Research funding

CSP Charitable Trust 16

21 Jan

uary 201

5

VOL 21

NO 2

Rehab after cancer

National post-radiation service 32

THE VOICE OF PHYSIOTHERAPY

Children and hemiplegia

Going to GazaVolunteers tell their stories 24

Help at hand

Untitled-2 1 13/01/2015 09 51

HOW GREEN IS YOUR FRONTLINE? FSC certi ed text and cover paper Recyclable polywrap

3

32REGULARS

TALKBACK@CSP Have your say catch up with the latest debates 6

DIRECTORYCourses, conferences and member information 41

RECRUITMENTLook no further for your next positive career move 53

3 MINUTES WITH ... Kayleigh Clitheroe, on freeing up bed nights 66

21 January 2015

CONTENT10

NEWS

Plan to curb industrial action triggers outcry 8

CSP unveils physio works obesity brie ng 10

Paediatric physios bag 250,000 for study 13

New Year Honours for physiotherapy 14

18

24

FEATURESPhysios making a di erence in Gaza 24

Helping children with hemiplegia 28

Specialist rehab after radiotherapy 32

FOCUSESFunds available from CSP Charitable Trust 16

Pilates exercise and older peoples balance 18

Karen Middleton: be part of the solution 21

How physiotherapists in A&E help cut costs 22

Karen Middleton: be part of the solution 21

How physiotherapists in A&E help cut costs 22

32

18

FEATURESPhysios making a di erence in Gaza

Helping children with hemiplegia

Specialist rehab after radiotherapy

FOCUSESFunds available from CSP Charitable Trust

Pilates exercise and older peoples balance

Karen Middleton: be part of the solution

How physiotherapists in A&E help cut costs

3232

F on l ne www csp org uk21 Janua y 2015

Stng

eRe

tesCo

bs

A UNIQUE SERVICE IS HELPING SURVIVORS OF BREAST

CANCER TO COPE WITH THE LONG TERM AFTER EFFECT

S OF

HISTORICAL RADIOTHERAPY. ROBERT MILLETT MEETS

THE TEAM

Pam a so ial worker f om Su o

lk dis overed she had

b east can er in 1982 She underwent a ourse of

adi ther py and went on o make a go d ecove y

th nkfu ly rema ning cancer ree But more than 20

years ater the t eatment that had sav d her i e egan o

cause unfo eseen prob ems

n 2003 she s arted to expe ien e a fee ng of numbness

and t ng ing in her eft a m The sens t ons be ame

nc easing y pain ul and she gradua y ost mobi i y and

fun t on n he mb Fol ow ng th s she st rted to expe ien

ce

re pi ato y p ob ems brought on by exert on t took some

years be ore the cause of boh cond t ons w s dent ed an

d

Pam was na y d agnosed wth r dio herapy indu ed b ach

al

plexus nju y nd ung b os s

Luck y she w s able to se f-efer o a p oneer ng erv ce

hat aims to impro e he i es of peo le a ected by his or c

al

b east ra io herapy As a re ult her qua i y of i e d amat ca

ly

mp oved Be ore at ending the prog amme he was

wheelcha r dependent and choni al y brea hless Af erward

s

she began o wa k ag in u ing a ro la or f ame and wi hou

t

any p in or undue brea hlesness

The l nic she at ended was pa t of the nat onal Brea t

Rad othe apy n ury Rehabi tat on Serv ce (BRIRS) a high y

specia ised se vi e whi h tarted n 2012 The fu y NHS

funded prog amme is the rt of its k nd in the UK It s

ava lab e to pat ents reg st red w th a GP n Eng and and s

ndorsed by Ma m l an Cancer Suppo t

Unt l ast year the se vice was managed co abora ive y

be ween Bar s Hea th NHS rust n Lo don The Chr st e

Founda ion NHS rust n Manche ter and the Royal Nat on

al

Hosp tal or Rheuma ic D seases in Bath RNHRD) But s h

as

now been cent a ised and is ba ed so e y at he RNHRD Th

e

serv ce w s s t up o he p eople w th comp ex ch onic he

a th

prob ems caused by rad otheapy tre tment for br ast canc

er

Helen Whi ney an onco ogy ph sio herap st wo ked for

he BR RS whi e it was runn ng at Ba ts Heal h NHS rust

She exp ains th t echno ogial advances mean that peop e

who ha e adio herapy t day a e at far ess r sk of rad at on

damage han p ti nts we e n the past Do es re now

ca efully con ro led and accuate y de vered and urround

ing

unta geted body arts a e p ote ted to m nimi e expo ure

But many pe ple who we e rea ed n the past rece ved

b east radio herapy t eatment that was qui e rude n term

s

of the p anning and de ive y says Ms Wh tney The tre tm

nt

cyc es were often p olonged and the doses we e much h gh

er

As a resu t some p evious paien s who we e rea ed

for b east cancer n the past most y women a e now

exper enc ng adi ther py- nduced heal h p ob ems The

ssoc ated symptoms are chron c and many such as nerve

damage a e i reve si le They can a so be agg avat d by

age re ated l nesses and co mo bid t es

Ma ianna Sh a ou a l ni al nurse spe ia i t for the

se vice says that wi hout appro r ate management pa ien

s

can deve op se ondary compica ions wh ch m y c use a

sign cant de er ora ion n hea th mob l ty and soc al fun t

on

Secon ary sym toms an ncude hron c pain and

numbness mus le w akness and imbala ce ymphoedem

a

pumo ary bros s educed and es r cted mo emen s

and lo s of unct on in the arms and h nds Pat ents can

a so xper ence sym toms nc uding br ath ng problems

f equent chest nfec ions due to scarr ng of the lungs he

a t

prob ems os eoporos s and ee ings of dep ess on anx ety

32 Cancer care

33

>

13

The 2014 An ual Repre entat ve Confe ence was he d on 3 4 Mar h n C rd Confe ence debated 36 mo ions

(numbe s 133) f om the prmary agenda and three emergency mot ons Of the 36 mot ons deba ed 33 we e

c rr ed of wh ch one was rem tted to CSP council and hree fa ed One eme gency mo ion and three f rther

mo ions f om the p imary agenda wh ch were not debated due to la k of ime we e a so rem tted to coun il

Mot ons or deba e at he 2015 ARC wi l be ava la le online f om 28 anuary at wwwcsp org uk

Responses to resolutionsANNUAL REPRESENTATIVE CONFERENCE 2014

2014

Also inside: Working for you:

whats been done on resolutions from the 2014 annual representative

conference

03_ L_21_jan_cont indd 6 16/01/2015 14 12

3-4 March 2015 NEC Birmingham

Organised by Sterling Events

and wellbeing

Register at www.healthatwork2015.co.uk

22 CPD conference programmes to choose from including:

Managing MSDs and back pain Human factors and ergonomics Long term conditions and disability Sickness absence management

Vocational rehabilitation and case management

Occupational psychology And see the CSP and ACPOHE on stand 114

Health and Wellbeing@Work

@HealthAtWork15#HealthAtWork15

Exhibitor enquiries: adam@sterlingevents.co.ukDelegate enquiries: www.healthatwork2015.co.uk

0151 709 8979

Register today for the UKs leading conferenceand exhibition for improving the health andwellbeing of work-aged people

Nicola HunterWorking Towards Wellbeing

Fiona AmbroseBBC

Mark ArmourRehabWorks

Prof. Jeremy MyersonRoyal College of Art

Prof. Kim Burton OBEUniversity of Huddersfield

Colonel John Etherington OBEMoD/NHS England

Physio Frontline Layout 1 19/11/2014 11:43 Page 1

Research funding

C P Ch r t b e T u t 16

21 an

ay 20

15

VOL

1 NO 2

Rehab af er cancer

a i na po t ad t on e v ce 32

THE VOICE OF PHYSIOTHERAPY

Chi dren and hemiplegia

Going to Gazao un e rs e th i s o i s 24

Help at hand

Sta at the CSP strive constantly to provide the best possible service to members. Frontline is part of that drive, aiming to keep you abreast of your professional interests, while agging up opportunities (and threats) and telling you what your organisation is doing on your behalf.

We also hope Frontline inspires you with reports of the achievements of CSP members. Those could be anything from getting research funding, or nding ways of improving a

service, through to getting involved in a charity event.Youve told us, through surveys and focus groups, that the vast

majority of you highly value receiving a fortnightly print magazine. This is despite the many other channels of communication available today.

But you also told us that you lead busy lives and want a magazine thats easy to nd your way around. Weve been working on that, so look

out for a refreshed look from the next issue. As ever, well be interested to hear your feedback.

