trust spasticity service (2021)

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Type of publication:Journal article

Author(s):*Fitzgerald, A. ; Pandyan, P.A.

Citation:Physiotherapy, December 2021. Vol 113, Supplement 1, p. E21-E22

Abstract:The management of spasticity in specialist clinic has not been evaluated objectively. One of the barriers to conducting an audit is the lack of a robust patient-centred assessment framework. The aim of this study was to audit the existing patient notes and from this develop a patient-centred assessment framework that provides objective data that can be used to audit the service.

Transcutaneous electrical acupoint stimulation for people with chronic musculoskeletal pain: an exploratory review (2019)

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Type of publication:
Journal article

Author(s):
Ely, S. ; Barlas, P.

Citation:
Physical Therapy Reviews, Dec 2019 Vol. 24(6) p.377-388

Abstract:
Background: Transcutaneous electrical acupoint stimulation (TEAS) is a form of stimulation-induced analgesia with potential as a non-invasive alternative to acupuncture, suitable for self-application. The clinical evidence for TEAS for people with chronic musculoskeletal pain is limited.
Objectives: This exploratory review aimed to evaluate the potential of TEAS as a pain relief option for people with chronic musculoskeletal pain and explore the evidence relating to dose parameters.
Methods: A literature search was conducted using Medline, EMBASE, CINAHL, AMED and the Cochrane Database for studies that used TEAS or specified the use of Transcutaneous electrical nerve stimulation (TENS) over acupuncture points for people with chronic pain. Data relating to the treatment dose parameters was extracted including frequency, intensity, treatment duration and stimulation location, to identify themes and trends with a narrative analysis and review.
Results: The review included 20 studies consisting of 13 randomised controlled trials, four comparative trials and three cross-over studies. Most RCTs indicated some beneficial effect on pain scores, but the overall quality of evidence was low. Most studies applied a TENS device for 20–40 minutes, several times a week similar to an acupuncture treatment protocol. There was no clear evidence that the electrical parameters of frequency and intensity or the choice of acupuncture points had an effect on the outcomes.
Conclusions: People with chronic musculoskeletal pain may achieve pain relief using TEAS but the existing evidence is limited and high quality clinical evidence is required to establish efficacy. Effects appear to be achieved with short applications, several times a week in a protocol similar to those used with acupuncture. It is not clear whether the choice of acupuncture point, stimulation frequency or intensity has an impact on the results. Further investigation of the effect of stimulation duration for both TEAS and TENS is recommended.

Pitfalls in the study of neovascularisation in achilles and patellar tendinopathy: a review of important factors for clinicians to consider and the need for greater standardisation (2019)

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Type of publication:
Journal article

Author(s):
Fallows, R. and *Lumsden, G.

Citation:
Physical Therapy Reviews; Dec 2019 Vol. 24(6) p.346-357

Abstract:
Background: The search for new vessels in pathological tendons is a relatively new field. In spite of a rapid growth in research and clinical experience, there is still poor agreement in the musculoskeletal community regarding the significance and measurement of so called “neovascularisation”. Any relationship between vascularity, tendon healing, degeneration and pain is not yet clear, as it has been considered as a normal physiological adaptation to loading yet also seen in chronic painful Achilles tendons. An expression of the degree of “neovascularisation” could potentially have significance if the amount of neovascularisation could be related to the degree of symptoms or dysfunction caused by the pathology in the tendon.
Objectives: This review examines the potential variables that can affect the quantification of the Doppler signal in Achilles and patellar tendinopathy under three perspectives. Firstly, the variables that arise from the actual technology that allows the capturing of the Doppler signal from intra-tendinous microvasculature flow, secondly by an awareness of known and highly likely physiological factors that may alter the rate of flow and thirdly by an exploration describing the actual methods and qualities of acquiring quantitative data of the microvascular flow with Doppler.
Methods: A literature search was conducted across AMED, CINAHL, Google Scholar, SPORTDiscus, MEDLINE and NCBI (PubMed) for studies related to the qualitative or quantitative measure of the Doppler signal in relation to a clinical outcome of Achilles or patellar tendinopathy. Parameters regarding machine settings and examination conditions were extracted to identify the utilisation of important factors and consistency with a narrative analysis.
Discussion: Many of these influential factors have never been controlled for in previous studies and the methods have been unreliable and poorly reported. There is a need for international agreement on a standardised protocol in the assessment of the microvascularity of tendons, which could then help determine if the quantification of “neovascularisation” is a reliable and clinically relevant finding.