REHAB CURE FOR WORK ABSENCE SAVES MILLIONS - IRISH EXAMINER

http://www.irishexaminer.com/ireland/health/rehab-cure-for-work-absence-saves-millions-135875.html

Painful Joints? Exercise may be the Answer

It can come on suddenly, your knee is painful after sitting or driving, or your hips are stiff and it's painful to rise from a chair or climb the stairs. Life becomes more difficult, you can no longer enjoy that long walk with the dog, get out hillwalking at the weekend or stand watching a match. 
Gardening becomes a drag and every day you experience reminders of your aching joints, ageing body and impending limitations. Do NOT avoid activity – get help and advice of what exercise you CAN do to aid recovery.

It doesn’t have to be inevitable, that our shoulders, hips, knee, ankles, feet and hands cause so much discomfort and misery. The right exercises prescribed by your CHARTERED PHYSIOTHERAPIST will help subdue pain by:

Increasing muscle strength and flexibility of soft tissues around the joint, increasing support for the painful joints.

Relieve stiffness by mobilising tendons, muscles and ligaments, which shorten when not used. MOVE IT OR LOSE IT is true. Increasing your joint motion, helps to polish the joint surfaces and release the hardened swelling which can restrict joint motion.

Exercise helps to increase release of synovial fluid into the joint, which is the lubrication fluid within the joint capsule. Synovial fluid carries Oxygen or fuel into the joint and is the source of energy for “well oiled” joints.

Exercises increases the production of substances that dampen down pain. If not exercising, you are more aware of every twinge and ache. Exercise releases the body’s own pain relieving substances, endorphins, so that pain does not register so easily.

Exercise is a necessary component of weight control. Reducing weight helps to relieve pressure on weight-bearing joints, particularly as we age. Hips, knees and ankles are particularly susceptible to increased degeneration if too much weight increases pressure on the joints.

Exercise has been found to increase hormone release in the brain which improves our mood. Mental health benefits accrue from regular exercise as when we are fitter, we feel happier!

Contact your Chartered Physiotherapist for an individual consultation. We will assess your joint range of motion and muscle strength and flexibility, we can determine your aerobic fitness level and we will design a customised exercise programme just for you! Start now, exercise your way out of pain and stiffness and enjoy all the activities you have always loved.

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Increasing blood flow to the Brain

EXERCISE TO INCREASE BLOOD FLOW

AEROBIC EXERCISE
All aerobic exercise has positive effects on circulation and on health.

Modest exercise improves blood circulation to the brain in the older woman, 15% increase was found in one study.

Many studies indicate a connection between exercise and improvement in overall brain health.
 

                                         

Aerobic activities include swimming, cycling, brisk walking, dancing and sex, so find an activity that best suits your lifestyle and engage with enthusiasm.


WALK OFTEN

Short walks are beneficial in increasing circulation to the brain.

If you sit at work, use a timer to prompt you to get up and move, to ensure you walk regularly throughout the day.

Take the stairs in preference to the lift.

Park away from the workplace to build in a brisk walk twice daily.
Get off the bus earlier than your stop, to insure you have a walk before and after work.


STRETCH OFTEN DAILY
Helps prevent joint stiffness, reduces muscle tightness and improves blood circulation throughout the body.

Stretch hourly if you are sedentary at work.

Gentle stretches which increase blood flow to the brain include standing, bending forwards to touch knees, shins or toes.

                         
In sitting, back supported on the floor. Stretch out legs on floor, bend forwards, slowly unfolding your spine, to touch knees, shins or toes. Do not exceed your “comfortable” stretch position. Do not do anything which increases pain or discomfort in your back or legs.

                             
Interlink your fingers, bring palms together, bring both arms up over your head, turn arms to push palms upwards towards ceiling. Stretch x 20 seconds, lower slowly and repeat x 2.
Both stretches can be performed every 2-3 hours throughout the day


YOGA
Yoga incorporates breathing control and many poses encourage positioning of the head below heart.

Supported on back, lie on floor, rest legs up wall, bring buttocks to the wall.

Poses that stimulate blood flow to the brain include Plow Pose and Fish Pose.  

                                        

USE BREATHING TO INCREASE BLOOD FLOW

BREATHE THROUGH THE NOSE
Breathing deeply through nose, sinus cavities, oral cavities and upper lungs, with the diaphragm in the abdominal area, brings air and oxygen to the lower lungs where oxygenation of the blood circulation is greatest.

MEDITATE
Slowing of breathing and heartbeat occurs during meditation. Deep conscious breathing even-paced, increases oxygen saturation in the blood.