ISSN 2045-4910When the magazine relaunched on 21 April 2010 (Vol 16 No.7) its title changed from Physiotherapy Frontline (ISSN 1356 9791) to Frontline. It has been assigned a new ISSN number.

Copyright 2015 CSP. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Chartered Society of Physiotherapy or a licence permitting restricted copying issued by the Copyright Licensing Agency. This publication may not be lent, resold, hired out or otherwise disposed of by way of trade in any form of binding or cover other than that in which it is published, without the prior consent of the publisher.

5 Frontline

Frontline is your magazine. Make the most of it!

Busy? Let Frontline help

The next issue of Frontline is out on 4 February 2015

Until then, you can keep abreast of the CSP work and physio-related news: Log in to get the most out of our website, with all you need to know about physio-related issues, including latest news: www.csp.org.uk

Look out for interactive CSP (iCSP) a member-only networking site giving access to closed clinical forums, where you can exchange views with your peers. www.csp.org.uk/icsp

Check out the weekly Physiotherapy News emailed direct to you. For more details, see: www.csp.org.uk/physiotherapynews

Follow us on Twitter and retweet CSP messages to your followers: @thecsp Like us on Facebook by going to: www.facebook.com/charteredphysios Comment on or recommend Frontline articles at: www.csp.org.uk/frontline

Published 21 times a year, Frontline is your way of keeping in touch with the Chartered Society of Physiotherapy and physio-related news, views and features. It also o ers you an opportunity to have your say about the issues that matter most to you. We welcome your letters, emails and ideas for issues youd like to see covered.

Need to contact the CSP?For general enquiriesenquiries@csp.org.uk020 7306 6666 14 Bedford Row, London WC1R 4ED

Got a news story or idea for Frontline?Go to www.csp.org.uk/ideasforfrontline for details of how to contribute, or drop an email to frontline@csp.org.uk with a short summary and your phone number. Alternatively call the news desk on 020 7306 6665

Want to send us a photo?Use our datasend photo service rather than email. For details see photographs at: www.csp.org.uk/ideasforfrontline

Want to place an advert? Reach a 50,000-plus physiotherapy audience with your product, course or recruitment ad. cspads@media-shed.co.uk0845 600 1394

Got an item for the Noticeboard? directory@csp.org.uk020 7306 6166

Members have access to the CSPs quarterly peer reviewed journal, Physiotherapy. www.csp.org.uk/journal

Your Frontline team Managing editor Lynn EatonDeputy editor Ian A McMillanNews editor Gary Henson Sta writer Robert MillettSta writer Gill HitchcockDesigner Allyson Usher Corporate publications and production o cer Tim MorsePublications manager Nicky ForbesCorporate designer Tristan Reignier

KEEP IN TOUCH

published by

PRINTED BY WARNERS 01778 395111

Lynn Eaton managing editor Frontline and head of CSP member communications

5

is your magazine. Make the most of it! is your way of keeping in touch

with the Chartered Society of Physiotherapy and physio-related news, views and features. It also o ers you an opportunity to have your say about the issues that matter most to you. We welcome your letters,

KEEP IN TOUCH

05_ L_21_Jan_Contact indd 1 16/01/2015 13 44

21 January 2015

TopTweet@thecsp

Recommend content www.csp.org.uk

Follow us @thecsp

Commentwww.csp.org.uk

6 Frontline

Talkback@cspsend your emails to talkback@csp.org.uk or letters to the Editor, Frontline, csp, 14 bedford Row, london Wc1R 4ED. We reserve the right to edit contributions. please include your name and a daytime phone number.

Like uscharteredphysios

shedding a loadWeve recently been issued with iPads in our community trust in Oxfordshire and I have been enjoying using mine for work.

Having been used to carrying or dragging a huge bag everywhere I have now downsized to a small laptop case and have done away with my notebook, pens, address book and diary as I have it all on the iPad. I even have patient notes and referrals on a password protected app and can do away with taking a heavy pile of these around. Im quite excited about this change to my working practice, not to mention the release of stress on the back, after 12 years of having to carry so much around.

We can write notes on the iPad and they are transferred to our laptops automatically which saves time. We are also looking forward to getting our main patient application compatible with the iPad in the new year so we can get access directly to notes and documents in the community and write up notes.Jessica Deguara

source of prideThe therapies team at my trust felt the article on apprenticeships (page 24, 3 December) really captured the benefits of these programmes for departments, trusts, local communities and the apprentices themselves.

It also highlighted the variations in pay and potential disadvantages of these programmes.

At our trust we are pleased to report our current cohort of three apprentices have all being promoted to band 3 technical instructor positions after out-performing 15 other candidates. We are also very proud to report that one of our former apprentices is leaving her band 3 position to undertake an occupational therapy degree at Leeds University, in addition to another former apprentice having completed year one of his physiotherapy degree at Leeds University. As a result of these experiences we are increasing the number of apprentices in the therapy team as we have found it is the most effective way of recruiting local talent into the therapy professions. (Elizabeth) Caroline Brown, University of North Midlands NHS trust

welcome news on cubaLast month I and a number of others from the CSP attended what has become an annual vigil outside the American Embassy in London calling for the release of Cubas unjustly imprisoned Miami 5.

I dont know whether our voices carried to the White House but a few days later, president Barrack Obama announced the release of the remaining three of the five Cuban men being held in US jails.

The campaign for justice for the Cuban

people has not ended, however. The US persists in a devastating 50-year economic blockade against the poor but proud Car bbean island. So now more than ever we need to put pressure on the US, the UK and EU governments to reverse this unjust policy.

Despite the most difficult conditions, Cuba has strived to ensure its people are well educated and are provided with a universal free public health service that is the envy of many Americans and particularly in todays climate of cuts and privatisation Europeans.

Most members wont be aware that the Cuban health service sent more healthcare professionals than the rest of the world to help deal with the Ebola crisis in west Africa. To find out more about the Cuba Solidarity Campaign, which the CSP supports, visit: www.cuba-solidarity.org.uk Louise Walker, head of stewards training

lets have a debateTo develop the debate around exercise that came to the fore at the end of last year, I propose the following questions which, if answered, could to used to formulate a useful exercise framework.

Please add to or subtract from the questions and lets take the discussion forward to produce some concrete physiotherapy guidelines: how do you strengthen a muscle? how do you stretch a muscle? how do you teach an exercise? how do you progress an exercise? how do you increase the endurance

of a muscle? can you do all this by handing out

generic exercise sheets?Dr Simon Rouse, freelance practitioner

the sports physio @adam meakinsFantastic paper! How & why to integrate pain education with exercise therapy... ncbi.nlm.nih.gov/m/pubmed/25090

Go to www.twitter.com to open your own personal account, then follow @thecsp

06_07_ L_21_jan_ alkback indd 1 15/01/2015 15 04

www.csp.org.uk

7

Learn from your peers and join discussions on a wide range of clinical, professional and employment issues. Login to www.csp.org.uk and use the find code to access the examples below.

Burning Question

What is a reasonable adjustment?If you have a disability (as defined by the Equality Act) you are legally entitled to ask your employer for reasonable adjustments to be made to remove any disadvantage that you may face in the workplace. This may be a piece of equipment, a change to your working hours or amendments to your duties. Your employer does not have to provide this but must consider the request and give objective business reasons if this is not possible. The CSP has recently produced a short video in conjunction with our solicitors Thompsons on reasonable adjustments. It is available on the CSP website in the legal services section. It is always a good idea to speak to your local CSP steward if you are experiencing problems at work. If you do not have a CSP steward you should call the CSP on 020 7306 6666.

This is intended as general information only and does not replace individual advice

Avulsion of hamstring originNetwork: Sports and exercise medicine therapyFlavour: A clinical dilemma regarding a 60-year-old patient.Comments: 5 replies at 11 December Find: qqq458

Polymyositis and dermatomyositisNetwork: RheumatologyFlavour: How do other specialist rheumatology physios decide how to progress patient exercise?Comments: 19 replies at 5 JanuaryFind: qqq459

Postural care patientNetwork: Learning disabilitiesFlavour: The discussion explores different sleep systems and what to do if they do not work.Comments: 15 replies at 30 December Find: qqq460

Does your hospital follow hip precautions post surgery?Network: Profession wideFlavour: Hip precautions may not be necessary post surgery but some trusts are still giving them out. Comments: 36 replies at 7 JanuaryFind: qqq461

A news item on the CSP website titled Bury physios make I will if you will exercise pledge elicited several comment. Gillianrandall said: Its great how introducing healthier lifestyles into our own lives inspires others to see and feel how that could be for them. When 20 physios in Bury get together and pledge to do more exercise, and make some changes to their own fitness, it shows how we can be, as a professional group, looking after ourselves with more self-care. When we start with gentle exercise, like walking, it will definitely encourage others to realise they can do the same.

