Synapse SPRING 2000 - acpin

SYNAPSE ● SPRING 2000REVIEWSmust continue to utilise ourclinical experience in thesedecision making processes. Weshould not however be carryingout a pivot transfer rather thanhoisting just because its in thegym so therefore its therapy!Documentation of riskassessment is a key requirementin our clinical practiceand an area we would urge allmembers to place particularemphasis on. It is particularlyimportant to document theclinical reasoning for carryingout a particular procedure,especially if within therapythis is different to the manualhandling being used by otherdisciplines.In conclusion the workshopwas obviously a very usefulday. I am sure everyone wouldbe interested in the next stageand how Merseyside ACPINmembers have moved on fromthe conclusions drawn. If otherareas of the country decide toor have nominated liaisonpeople in the same wayperhaps we could use theworking party to facilitate aNational network to assist insharing all of the good workthat is going on throughoutthe country and save some ofthe reinventing of the wheelthat notoriously happens inthese situations.■C ACPIN MANUALHANDLING WORKINGPARTYAnthea DendyACPIN Executive CommitteeThis group was formed in theautumn last year as members’concerns regarding manualhandling issues continued, andas the CSP working partywithin which we had representationhad not reformed.To date the group has mettwice. The members of thegroup are:■ Anthea Dendy, ClinicalSpecialist, St GeorgesHospital, London■ Vicky Sparkes, Lecturer,University of Hertfordshire■ Monica Busse,Physiotherapist, PrivateRehabilitation Centre■ Rosie Hitchcock, Lecturer,University of SouthamptonFollowing correspondencewith the Superintendents inSpinal Cord Injury we have alsobeen pleased to welcome theirrepresentative, Dot Tussler(Superintendent Physiotherapist,Stoke Mandeville) to thegroup.At our first meeting webrainstormed all the issuesaround manual handling and,as always, seemed to end upwith more questions thananswers! We agreed that wewould limit our current work tolooking at Manual Handling inTherapy, and associated topics.From this we drew up a list ofseveral sub sections such asrisk assessment, equipment,research etc. and agreed todecide on which aspect to considertackling first. We were allin agreement that attemptingto write National guidelines formanual handling in therapywas a huge task which wecould not feasibly take on andfelt that by the time we hadachieved our objective most ofour members would have localguidelines in place and wouldtherefore gain little benefit.As all areas will have to lookat this issue locally consideringthe environment, staff andcarers, client group, etc we feltit would be more useful to tryand provide some frameworkswith which people could workto assist them in the riskassessment process.The group is therefore currentlytrying to develop a flowchart demonstrating the riskassessment process for handlingin neurophysiotherapy,indicating where risk assessmentsmay be required andwhere a protocol format maybe able to be utilised for this.Headings to consider for theseprotocols with one or twoexamples may also be developed.The group will continue tomeet every two months anddisseminate its work throughSynapse and the regionalnetwork as appropriate.Examples of local work whichwe have received have beeninvaluable in assisting with ourdiscussions so please continueto send these to the addressbelow so that we can shareyour work with ACPIN membersnationally.Anthea DendyPhysiotherapy DepartmentSt George’s HospitalBlackshaw RoadTootingLondon SW17ARTICLES■A SHARED RESPONSI-BILITY FOR ONGOINGREHABILITATION: ANEW APPROACH TOHOME-BASED THERAPYAFTER STROKEJonathan J Basket, Joanna BBroad, Gabrielle Reekie, ClareHocking and Geoff Green.Clinical Rehabilitation 1999,13: 23-33Anne Murray, Linzie Bassett,Lucy Johnson, Annette PriceThis article describes a comparisonbetween a hospitalbased outpatient therapy programmeand a community styleapproach for two groups ofstroke patients.The paper itself is clear toread and divided well into sectionsaiding its review. It wasfelt that the title does not adequatelyreflect the article, butthe abstract is well written andlogically presented. Althoughan address for correspondenceis included there is no backgroundinformation about theauthors.OVERVIEWA randomised control designwas used to ‘assess the efficacyof a programme of continuingself directed