Meditation lowers stress levels, increases ability to focus and strengthens the immune system.
Sit comfortably, eyes closed, count deep belly breaths to 10, then start again. Focus attention on counting breaths when other thoughts enter, acknowledge and let them go. Resume counting breaths.

                           

STOP SMOKING
Nicotine decreases blood flow by restricting arteries.

Smoking is linked to strokes and brain aneurysm where weakness in blood vessel wall bulges and bursts, causing stroke.

E-cigarettes contain nicotine and are not recommended as a substitute, being still harmful to circulation to the brain.

CHANGE YOUR DIET

EAT CHOCOLATE!
Chocolate has flavonoids, found in cocoa beans. Flavonoids are present in red wine, red grapes, apples and berries, also green or white tea.

Control calorie intake, monitor fat and sugar intake.

           
             

DRINK BEET JUICE
Beets contain nitrates where are converted into nitrites which increase blood vessel diameters, increasing blood flow to the brain.

Nitrates are found in celery, cabbage and other green, leafy vegetables.

Eat fruit and vegetables high in nitrites for optimal brain functioning.


EAT “SUPERFOODS” IN YOUR DIET
Superfoods are known for their high nutritional value. Nuts, seeds, blueberries and avocados.

Nuts: walnuts, pecans, almonds and cashews are excellent sources of Vitamin E. Decline in cognitive function is linked to deficits in Vitamin E.

Avocado are high in monounsaturated fat, which is linked to increased blood flow in the brain. Monounsaturated fat reduces bad cholesterol and lowers blood pressure.

                                 

Blueberries help protect the brain from oxidative stress. Eating one cup of blueberries daily has been shown to increase efficiency of brain functioning.

                             

Consider Ginkgo Biloba supplements. It contains flavonoids and terpenoids. Flavonoids are plant-based antioxidants which protect nerves, heart muscle, blood vessels and retina from damage. Terpenoids improve blood flow by dilating blood vessels and reducing the stickiness (viscosity) of platelets.

Ginkgo is used to treat dementia, improve thinking, learning and memory (cognition). People have shown improvement in daily activity function, improved social behaviour and reduced feelings of depression.

                                             

It is known as the “brain herb”. Doses of 120 to 240 mg daily in divided doses containing 24-32% flavonoids and 6-12% terpenoids have been recommended in studies.

It can take 4-6 weeks for improvement to be evident. All herb supplements should only be taken with medical consultation as they can interact adversely with other medication, especially blood-thinning drugs. Always alert your doctor or dentist before surgery if you have taken a ginkgo supplement, due to increased risk of bleeding.

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Exercise Treats Cancer & Helps Prevent Recurrence

Cancer sufferers are less likely to exercise after their diagnosis, which is of course understandable, due to the severe physical effects of the disease, which can be devastating.

However recent research in Australia has indicated regular exercise for cancer sufferers is highly beneficial in the following ways:

§  increases the chances of a remission of symptoms and cancer activity

§  supports the body’s immune system which helps fight cancer and

§  improves the general quality of life of someone who has had cancer.

MUSCLE MASS

Resistance exercise, dynamic and aerobic training prior to and during cancer treatment, has been shown to:

§  aid cancer recovery by helping to maintain muscle mass and body strength

§  thereby maintaining higher functional levels during and after the cancer episode.

A Canadian study of bowel cancer sufferers found that:

§  81% of the prehabilitated group, who did regular exercise before treatment, recovered their basic walking ability within 12 weeks and were able to walk further distances post-operatively.

§  Only 40% of the control group, who did not participate in the prehabilitation, achieved the goal of walking ability by 12 weeks. Distance walked was less.

BONE DENSITY AND STRENGTH

Prostrate cancer treatment depletes testosterone supply which reduces bone density and increases risk of osteoporosis. This increases the risk of bone fractures whether occurring spontaneously or as a result of a minor impact or fall.

Research in Perth indicated dynamic training, including jumping exercises, will reduce loss of bone density and risk of developing brittle bones.

Some participants experienced increase in bone density as a result of the exercise programme.

OXYGENATED BLOOD FLOW

Regular exercise increases oxygen-rich blood flow through the body, reducing the hypoxic state around tumours, where cancer cells exist in a minimal oxygen microcosm.

Cancers are more aggressive and resistant to treatment where oxygen is lacking. Exercise improves the effectiveness of cancer treatments which rely on oxygen-rich blood vessels travelling to cancer cells.

   

PREVENTION

Lack of physical exercise is the 2nd Highest Contributor to Cancer  incidence in Australia.