CarolineMoss added: As one of those physiotherapists involved in having the healthy conversations, it is amazing how honest patients can be about how much exercise they do and what their barriers

are without the conversation being an elephant in the room. I will be working in the next 20-25 years and I hope my patients in general at that time prioritise their own health as much as they do with work.

An article on in Frontline (page 29, 3 December) on record keeping elicited a comment from davidrm: There is an excellent, affordable software program, designed specifically for AWPs (but which can be amended to suit others eg OTs, podiatrists, midwives) which can keep records of treatment and produce data information for any given time period.

This data report can then be emailed directly and securely from the program to whomever one chooses. This software, from medicaldatareporting.com can save hours of time and help to maintain accurate records.

CSP experts give you regular updates on employment-related issues. Got an issue youre worried about? Ask your steward/student rep or, if you dont have one, contact the CSP. View previous columns at: www.csp.org.uk/burningquestions

iCSP

You can comment on articles from this issue of Frontline online. CSP members can log in at: www.csp.org.uk/frontline and then go to the current issue section. Youll also find icons to recommend articles to other members, Facebook like Frontline or tweet articles. Comments posted online may be printed in shortened form in the Talkback section of Frontline .

Youve ADDeD...

Forgot your CSP login?Go to www.csp.org.uk/password and tell us your email. Well immediately email your details to you

06_07_ L_21_jan_ alkback indd 2 15/01/2015 15 04

21 January 2015

The CSP has criticised the Conservative partys election pledge to restrict the ability to call for industrial action in the public sector.

If enacted, 40 per cent of all eligible union members would have to vote in favour of industrial action, rather than a simple majority of those balloted.

The Conservatives have also proposed a minimum 50 per cent turnout in industrial action ballots.

Claire Sullivan, the CSPs director of employment relations and union services, said: These proposals are a blatant attempt to undermine the right of public

sector workers to resist the concerted attack on their pay, terms and conditions which they have suffered in recent years and which is set to continue.

This government has already imposed an 8 to 12 per cent real terms pay cut on CSP members and other NHS staff, amid serious staffing pressures.

Commending the hard work and professionalism of physiotherapy staff during a time of major reorganisation and enormous financial pressure, CSP chief executive Karen Middleton said: There is a direct link between staff morale, quality of services

and patient care, so all parties need to recognise the importance of quality jobs.

On the rare occasions when public sector workers have been left no option but to take industrial action there has always been a wider public interest.

Ms Sullivan also argued

8 Frontline

Sport England campaig Sp

ort En

glan

d

CSP slams plans to clamp

Physiotherapists from 19 European countries have joined forces to produce evidence-based guidance about the treatment and care of people with Parkinsons.

The European physiotherapy guideline for Parkinsons disease is the first of its kind. Endorsed by the CSP, it provides recommendations that are applicable to international healthcare systems.

The guidance is suitable for physiotherapists who have limited knowledge about Parkinsons as well as those who are experts, says Bhanu Ramaswamy. The education and project officer for the older people professional network Agile represented the society on the development group.

As well as focusing on the physicality of our interventions, this guidance considers assessment and interventions that are indicated for people with cognitive impairments, she said.

It also has a section on respiratory interventions, because a large proportion of people with Parkinsons die from respiratory complications.

The guide includes four quick reference cards. These cover history taking, physical examination, treatment goals and grade-based recommendations.

Agile president Anna Jones, who was also part of the guideline steering group, said: This guidance has the potential to support equality of access to evidence-informed care across Europe.

The guidance is available as a free download. Visit: parkinsonnet.info/guidelines/european-guidelinesRobert Millet

Download Europe-wide guidance on Parkinsons

Tweeting on 10 January, after the news broke, CEO Karen Middleton wrote: So NHS staff going the extra mile right now, volunteering for Ebola sit & yet no PRB rec pay rise & now being limited from protesting Mmm!

8_9_ L_21_Jan_news indd 1 16/01/2015 14 19

Frontline www.csp.org.ukSOMETHING TO ADD?...go to www.csp.org.uk/icsp

A campaign has been launched to tackle the barriers that stop women from taking exercise and getting t.

Sport Englands This girl can campaign will aim to show real women exercising, and change the widely-held view that active females must be Lycra-clad and super- t.

Research commissioned by the sport promotion body found that two million fewer women in England aged from 14-40 played

sport regularly than men, but that 75 per cent of women would like to be more active.

The ndings show that the biggest barrier to

women exercising is a fear of being judged. Sport England chief executive Jennie Price said: We want to tell the

real story of women who exercise and play

sport. They come in all shapes and sizes and all levels of ability. They have a myriad of reasons for doing what they do.

This campaign says it really doesnt

matter if you are a bit rubbish or completely brilliant, the main thing is that you are a woman and you are doing something, and that deserves to be celebrated.

CSP professional adviser Carley King told Frontline: Exercise is one of the pillars of physiotherapy practice, and we are one of the key professions involved in the battle against sedentary behaviour.

She said there was a vast range of barriers to exercise, and physios should be mindful of these when encouraging an increase in physical activity or prescribing exercises.

Exploring barriers, such as fear, with patients and collaboratively looking at potential solutions, can increase engagement with exercise, she said.Graham Clews

the biggest barrier to women exercising

real story of women who exercise and play

but

75%of w

omen wo

uld

like to b

e more

active

news 9

The number of NHS-funded education and training places for physiotherapists in England is to increase from next September.

It will rise by 53 places (3.6 per cent) from 1,490 to 1,543 in 2015-16, according to Health Education England.

Its plan is key to providing the workforce needed for the governments Five year forward view for the NHS in England.

This is a step in the right direction for physiotherapy, said Karen Middleton, CSP chief executive. It re ects the growing need for physiotherapists

as a key part of skilled and appropriately trained multi-professional primary care teams in the future.

However, we have some concerns about the workforce planning process and how far this is developing to form a strategic approach to meeting population, patient and service needs in the most e ective, a ordable ways.

We will be writing to Health Education England, to seek discussion and active input to these.Lynn Eaton

aigns to get women exercising

Physio training place numbers to rise

mp down on strikes

CALCULATE THE COST OF FALLS IN YOUR AREAFalls leave 1.2 million people in A&E every year, costing the NHS 1.6 billion. See how much money physiotherapy can save in your area with the CSPs new online calculator, infographics and the falls prevention economic model. Discover the headline savings by choosing your locality, then share the evidence as part of the Physiotherapy Works campaign. Get started at www.csp.org.uk/costo alls

that the plans were deeply hypocritical.

If their proposals were applied to parliamentary elections, only 16 out of 650 members of parliament would have secured a

seat in the last general election, as it was only this tiny handful of parliamentarians who obtained 40 per cent support of people entitled to vote.Gary Henson

sport regularly than men, but that 75 per cent of women would like

but

75%75%75%75%

Research

found

2mfew

er wome

n played

sport reg

ularly

than men

A poster from Sport Englands new campaign

Brian Duc

kett

8_9_ L_21_Jan_news indd 2 16/01/2015 14 19

21 January 2015

10 Frontline

The ESCAPE Pain programme to improve the self-management of arthritis through exercise has been adopted by ve NHS hospitals.

The programme was produced by organisations including Arthritis Research UK and the Health Innovation Network, an academic health science network for south London. It has been adopted by Dulwich and Lewisham hospitals in south London, Sevenoaks and Queen Marys hospitals in Kent, and Bristol Royal in rmary.

ESCAPE Pain, typically delivered by physios in outpatient departments, aims to teach patients about their condition and delivers a

progressive exercise programme..It was created after two studies

at Dulwich and Sevenoaks hospitals showed improvements among patients with arthritis who followed the programme, compared with traditional GP management of arthritis and with physiotherapy.

Des Carter, project manager for the Health Innovation Network, said the programme could be extended to other NHS trusts as well as to gyms and leisure centres.

He said that although ESCAPE Pain was provided mainly by physios, it was possible for other health professionals to deliver it.

Michael Hurley, professor

of rehabilitation sciences at St Georges, university of London, led the design and evaluation of the programme.

