File
Govan D.1, Brebner E.1
1Northamptonshire Healthcare NHS Foundation Trust, Integrated Musculoskeletal Service, Northampton, United Kingdom
Background: High demand and insufficient capacity for post operative rehabilitation was observed to be leading to delayed access and poor outcomes in our institution. A class was set up to improve access and outcomes for patients who had undergone arthroscopic subacromial decompression +/- acromioclavicular joint excision, and MUA/arthroscopic capsular release.
Purpose: The aim was to evaluate whether implementing a post operative shoulder class improved:
- timely access to physiotherapy
- regular access to physiotherapy
- post operative outcome measure
- attendance rate
- patient and consultant satisfaction
- time and cost efficiency
Methods: A literature search found no published literature on the effectiveness and feasibility of running a post operative shoulder class.
A collaborative pathway was agreed between the community based musculoskeletal service and the hospital orthopaedic team. Patients assessed as being suitable to perform exercises in a group attended a weekly 30 minute circuit based class. Classes were divided into early and late progression, with the ability for individual treatment if needed. Outcomes were measured by Oxford Shoulder Score (OSS) and Patient Satisfaction Questionnaire.
This was a retrospective evaluation of patients who attended the post operative shoulder class between April 2012 and September 2013. The outcomes were compared to patients seen individually after shoulder surgery between January 2011and December 2011. A total of 175 patients attended the post operative shoulder class between April 2012 and September 2013. Of this 110 had completed outcome measures and were eligible for inclusion in the audit. This cohort was compared to 61 individual treatments between January 2011 and December 2011.
Results: The post operative shoulder class is a successful service improvement initiative for the following reasons:
1. Average wait for initial appointment was 8 days compared to 16 days
2. Weekly access to physiotherapy compared to once in three weeks
3. Average change in score on the Oxford Shoulder Score was 14 .
4. Patient satisfaction rated as excellent on majority of the domains with 100% of patients recommending the class
5. Improved Consultant satisfaction with service
6. Class saved £5234.25 over a one year period when compared to individual treatment sessions
Conclusion(s): The post operative shoulder class ensured regular and timely access to physiotherapy, improved attendance rates, and achieved excellent patient and consultant satisfaction. Group therapy also proved time and cost effect.
Implications: The design and pathway of the post operative shoulder class in Northampton was subsequently used to set up a Total hip and knee replacement class and similar classes in other parts of the county.
Funding acknowledgements: This work received no funding
Topic: Musculoskeletal: upper limb
Ethics approval: This was a retrospective evaluation of a service improvement initiative and as such did not require ethical approval.
All authors, affiliations and abstracts have been published as submitted.
