Occupation

Abstracts Wednesday 29 June 2016
Trauma and Orthopaedics Annual Conference
Session 41.1
Occupational therapy: a vital role in rehabilitation
with patients having a circular frame
Gray C 1 , Cole M 1 , Mein G 2 , St George’s University Hospitals
NHS Foundation Trust 1 , St George’s University of
London 2
External skeletal fixation using a circular frame is increasingly
being used to treat complex lower limb injuries but is a long
process and can be hampered by complications (Baschera et al.
2014, Lee et al., 2010). There is little research about patients’
experiences during rehabilitation or the role of the occupational
therapist in this area.
The aim of this study was to understand how adults undergoing
limb reconstruction following trauma managed their usual
activities including activities of daily living, leisure and work
activities. It also sought to explore participants’ perceptions of
the rehabilitation services they encountered. Using a descriptive
qualitative approach, interviews were conducted with five people
who were admitted to one London Major Trauma Centre and
had had a circular frame on their leg for at least three months.
Approval to conduct the study was gained from the National
Research Ethics Committee.
Four main themes were derived from the interview data using
thematic analysis: feelings about the frame, understanding the
frame, efforts made to maintain participation in usual activities,
and managing rehabilitation.
Having treatment with a circular frame presents significant
challenges in daily life, as well as feelings of isolation and
anxiety. Despite this participants demonstrated resilience
and developed an array of adaptive strategies to maintain
participation in their usual activities. However, participants also
described variation in the rehabilitation services they received,
with several patients having no access to an occupational
therapist despite significant challenges in their daily lives.
The study’s findings highlight that the difficulties encountered
during treatment with a circular frame can be overcome, and
that occupational therapists could play a vital role in enabling
trauma patients who have a circular frame to cope with the
treatment as well as engage in their usual activities and roles.
References
Baschera, D., Kingwell, D., Wren, M. & Zellweger, R. (2014)
A holistic perspective of patients’ lives post-Ilizarov external
fixation. ANZ Journal of Surgery, 84, pp. 776–780
Lee, D.K., Duoung, E.T.A. & Chang, D.G. (2010) The Ilizarov
method of external fixation: current intraoperative concepts.
AORN Journal, 91(3), pp 326–340
Keywords
Adult physical health, Research, Practice – present and future,
NHS
Contact E-mail Addresses
catherine.gray2@stgeorges.nhs.uk
Author Biographies
Catherine Gray is Principal Occupational Therapist at St George’s
Hospital, London and has an interest in major trauma, in
particular, complex musculoskeletal injuries.
Mary Jane Cole is a Senior Lecturer at St George’s University of
London as well as holding a role as Honorary Amputee Clinical
Specialist at St George’s Hospital, London.
Session 41.2
OT: making a difference seven days a week in the
acute hospital setting
Gray C, St George’s University Hospitals NHS Foundation
Trust
Provision of health services over a seven day period is a
key national service agenda and the importance of Allied
Health Professionals, including Occupational Therapists, is
recognised (NHS England, 2014). OTs in acute care help identify
rehabilitation goals, enable participation and facilitate safe and
timely hospital discharges. Furthermore, clinical areas, such as
stroke and major trauma, also require early assessment and
rehabilitation that have financial implications (ISWP, 2012 BSRM,
2014). Finally, feedback from patients and the multi-disciplinary
team (MDT) indicated that there was a perceived need for OT
throughout the week.
Drawing upon principles of change management a seven day
OT service was implemented as part of a larger MDT project at
St George’s Hospital, London, between 2012 and 2014. Initially
a pilot feasibility project was undertaken. Following this staff
feedback was sought, and business cases developed to obtain
both financial and organisational support before a wider staff
consultation was undertaken. The resulting weekend service was
implemented in phases, regularly seeking feedback to ensure
successful implementation.
OT is now provided over a seven day period in a number of
clinical areas in the hospital, including stroke, neurosciences,
trauma, orthopaedics, and A&E with plans in place for staged
expansion of services to medical and senior health areas.
MDT feedback was positive with benefits of reduced length
of stay, and improved team working and patient experience
highlighted. Despite changes in working patterns and the
challenges of balancing effective team communication, CPD
and training with rest days, OTs also provided positive feedback
about the service.
This project demonstrated that OTs working in an acute hospital
setting have an important role to play in rehabilitation and
facilitating timely hospital discharges over a seven day period
and that with careful, phased implementation a sustainable
service can be established.
References
Intercollegiate Stroke Working Party. National clinical guideline
for stroke, 4th edition. London: Royal College of Physicians,
2012.
British Society of Rehabilitation Medicine (2013) Specialist
Rehab in the Trauma Pathway: BSRM Core Standards. [online]
Available from: http://www.bsrm.co.uk/publications/BSRM%20
Core%20standards%20for%20Major%20Trauma%20
24-10-13-NewLogo-chk-1-12-14.pdf (accessed 25 th March 2015)
NHS England (2014) The NHS Five Year Forward View.
[online] Available from: www.england.nhs.uk/wp-content/
uploads/2014/10/5yfv-web.pdf (Accessed 7th May 2015)
Keywords
Adult physical health, Service improvement or transformation,
Pathways or models of service delivery, NHS
Contact E-mail Addresses
catherine.gray2@stgeorges.nhs.uk
Author Biographies
Catherine Gray is the Principal Occupational Therapist in Trauma
& Orthopaedics at St George’s Hospital, London. She has an
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