He told Frontline: Weve shown that the programme is cost e ective and that patients and physios enjoy it. The site includes all the information physios need, is free to download and includes

videos of the programme in action, so people can see what it entails. Graham Clews

Visit: www.escape-pain org

Physio works for obesi Physiotherapy works for obesity, the CSPs latest brie ng for clinicians and decision makers, is now available.

It was published to coincide with national obesity awareness week, which ended on 18 January.

The brie ng sets out how physios can prevent and manage

obesity. It says that exercise and movement are the keystone of physiotherapy and physios are ideally suited to address the physical and psychological

complexities of obesity. Carley King, a CSP professional

adviser, urged physiotherapists to use the brie ng: It can help to articulate why we have the skills to provide the physical activity component of a weight management service.

And the principles in the brie ng do not just apply to speci c weight management services. They can be applied when we are treating a patient who is clinically obese, she said.

National obesity awareness

Joan

ne OBrie

n

Ken OMah

ony

obesity. It says that exercise and movement are the

The repo

rt

found th

at

33.5%

of 10-11

year

olds are

obese

NHS trusts adopt self-management scheme for arthritis pain Physio using the ESCAPE programme with patients

at Dulwich hospital

10_11_ L_21_Jan_news indd 1 16/01/2015 14 09

FrontlineGET IN ON PUBLIC HEALTHgo to www.csp.org.uk/publichealthFrontline

news 11

Fewer than half of all frontline NHS sta in England chose to receive the seasonal u vaccine this autumn.

Figures collated by Public Health England show that 48.2 per cent of frontline healthcare sta were given the jab between 1 September and 30 November last year, compared with 48.6 per cent during the same period in 2013.

There were signi cant regional variations in uptake of the vaccine, with 70.4 per cent of sta in the Merseyside area being given the u jab, compared

with 36.8 per cent in the London area.The proportion of frontline sta

receiving the u vaccine also varied between NHS trusts. For instance, just 10.6 per cent of healthcare sta at Brighton and Sussex university hospitals trust were given the vaccine, while 81 per cent of sta at St Helens and Knowsley hospitals trust volunteered to have the jab.

CSP national policy o cer Penny Bromley said: The voluntary u jab for NHS sta is an important element in protecting both members and their patients during the winter months.Graham Clews

The only physiotherapist on Public Health Englands (PHE) pilot programme for future public health leaders said she intends to develop her interests in better information for patients.

Amanda Michael, clinical lead of the musculoskeletal physiotherapy team at Barnet and Chase Farm hospitals in north London, was chosen last year to take part in PHEs public health system talent management programme.

Ms Michael, who was nominated by her line manager, said

she hopes to develop her interests in behavioural change among patients and

service development during the programme.

A big part of my role is to develop a culture in my department where health messages are delivered to every patient, wherever possible, she said.

And one of my goals on the course is to embed this behaviour in the department where I work.

The scheme, from November 2014 to

summer this year, aims to

develop sta with the potential to take on in uential roles within public health.

According to PHE, it is centrally funded with no charge to the participants or their organisations.

Most of the 29 participants on the programme are from NHS England and local authorities, and Ms Michael said it would be useful to get a range of perspectives on physiotherapy and its role in public health.

PHE is running another public health pilot talent management programme in north west England. It is expected to decide whether to run further programmes following the outcome of the pilots.Graham Clews

NHS staff turn their backs on fl u jab

Physio on leadership scheme wants to focus on public health messages

NURSE WITH EBOLA IS IMPROVINGA nurse who was diagnosed with Ebola in December was showing signs of improvement as Frontline went to press. Pauline Ca erkey, from Glasgow, was being treated in an isolation unit at the Royal Free hospital, London, by a team of specialists including physios (see Frontline, 7 January). She contracted the virus while volunteering in Sierra Leone.

week aimed to highlight the growing public health problem of obesity, which a ects one in four of the UK adult population.

The week was coordinated by the National Obesity Forum. Its report, the State of the nations waistline sets out the scale of obesity in the UK This includes the problem of obesity among children. Gill Hitchcock

Physio works brie ngs: www.csp.org.uk/theevidence

Fewer than half of all frontline NHS sta in England chose to receive the seasonal u vaccine this autumn.

England show that 48.2 per cent of frontline healthcare sta were given the jab between 1 September and 30 November last year, compared with 48.6 per cent during the same period in 2013.

variations in uptake of the vaccine, with 70.4 per cent of sta in the Merseyside area being given the u jab, compared

backs on fl u jab

www.csp.org.uk/theevidence

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21 January 2015

The CSP wants physiotherapy teams in stroke care to collect data on their services. The call comes as the rst annual audit of stroke care in England and Wales reveals wide variations in provision.

How good is stroke care was published last month by the Stroke Sentinel National Audit Programme (SSNAP). It reveals that patients who need physiotherapy receive a daily average of 32 minutes of treatment on over half of their days in hospital.

But this means the amount of treatment in many acute physiotherapy services falls several minutes short of the National

Institute for Health and Care Excellence (NICE) benchmark. NICE says that patients should receive the equivalent of 45 minutes of physiotherapy a day for ve days or 32 minutes over seven days.

Based on data from 74,000 patients, the SSNAP report gives an overview of patient care from April 2013 to March 2014, measured against national clinical standards.

It found that while patients really value therapy, they do not feel they receive enough on stroke units.

Cherry Kilbride, CSP representative on the SSNAP and a senior lecturer in physiotherapy

at Brunel university London, said: Specialist stroke physiotherapy is continuing to make great strides in delivering treatments, but there is still a considerable way to go.

If the median is 32 minutes a day, we know that the level across seven day working is still very low so that the majority of patients will not be receiving the benchmark.

Jakko Brouwers, chair of the Association of Chartered Physiotherapists in Neurology, said: Those patients who have been identi ed to have physiotherapy needs receive less than 60 per cent of the amount required.

This shocking statistic needs to be improved, possibly with improved sta ng ratios and the adoption of novel treatment methods using new technology.

The report suggests that the rehabilitative work of these teams may be signi cantly under-reported. The SSNAP data show that fewer than 5,000 patient records from

early supported discharge (ESD) or community rehab teams had been completed out of a possible 23,000.

It also found that only 17 per cent of people who have a stroke has an assessment six months after admission, though poor records on this may be a factor.

In addition access to ESD teams increased from 31 per cent of patients in 2008 to 74 per cent in 2014, but the goal is for all patients to have this support, the report says.

The CSP called on all physios involved in stroke care to participate in SSNAP audits.

Ralph Hammond, a CSP professional adviser and neurology physiotherapist, said: Its vital that all teams treating at least 10 stroke patients a year are part of the audit, as its only when we have full participation across the care pathway that we can get a complete picture of the care stroke patients receive. Louise Hunt

12 Frontline

Patients lose out on physio help, stroke audit reveals

Access to early discharge teams rose from 31 per cent of patients in 2008 to 74 per cent in 2014, but the goal is for all patients to have this support, the report says

31% 74%

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news 13

Award-winning physios Jennifer Ryan (far left) and Cherry Kilbride.Paediatric physiotherapist Wendy Levin (above)

Physios bag 250,000 for paediatric research

and Wendy Levin, a specialised paediatric physiotherapist at the Royal Free hospital, London.

The funding will be used for a three-year study to evaluate resistance training in young people with cerebral palsy.

For further details of this and other awards available from the CSP see page 16.Robert Millett

P f

Three physiotherapists have jointly been awarded 250,000 from the CSP Charitable Trust and childrens

charity Action Medical Research to fund paediatric research.

The award was granted to Jennifer Ryan, a physio lecturer at Brunel university London, Cherry Kilbride, a senior physio lecturer at the university,

RETIRED MEMBER PRIZE WINNERCongratulations to Susan Bond from Exeter, the prize winner of a 50 Love2shop gift voucher. Ms Bond took part in the CSPs rst retired member survey, which was held to gauge views on the bene ts and services o ered by the society. Results from the survey will help the CSP to develop new services.

Frontline www.csp.org.uk

Photog

raph

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SOMETHING TO ADD?...go to www.csp.org.uk/icsp

12_13_ L_21 Jan_news indd 2 16/01/2015 13 45

21 January 2015

Three physiotherapists received recognition in the Queens 2015 New Year Honours list.

Philippa Ford, CSP public a airs and policy manager for Wales, was made a Member of the Order of the British Empire (MBE) in recognition of her services to physiotherapy.

She told Frontline : Im absolutely thrilled with the nomination and thank the wonderful Welsh members for nominating me. Im completely honoured and hope I can continue to make them all proud.