exercises forpeople discharged home afterstroke, supervised once a weekby therapists’. A total of 100stroke patients were assessedon the week of discharge, atsix weeks and at three monthspost discharge. A range ofoutcome measures were usedto evaluate gait speed, limbfunction and activities of dailyliving. Therapist contact time,the mood of the patients andcarers together with theiranticipated and perceived outcomeswere assessed. Theresults demonstrated no statisticaldifferences between thecontrol and experimentalgroups, except relating to thecontact times (p=0.003). Theauthors concluded that thesupervised home based programmeis as effective asoutpatient or day hospitaltherapy.CRITICAL REVIEWIntroductionThe aims of the study areclearly stated but the backgroundto the development ofthe design refers mainly to theauthors’ past experience ratherthan the literature.MethodThe method described appearsto be comprehensive. Inclusioncriteria are stated; the exclusioncriteria appear later in theresults. Ethics approval andinformed consent wereobtained. The method of randomisationis clearly described.Baseline data were collectedfor all subjects to evaluate ifthe two groups of strokepatients were comparable.The patients in the controlgroup were treated either in aDay Hospital setting or the relevantoutpatient department,when only physiotherapy oroccupational therapy wasrequired. Thus, there may havebeen a difference in inputgiven within this group. Dayhospital patients were assessedby the multidisciplinary teamand treatment goals agreed.Patients attended two or threetimes a week, with progressmonitored at weekly reviewsbut the duration of outpatienttherapy input is not clarified.Information is provided on thetreatment approaches, butthere is none on the skill mixof the therapy teams.The patients in the experimentalgroup were assessed athome by a research physiotherapistand occupationaltherapist and goals set. Noinformation is provided of thelevel of expertise in neurologicalrehabilitation of eithertherapist. The subjects followeda self-directed therapyprogramme, receiving weeklyvisits from the therapist for amaximum of 13 weeks or ‘aslong as judged necessary’. It iscommented that if the therapistdecided that some ‘handson’ therapy was essential, itwas provided and the time documented.It is noted that transfer tothe control group could bemade, when patients requiredmedical input or support,which could not be provided onthe home-based programme.Outcome was assessed bytwo independent ‘research officers’,who were blind to thenature of the two interventionprogrammes. A series of referencedmeasures were used toassess both the experimentaland control groups over time.The authors comment thatevery ‘effort was made to standardiseassessments’. Anun-referenced scale is used tomeasure and record thepatients and ‘caregivers’ expectationsand perceivedimprovements from thetherapy.Statistical informationregarding the size of groupsthat are required to determinesignificant changes in the testsis given, stating that a samplesize of 45 subjects in eachgroup is necessary to detectclinical significance withvarious measures.Acknowledgement of thelimitation of the ModifiedBarthel Score to detectimprovement when the entryscore is high is included.ResultsA clear diagrammatic representationof the patient progressthrough the study is provided.Out of the 50 patients ineach group at the start, 46 ofthe control and 44 from theexperimental group were finallyassessed at three months.However, one subject who wasinitially allocated to the hometherapy group crossed into thecontrol group, as the caregivercould not be provided withenough support; this subjectremained in the experimentalgroup for data analysis ratherthan being excluded from thestudy.It is stated that there wereno significant differencesbetween the two groups, inage, sex, side or severity ofstroke or associated diseases orconditions at the beginning ofthe study.The results state that therewere no significant differencesbetween the groups for neurological,physical and activitiesof daily living function as measuredby the assessments atbaseline, six weeks and threemonths. The data is included ina table, showing the mean andstandard deviation for eachmeasure. A statistical significantbias towards the controlgroup was obtained for theBarthel score (p=0.048). Theauthors comment that this wasnot apparent when very lowscores (