Ms Ford, who quali ed as a physiotherapist in 1986, began working for the society in 1999, just after the Welsh assembly was established. And since then she has worked with three di erent sets of politicians and ve di erent ministers for health

and social services.She says the many changes have

made her job both interesting and challenging.

The job has given me some wonderful opportunities and I have

met some really interesting people in the world of politics and public a airs. Its a fantastic job and I feel very lucky, said Ms Ford.

Prior to her current role Ms Ford worked as a physiotherapist at Cardi Royal In rmary, specialising in the care of older people.

Since 1986 she has also acted as a workplace steward, a regional steward for Wales and secretary of the national group of regional stewards.

CSP chair Sue Rees told Frontline : I am absolutely delighted that Pip has been awarded an MBE. As a Welsh member myself, I know the huge and valuable contribution she has made to physiotherapy and to health and social care in Wales.

This well deserved honour not only recognises that but is also a

re ection of the high esteem in which she is held by members and colleagues across health and social care.

Also recognised were retired physiotherapist Sally Williams who was made a Medallist of the Order of the British Empire (BEM) for her services to charity and to the community in Bourne End, Buckinghamshire.

Mrs Williams has held an open garden event for the last 25 years, raising money for charities including Colon Cancer Concern, Diabetes UK, Scanappeal, The National Autistic Society, Air Ambulance, Iain Rennie Hospice at Home and Sail Training International.

Retired physiotherapist Valerie Jourdan was made a Member of the Order of the British Empire (MBE)

14 Frontline

CSP physio receives new

CSP public a airs and policy manager Philippa Ford

Chris Christodoulou

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An army physiotherapist was chosen to sing solo at the Royal Albert Hall as part of a First World War commemoration that was watched on TV by millions of festive viewers.

Captain Skye Manton, (pictured left)who works at the militarys regional rehabilitation unit in Aldershot, took part in the BBC2 series The Choir: New Military Wives. But she was plucked from the chorus by TV choirmaster Gareth Malone and given the soloists role for the nale of a special War Horse Prom concert.

Footage of the commemoration and its build-up was broadcast just before Christmas and was watched by more than

Millions watch phy

14_15_ L_21_Jan_news indd 1 16/01/2015 13 46

Frontline www.csp.org.uk SOMETHING TO ADD?...go to www.csp.org.uk/icsp

for her services to improving the lives of disabled children in the West Bank, Palestine. Mrs Jourdan founded Action around Bethlehem Children with Disability (ABCD) in 1984.

Since then the charity has worked to improve the quality of life for children in Palestine with disabilities, regardless of their faith. Robert Millett

news 15

year honour

BOOST FOR CHILDRENS EPILEPSY SERVICESThere has been a signi cant expansion in epilepsy clinics treating children and young people, a UK audit has found. The second round of data collected by Epilepsy12, a clinical audit, found that the frequency of clinics has also increased, with two-thirds (66 per cent) now operating weekly. Visit www.rcph.ac.uk for Epilepsy 12 national reports.

HONOURS FOR OTHER ALLIED HEALTH PROFESSIONALSAs well as physiotherapists other allied health professionals were among those honoured. They included: Jacqui Lunday Johnstone, chief health professions o cer for the Scottish government, who was made an O cer of the Order of the British Empire (OBE) for her services to healthcare and the health care professions

Anna van Der Gaag, chair of the Health and Care Professions Council, who became a Commander of the Order of the British Empire (CBE) for her services to health and care

Bryony Simpson, chair of the Royal College of Speech and Language Therapists, who was made a Member of the Order of the British Empire (MBE) for her services to speech and language.

The introduction of widespread seven-day services in the NHS must be properly funded if it is to succeed, the CSP says in its written submission to the NHS Pay Review Body.

The CSP says seven-day services in the NHS have not so far always produced better quality outcomes for patients, or more e cient services. It calls for a relentless focus on improving the quality of care for patients, through integrated service delivery, as full-week services are rolled out across the NHS in England.

The government has asked the NHS Pay Review Body and the Review Body on Doctors and Dentists Remuneration to examine the provision of seven-day services, which is one of its key objectives for the NHS in England.

The CSP also criticised the rejection of a one per cent across the board rise for all NHS employees in England and Northern Ireland by the countrys

respective governments. The society argues that

nationally-agreed pay and conditions of employment must be maintained as seven-day services becomes more widespread, and calls for early consultation with sta and trade unions over any proposed changes.

CSP assistant director Peter Finch said seven-day services could improve clinical outcomes for millions of patients, but they must not be introduced on the cheap.

An approach that seeks to deliver seven-day services with the resources allocated to a ve-day service, or which seeks to reduce the pay of sta providing services over seven days, will fail, he said.

There needs to be proper funding to ensure hard-working professional physiotherapy sta and their colleagues in the NHS are both properly rewarded for a step change in provision and have the resources, including appropriate sta ng levels.Graham Clews

NHS seven-day services cant be done on the cheap, says CSP

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two million viewers, according to gures from the Broadcasters Audience Research Board.

Captain Manton auditioned successfully. Then, after being put on the spot and asked to sing immediately, she was given the solo part.

I have sung in choirs throughout my life and the Military Wives Choir Foundation allowed me to start singing again after a few years of not being able to do so due to my job and moving around. It is due to them and my role that I was fortunate

enough to be given this once in a lifetime opportunity.

I was immensely proud and honoured to be involved and it was a huge honour to stand on that international stage along with 99 amazing ladies, she said.

As part of the TV programme, Captain Manton interviewed her grandfather who was shot and captured during the Second World War. She has also lost friends in Afghanistan and in her job as a physio she treats patients injured in con icts.Graham Clews

hysio sing TV solo

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21 January 2015

Research and education are vital to the profession, but both can prove expensive. Luckily, CSP members who are keen to pursue research

or advance their education can apply for funding from the CSP Charitable Trust. Set up in 1980, the trust is an independent charity which supports education and research relevant to physiotherapy.

Trustee and CSP honorary treasurer Sue England explains: Each year the charitable trust receives two per cent of the societys membership subscription income, as well as occasional bequests and legacies from

members, member groups and external organisations. These contributions help to fund various grants to members as well as a wide range of initiatives that bene t the profession.

The CSP Charitable Trust allocates funding across three main categories. They are: physiotherapy research, paediatric research and education grants.

Research grantsBy funding physiotherapy research in the UK at a number of levels, the trust aims to broaden the evidence base informing

physiotherapy practice. Annually, it allocates about 200,000 in research grants through the Physiotherapy Research Foundation. This year the grants have been split between start-up funds of up to 25,000 for novice researchers and funding of up to 50,000 for more experienced researchers.

Physiotherapist Claire Marcroft, who leads a team at Newcastle upon Tyne NHS trust, applied to the trust as a novice researcher and received a 20,000 award. She is using the money to fund studies into the motor assessment of pre-term infants.

Ms Marcroft told Frontline: Assessment

16 CSP Charitable Trust

Funding the future THIS YEAR FUNDING OF 200,000 IS AVAILABLE TO CSP MEMBERS FOR RESEARCH, AND 84,000 FOR EDUCATIONAL ACTIVITIES. ROBERT MILLETT FINDS OUT MORE

16_17_ L_21_Jan_ct indd 1 16/01/2015 13 52

of infant neuro-developmental stage and progress is very important for both clinicians and parents of pre-term infants. It will result in direct improvements in the way care is delivered. And having the opportunity to contribute to the development of the role of the clinical academic by leading clinical research is also very exciting for the physiotherapy profession.

As well as funding research in a range of elds, the trust provides awards speci cally for paediatric research. This year grants of up to 25,000 are available for novice researchers who submit projects addressing research questions in the areas of paediatric non-acquired brain injury and paediatric cerebral palsy.

In addition, for the second year running the CSP Charitable Trust and childrens

charity Action Medical Research have teamed up to o er experienced researchers an award of up to 250,000 for paediatric research (see News on page 13).

Last year saw the trust grant a special care of older people research award of 300,000 to Anne Forster, professor in the academic unit of elderly care and rehabilitation at the University of Leeds. Professor Forster and colleagues are using the funds to conduct a randomised controlled feasibility trial of a training package designed to upskill care home sta .

The care training course was devised by physiotherapists Jill Fisher, Karen Hull and other members of the Physiotherapists Care Skills Group. The training is designed to improve the postural care of care home residents and enable sta to practise good

physical management when they move and handle people (see Frontline, page 24, 6 November 2013). Professor Forster said: This is a wonderful opportunity to evaluate a physiotherapy-led intervention which may improve the care environment for frail older people in care homes.

Ms England says the trust has been able to fund larger projects like this over the last ve years, thanks to extra funds from the CSP. These projects have been very practical in nature and should produce the evidence to underpin everyday clinical practice, she says. And as the results come through they will be disseminated across the profession. fl

For details on applying for Charitable Trust funding visit: www.csp.org.uk/2015awards

of infant neuro-developmental stage and progress is very important for both clinicians

charity Action Medical Research have teamed up to o er experienced researchers

Frontline www.csp.org.uk

17

SOMETHING TO ADD?...email us at talkback@csp.org.uk

e of physiotherapy

CSP awards administrator Susan Williams says the trusts educational awards are designed to help members fund various activities. These can include overseas development projects, visits to international centres of research excellence, academically accredited courses, student elective placements and presenting at conferences.

Last year the trust made 71 educational awards and, with the exception of the masters dissemination award, all of these awards are open to quali ed, student and associate members, says Ms Williams.

In 2014 Gail McAndrew, a nal year student at Robert Gordon University in Aberdeen, received a 700 education and development placement award that helped to fund a ve week placement at Headley Court, the armed forces rehabilitation centre in Surrey.

It made a massive di erence to my placement costs, says Ms McAndrew. It really makes you think about what you want out of your elective, and how you can use that knowledge to help others further their learning. I feel that I actively contribute more as a student because of this placement and the focus

that the award provided.Meanwhile Lauren Fordham, a senior

physiotherapist at Derbyshire Healthcare NHS trust, applied for a masters dissemination award and received 500. She said: This award is a really positive scheme because disseminating your information often involves travelling and publishing, and these things often fall outside of a clinicians everyday experience so the additional funds can really help.

Ms Fordham has used part of the funds to produce printed copies of her thesis on pain assessment methods in community mental health, which she has now supplied to local libraries. The money also helped her organise and host a pain in mental health study day, due to be held in Derby on 26 February.

The funds have helped to make the workshop more attractive. As a result, I have lots of speakers and a diversity of clinicians attending including psychologists, physios and doctors who will have the opportunity to network and share best practice and evidence-based training, she says.

EDUCATIONAL AWARDS

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18 Physio findings

21 January 2015

Stabilisation exercises are widely taught to treat non-speci c lower back pain, but are they any more helpful than other forms of active exercise?

Benjamin Smith, a senior physiotherapist at London Road Community Hospital in Derby, and colleagues set out to see how e ective the use of stabilisation, or core stability exercises has proved to be.

Despite it being the most commonly used form of physiotherapy treatment within the UK, there is a lack of positive

evidence to support its use, say the team.In 2008, a systematic review found that

speci c stabilisation exercises might be more helpful than no treatment, but were unlikely to produce a better outcome than any other form of exercise.

Many more studies have been published since then, so Mr Smiths team updated the 2008 review by searching ve databases. Unlike the 2008 team, they restricted their search to studies in which a core stability programme was used alone.

In the 2008 review the majority of studies favouring stabilisation exercises combined the exercises with some other form of treatment, implying that it was the package of care that was e ective rather than stabilisation exercises alone, say the authors.

Mr Smiths team found that a core stability programme could give patients slightly more short-term relief than other exercise. But when followed up for a year or more, the di erences became insigni cant.

IN OUR REGULAR SURVEY OF RESEARCH THATS RELEVANT TO PHYSIOTHERAPY STAFF, JANET WRIGHT LOOKS AT RECENTLY PUBLISHED STUDIES

BACK CARE

Pilates exercise can improve older peoples balance, according to researchers in Australia who reviewed existing studies.

But, although poor balance increases the risk of falling, there isnt clear evidence on whether learning Pilates actually reduces the number of falls.

Anna Lucia Barker, of Monash University in Melbourne, and colleagues found six suitable published studies. But only three gave enough detail to show whether the exercises they used provided a moderate or high challenge to balance as recommended for best practice.

The evidence suggests Pilates can improve balance, an important risk factor for falls in older adults, say the team.

However, there is limited data on the

impact on falls. E ects may have

been over-estimated due to the low

methodological quality of studies. Best-practice

recommendations were rarely applied in prior studies.

The team wants future studies to include best-practice recommendations.

Barker AL et al. E ect of Pilates xercise for improving balance in older dults: a systematic review with meta-

analysis, Archives of Physical Medicine and Rehabilitation 2014; http://dx.doi.rg/10.1016/j.apmr.2014.11.021

Quality of research clouds ndings on balance and falls

Reviewers question use of core

PILATES

Pilates exercise can improve older peoples balance, according to researchers in Australia who reviewed

But, although poor balance increases the risk of falling, there isnt clear evidence on whether learning Pilates actually reduces the number of falls.

Anna Lucia Barker, of Monash University in Melbourne, and colleagues found six suitable published studies. But only three gave enough detail to show whether the exercises they used provided a moderate or high challenge to balance as recommended for best practice.

The evidence suggests Pilates can improve balance, an important risk factor for falls in older adults, say the team.

However, there is limited data on the

impact on falls. E ects may have

been over-estimated due to the low

methodological quality of studies. Best-practice

recommendations were rarely applied in prior studies.

The team wants future studies to include best-practice recommendations.

Barker AL et al. E ect of Pilates et al. E ect of Pilates et alexercise for improving balance in older adults: a systematic review with meta-analysis, Archives of Physical Medicine and Rehabilitation 2014; http://dx.doi.org/10.1016/j.apmr.2014.11.021

Quality of research clouds ndings on balance and falls

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ABSTRACT DEADLINEfor Physiotherapy UK see page 52-53

There is strong evidence stabilisation exercises are not more e ective than any other form of active exercise in the long term, the authors conclude.

This review cannot recommend stabilisation exercises for low back pain in preference to other forms of general exercise, and further research is unlikely to considerably alter this conclusion.Smith B et al. An update of stabilisation exercises for low back

pain: a systematic review with meta-analysis, BMC Musculoskeletal Disorders 2014; http://dx.doi.org/10.1186/1471-2474-15-416May S & Johnson R. Stabilisation exercises for low back pain: a systematic review, Physiotherapy 2008; http://dx.doi.org/10.1016/j.physio.2007.08.010

Frontline www.csp.org.uk

Playing a musical keyboard can help people with multiple sclerosis to improve control of their hands, say researchers, who used a special keyboard with hospital patients. The half-hour exercise sessions, carried out daily for 15 days, also improved patients hand strength and dexterity. Gatti R et al. Physiotherapy Research International 2014; http://dx.doi.org/10.1002/pri.1600 The quality of articles published in physiotherapy journals has improved and the proportion of original studies and review articles has increased, say researchers who studied work published in 2000-2002 and 2010-2012. Snell K et al. Physiotherapy Canada 2014; http://dx.doi.org/10.3138/ptc.2013-67 Overweight children taking part in a trial had poorer balance than those of a healthy weight, perhaps partly because they

also had weaker legs, researchers say. Martino SA et al. Archives of Physical Medicine and Rehabilitation 2014; http://dx.doi.org/10.1016/j.apmr.2014.07.347 In tests of memory and mental speed, 1484 former or current shift workers scored less than 1685 other people. The e ects lasted at least ve years after they stopped working shifts.

Meanwhile, the governments Health survey for England has found that shift workers are more likely to be unwell and overweight, even though they tend to be younger than the general workforce. Marqui JC et al. Occupational & Environmental Medicine http://dx.doi.org/10.1136/oemed-2013-101993; http://www.hscic.gov.uk/catalogue/PUB16076/HSE2013-Ch6-sft-wrk.pdf

Comments Conclusions&&Comments &Comments & Conclusions&Conclusions

e stability exercises

Playing a musical keyboard can help people with multiple sclerosis to improve control of their hands, say researchers, who used a special keyboard with hospital patients. The half-hour exercise sessions, carried out daily for 15 days, also improved patients hand strength and dexterity. Gatti R http://dx.doi.org/10.1002/pri.1600

The quality of articles published in physiotherapy journals has improved and the proportion of original studies and review articles has increased, say researchers who studied work published in 2000-2002 and 2010-2012. Snell K org/10.3138/ptc.2013-67

Overweight children taking part in a trial had poorer balance than those of a healthy weight, perhaps partly because they

Comments

18_19_ L_21_jan_Physio indings indd 7 15/01/2015 14 58

Physiotherapy Research Foundation

The CSP Charitable Trust is pleased to announce the Physiotherapy Research Foundation (PRF) award scheme this year. The trust is now accepting research applications for funding in 2015.

The deadline for outline applications is 12 noon, Friday 13 March 2015

Guidance notes and outline application forms for each scheme can be found at: www.csp.org.uk/prf

The CSP Charitable TrustRegistered Charity No. 279882Supporting the advancement of physiotherapy education and research

Scheme Afor experienced researchers

Up to 50,000 available for research projects

Scheme Bfor novice researchers

Up to 25,000 available for research projects

Scheme BPaediatric research funding

for novice researchers

Up to 25,000 of funding in the area of

paediatric non-acquired brain injury and paediatric cerebral

palsy, available for one research project

Research Awards 2015

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Frontline www.csp.org.uk

T owards the end of 2014, I was involved in two CSP-led working dinners. On the days after these

evening events, members and non-members in high-pro le, in uential jobs discussed the strategic direction for the profession and informed our Physiotherapy Works programme.

Some were senior allied health professional leaders in the NHS or higher education. Others were in the private sector in a range of roles, including elite sport. All were highly successful individuals in their elds who were making a real di erence. They were still registered with the Health and Care Professions Council and many were CSP members too,

Despite their diverse roles, I tried to work out what they had in common. My conclusion was that they had put themselves forward as being the solution rather than being associated with a problem.

Nurturing talentEven when they are students, we can all spot these individuals they go the extra mile; take on additional roles; theyre a little bit more courageous or they have some extra astuteness.

Personally, I know they can also be a little bit scary as they challenge some of our accepted wisdom and nudge us out of our comfort zones!

But these people are our future and we need to nurture their talent, not shut it down and knock the con dence out of them.

The strategic leaders had all had mentors, coaches and peers who had believed in them. But they had also worked out for themselves early on that to be associated with, or be seen as, the problem gets you nowhere. To moan and blame eventually means you will, at best, be ignored and, at worst, marginalised.

Being the solution or part of the solution means you will at least be listened to and, often, people will return to you to hear more. We all like people with solutions to our problems but we hate people who add to them.

The strategic in uencers talked about how often physiotherapists are not viewed as being in the solution game. This is such a paradox when you consider that the very essence of our clinical work is to nd solutions. Why is it that we dont always translate that clinical experience into other aspects of our working lives?

Being part of the solution is important when we are trying to exert our in uence, raise our visibility and get our contribution valued, commissioned and bought. Those in the private sector have always had to do this because they have always been customer-focused. rst and foremost. They simply cannot a ord to be anything

other than the solution to other peoples problems.

Those of us working in the public sector are learning

how its done ...

WE HATE PEOPLE WHO ADD TO OUR PROBLEMS SO DONT BE ONE OF THEM, SAYS CSP CHIEF EXECUTIVE KAREN MIDDLETON

Be the solution, not the problem

InPerson...

You can email Karen at: middletonk@csp.org.uk

other than the solution to other peoples problems.

Those of us working in the public sector are learning that the same imperative applies to us now. It is not just a matter of presentation, but also of substance.

So, when speaking to people who are buying your services, forget the message about needing more physiotherapists. Rather, focus on how you can solve their problems, whether these are increasing demand in A&E, the cost of long lengths of stay, the cost of care packages in social care or the cost of primary care.

This is the approach I took when I had a recent one-to-one meeting with the chief executive of NHS England, Simon Stevens.

I told him about our falls prevention economic mode and, in my next column, I want to share more about that experience with you to illustrate

SO DONT BE ONE OF THEM, SAYS CSP CHIEF EXECUTIVE

Be the solution, not the problem

Person...

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21 January 2015

Shining a spotlight on A

22 Frontline

VIEWS & OPINIONSin perspective

advice line

Are you up-to-date? From next month, you can te orientation and gender ide n

Rarely does a day go by without A&E services getting media exposure as they struggle to cope with rising demand and missed targets. We

read about waiting times and the enormous pressure sta face. But perhaps not enough

attention is paid to the skill mix in A&E teams and how they can

be expanded to help patients get through the system quicker and

more e ectively.A new brie ng on A&E in the

physiotherapy works series seeks to address this by setting out two crucial roles for the profession. Emergency physio practitioners mostly see patients presenting with musculoskeletal (MSK) problems. They provide expert assessments, order and interpret tests, such as X-rays, manage wounds, soft-tissue injuries and fractures, and provide advice and treatment.

As the brie ng shows, physios managing MSK injuries in this way have equivalent clinical outcomes and lower direct costs than doctors or emergency nurse practitioners. Physios also work in multidisciplinary therapy teams in A&E and medical admission units, bringing

to bear their expertise in assessment, discharge management and arranging care after leaving hospital.

This helps to stop older people who have fallen, for example, from being admitted and avoids the clinical risks linked to hospitalisation. This is critical as people over 65 are the fastest growing group of A&E attendees and delayed discharge is said to be at the highest ever level. That truly gets to the heart of physiotherapys o er, especially when it comes to emergency care.

The professions skills in assessment, diagnosis and treatment are allied with a knowledge, understanding and vision of how the system should t around people to get them to where they want to be, both physically and geographically. If used properly, these talents could bring huge bene ts for the NHS.

The CSP is keen to ensure that all members are able to participate fully in its business and that barriers to participation are identi ed and action is taken to remove or mitigate them.

For this to happen it is important that the CSP has information about the personal characteristics of its membership so that we can monitor levels of participation. This can range from involvement as a steward or safety rep to membership of CSP council and standing committees, to attendance at the annual representative conference (ARC) and Physiotherapy UK.

Only by having this information can we identify under-represented groups and take action to make sure that all CSP

members have a voice.For many years the CSP has collected information about

members age, gender, disability and ethnic origin. At last years ARC a motion was passed calling on the CSP to monitor members sexual orientation and gender identity.

From next month the CSP is adding questions about sexual orientation and gender identity to membership application forms and the online member pro le form. An option prefer not to say is available to members who choose not to provide this information.

The CSP wishes to assure members that we are aware of the sensitive nature of this information and will only use the data in

Log-jams in A&E hit the headlines again this month. Eve Jenner explains how physios can play their part in speeding up care and cutting costs

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frontline www.csp.org.uk

A&E

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Got somethinG to say?We encourage members to contribute to these pages. For information see the guidelines at: www.csp.org.uk/frontlineideas or email: eatonl@csp.org.ukThe views expressed here are not necessarily those of the CSP

The Association of Paediatric Chartered Physiotherapists (APCP) would like to highlight that selective dorsal rhizotomy (SDR) is now an NHS-commissioned service.

It has been available in England for children who fulfil certain criteria since 17 July 2014. These criteria are strict as only a select group of children will benefit. Current evidence on the effectiveness of SDR, especially on long-term function, is limited and it is important that we, as therapists, are fully aware of the literature to enable us to have honest and realistic discussions with families.

The aim of SDR is to relieve spasticity in younger children that is those aged from three to 10 years who fall within the gross motor function classification system levels II and III. The intervention aims to improve a childs functional abilities. Understanding a childs motor prognosis without intervention as well as establishing realistic goals is crucial.

Selective dorsal rhizotomy is frequently portrayed in the media as a miracle cure and it is important that families understand this is not the case. Children with cerebral palsy have many difficulties associated with their condition and spasticity is only one of these. As we know, muscle weakness and poor selective motor control have a major impact on the functional abilities of these children.

Cognition and a childs ability to comply with an intensive two-year rehabilitation programme are other factors that need to be considered. Relieving spasticity doesnt address these other difficulties and can result in a child whose level of function remains unchanged or even potentially worse.

Families wishing to explore whether SDR is a suitable intervention for their child should be encouraged to be assessed by one of the five commissioned centres in England.

susie turner and anita Patel are members of the APCP neurodisability group

For more information about the criteria and the commissioning services, visit: http://apcp.csp.org.uk/news/2014/08/01/nhs-england-news-sdr-commissioning

About a fifth of the 18.3 million people who attend A&E each year have MSK problems. Many of them could be assessed and managed by a physiotherapist, as could many people attending with other conditions, such as chronic obstructive pulmonary disease. This would free up doctors to see more medically complex cases and reduce waiting times.

It would also cut costs in a significant way when Salford Royal NHS Foundation Trust introduced an advanced physiotherapist role to assess, diagnose and treat people presenting with MSK injuries, the new pathway cut costs by 60 per cent or 32 for each patient. Finally, by viewing patient care in its wider context, physios working in A&E could help the NHS on its path to becoming

a more responsive, person-centred system. For the physios themselves, the rewards would also be significant.

The work demands high standards and presents opportunities to learn new skills and broaden your practice. As with all physiotherapy works briefings, various teams at the CSP will use it to make the case for the profession to commissioners.

However, members can play their part by using it as evidence in conversations with colleagues, commissioners and colleagues to demonstrate what we can bring to this high-profile service.

To download a copy of the briefing, visit: www.csp.org.uk/theevidence

eve Jenner is a CSP professional adviser

Susie Turner and Anita Patel set the record straight on selective dorsal rhizotomy

A special service

an tell the CSP about your sexual de ntity. Kate Moran explains why

viewpoint

aggregated form to produce reports about the proportion of members self-identifying within these categories. No individual members will be identified from these reports.

The information will be invaluable in helping the CSP equality and diversity group to take action to make sure that all members are truly able to participate in the full range of its work. So do please go online next month and check that all sections of your CSP membership profile information are up-to-date.

Kate moran is the CSPs head of employment research

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Gaza alert

24 International aid

21 January 2015

PHYSIOS WERE AT THE FOREFRONT OF THE HUMANITARIAN RESPONSE TO THE HOSTILITIES IN GAZA LAST SUMMER. LYNN EATON REPORTS

Rob Holden Ph

otog

raphy

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Three volunteers re ect on the day that a e Abi Aston: arriving in GazaWe arrived at Tel Aviv airport early in the morning, tired after the ight from Heathrow, but excited. We were driven to Jerusalem

and managed a little sightseeing in the old city.

We had planned to go in to Gaza the following day but our permits werent ready. Instead we did some teaching preparation. The following morning we got a call which con rmed we were clear to go to Gaza.

We had been briefed on how to conduct ourselves during the Erez border crossing, the o cial entry point for non-governmental organisation workers from Israel into Gaza.

We each carried huge, black 100 litre du e bags. They contained minimal personal

belongings plus donations for the local Handicap International teams, such as Theraband and compression bandages for amputees. We also carried large trauma kits.

The crossing point is a huge hangar where you pass through turnstiles l ke those once seen at football grounds. We struggled with the rucksacks, one person going through rst, putting the big bags through the turnstiles afterwards.

After three hours, we emerged through a grey sliding door and sat down on two benches nearby, waiting for a man in a golf buggy-type vehicle to appear and drive us along the nal stretch of no-mans land.

After the desert-like border area, my rst sight of Gaza was of damaged and blackened apartment blocks in a built up area. We were met by very friendly Handicap International sta and, after one nal bag search, we were in Gaza. Abi Aston is a paediatric physiotherapist based at the Royal National Orthopaedic Hospital, Stanmore, Middlesex

Zoe Clift: my nal clinical day7am At Handicap International (HI) o ce for security brief

9am Meet with Rafah area team to start clinical visits. First patient (median nerve and exor tendon injury) assessment/treatment plan completed by local Gaza team with only reassurance needed from us fantastic to see the progress in their clinical skills and their growing con dence.

10am Second clinical visit (median nerve and tibial ex- x, plus patients son with head injury). Local physio points out where he lives amid the rubble ... a reminder for me of the situation the clinicians are living and working in.

12.30pm Visit nine-year-old girl, arranged speci cally for review of possible lower limb peripheral nerve injury and wound/dressing review. Referred to me and Lesley

21 January 2015

Physios, like many other healthcare professionals, are always eager to help out in a humanitarian crisis. But, when CSP members put their names forward for a new register of volunteers, set up by the UK government in 2011 to help co-ordinate o ers of help, many would

have expected to be dealing with typhoons or earthquakes. However, last year volunteers on the UK International Emergency

Trauma Register (UKIETR) were called on for a very di erent situation: the humanitarian emergency in Gaza that followed the Israeli operation in July.

Although it was an entirely man-made crisis the challenges were similar to a natural one, according to physio Peter Skelton, who is no stranger to disasters. Peter is rehabilitation project manager with Handicap International, a charity that provides training for physios on the register. He has been involved in the relief operation after typhoons hit the Philippines in November 2013 (Frontline, 17 December 2013) and in Haiti, Libya and Jordan.

Although the rst reaction is to send surgeons in to such situations, Peter and his colleagues knew would not be enough. Whenever you have a large humanitarian crisis, surgery is performed in very di cult conditions, he says. There will be amputation, infection, peripheral nerve damage, spinal cord injuries, skin grafts and complex fractures, often with external xation. That all requires an enormous amount of rehab.

Handicap International has been involved in Gaza since 1996, working with children with disabilities such as cerebral palsy. So, when the severe escalation in hostilities in Gaza began, his organisation already had sta on the ground.

After an initial assessment team went to Jerusalem in August, three

26 International aid

Photos: M

ary Jane Cole/Handicap International

and managed a little sightseeing in the old city.

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www.csp.org.uk

ected them most

UKIETR teams were sent to Gaza in the following two months. There were 60 rehab professionals on the register at the height of the Gaza escalation, 20 of whom had completed a three-day clinical training course about starting humanitarian work. They were invited to join the mission.

Most of these were physios but some were occupational therapists. All had trauma experience, and some had experience of working overseas, says Peter. What was really great was that we engaged with organisations like the British Association of Chartered Physiotherapists in Amputee Rehabilitation (BACPAR), the Association of Chartered Physiotherapist in Neurology, Adapt, the CSPs international health and development network, and the British Association of Hand Therapists. We also worked with several non-governmental organisations.

Training in SussexBut the 20 volunteers werent trained for a con ict or post-con ict zone where threats might include being kidnapped or coming under re. We spent two days in the Sussex countryside going through hostile environment awareness training, says Peter. The rst of the three teams, including three physios, went out to Gaza with Peter in September, just after the cease re was announced, to assess the situation and provide training for the Handicap International teams already in Gaza.

During their visit, physios abandoned their normal duties to transport patients or took on auxiliary roles. They had responsibility for their existing disabled patients, many of whom were now living in di cult conditions often without water or electricity. Now they had newly-injured patients, many with complex multiple fractures, amputations or burns, who had to be discharged earlier than was ideal.

The local teams were, Peter says, fantastic. But their physio skills and training were not su cient for the complex cases they now faced. The two teams of UK volunteers who have been out since worked alongside Handicap International sta , providing treatment but more importantly training. We are at a critical moment for the role of rehab in responding to a humanitarian crisis, he says. Experts need to be deployed really early. fl

(major trauma nurse) as local therapy team all male. Simple clinical session gaining patient trust emotionally this is probably the toughest case we have seen.

13.30pm Debrief with Rafah team. Reassured them they are doing a fantastic job at learning new skills and applying them. Brilliant to feel we are leaving them with tools to continue.

3pm Final mission de-brief at HI o ce. Extremely positive feedback. We agree to continue work to provide plan/guidance for next time its not if but when.Zoe Clifton is an extended scope practitioner at Guys and St Thomas Hospital, London

Mary Jane Cole: a return visitReturning to Gaza after a visit six weeks previously, I saw a couple of amputees Id seen earlier. Ossama was one.

Like so many hed su ered multiple injuries Handicap International is an independent aid organisation working in

situations of poverty and exclusion, con ict and disaster. The charity works alongside disabled and vulnerable people in more than 60 countries worldwide. For more information, visit: www.handicap-international.org.uk

when his cousins house collapsed in the shelling head and facial fractures, widespread super cial burns, deep wounds to his left leg and an amputation on the right. And hed arrested twice. He was the only survivor of 19, many were relatives.

When we rst met Ossama, being able to walk again was naturally a concern for him. He was uncertain if he would get a prosthesis. He had remaining family to care for and was apprehensive about the future. But the local community team reassured

him and he was quickly referred to the local prosthetic service supported by the International Red Cross.

It was great to meet

him again. He volunteered to help us on an amputee rehab workshop we ran jointly with the Red Cross. He was doing well, coping with reduced vision and hearing and some pain but he was about to get his prosthesis and was having physiotherapy at the centre in preparation.

He seemed really motivated to return to his work as a supervisor in a local iron company. He said work was his hobby. Unemployment is especially high in Gaza, so to see him on the brink of returning was really encouraging, and his resilience humbling.Mary Jane Cole is a senior lecturer in practice education at Kingston University and St Georges, University of London, and vice chair of BACPAR

For information on applying to join the register go to: www.uk-med.org and search for UKIETRPeter Skelton is pictured far right

him and he was quickly referred to the local prosthetic

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He 28 Hemiplegia

21 January 2015

Photos: Hem

iHelp

A boy with hemiplegia at