First cause is tobacco smoking. 

A 2010 study indicated that a significant number of bowel, breast and endometrial cancer cases are associated with lack of regular exercise.  Regular exercise reduces insulin production. Excess Insulin is associated with obesity and cancer.

30 minutes of rigorous exercise or one hour of moderate exercise daily is recommended to increase the ability to prevent Cancer.

PHYSICAL ACTIVITY GUIDELINES : Adults aged 18-64 years

Doing any physical activity is better than doing none. If you do no exercise, start slowly and build up gradually to the recommended amount.

Be active on most days, preferably every day.

 

§  You need to accumulate 2 ½ - 5 hours of moderate intensity exercise each week or 1 ¼  to 2 ½ hours of vigorous intensity physical activity every week.

§  Do muscle strengthening exercise on at least 2 days every week, e.g. weight training, resistance training, weight bearing poses in yoga.

Physiotherapy enables people to STAY IN or RETURN TO WORK

The UK challenge:
health, work and austerity

At a time when the NHS is serving a growing and ageing population, the UK government estimates the need for £22 billion in NHS savings by 2020/21⁽³⁾. Yet public expectation remains that access to ever improving treatment should be available to all. So the drive to reduce the welfare bill and to have people in

productive work remains a government priority.⁽⁴⁾ There is clearly a pressing need for best value and productivity in healthcare.

Musculoskeletal disorders (MSDs), from short term back pain to complex, long term conditions such as rheumatoid arthritis, are the main reason for people being off work. These conditions can also link to mental health conditions such as anxiety and depression, which are associated with stress and are responsible for the most working days lost in the UK. Psychosocial factors such as workplace culture can in turn impact on the development of MSDs.⁽⁵⁾

Benefits of early referral to physiotherapy for work

§  Economic savings to the UK

§  Prevention of MSDs and work-related exacerbation of other conditions

§  Clinical effectiveness in the treatment of MSDs and other conditions affecting workers

§  High levels of staff satisfaction

§  'Healthy conversations' that support behaviour change

Early access to physiotherapy enables people to work

SICKNESS ABSENCE FROM WORK 

CURRENTLY COSTS THE UK

£14.3 BILLION

Physiotherapy can help. It is a regulated, clinically and economically cost-effective profession.

Physiotherapists are autonomous practitioners, with the skills to accept referrals directly.⁽⁶⁾

They assess, diagnose, advise and treat people in many clinical and non-clinical settings, both inside and outside of the NHS. They are experts in the prevention and treatment of MSDs and of other conditions affecting people of working age, such as cancer, cardiac, respiratory and neurological conditions.⁽⁸⁾

According to Macmillan, there are currently over 750,000 people of working age living with cancer and it is predicted that there will be 17million people living with arthritis and 3 million with cancer by 2030.⁽⁹⁾

 Work advice from physiotherapists

All physiotherapists can give advice to help people to prevent problems related to their work. They advise employees, enabling conversations with line managers, and liaise with other health care professionals, family and carers as needed. Where a problem or health condition already exists they work with people to achieve optimal function and mobility - with work an important treatment outcome.

Physiotherapists add further value in supporting the public’s overall health. For instance, they can give specific advice about physical activity levels based on an individual’s clinical physiotherapy assessment. This can help people address concerns such as obesity, leading them to better overall health and promoting self-management of their condition.

Within the workplace, physiotherapists specialising in occupational health and ergonomics can provide targeted support in response to the needs of staff and their roles, as well as the business needs of employers.⁽¹⁰⁾ They liaise with line managers and others to promote workplace health and minimise sickness absence.

 The NHS itself, the UK’s largest employer, has a high rate of sickness absence due to MSDs, costing around £400m per year.⁽¹¹⁾ Early access to physiotherapy is now included in government measures. For instance, as part of the work generated by the Five Year Forward View aimed at reducing sickness absence in NHS workers.⁽¹²⁾

Case studies

41,000 working days saved

John Lewis partners (staff) reporting an injury receive a triage call from Physio Med within four hours, and initial assessment from a chartered physiotherapist within three days. 2,324 partners engaged with the service over 12 months. JLP estimates it saved 41,010 working days, saving £2,676,000

93% improvement

The Royal Free London NHS Trust provides a physio-led health and work centre for staff with self-referral to physiotherapy, workplace and ergonomic assessments and health and wellbeing advice. 89% were recommended fit to stay or return to work; data shows 93% improvement in spinal, upper and lower limb disorders.

 Worst to best

NHS Lanarkshire put in place a ‘self-referral to support’ service, including physiotherapy, from day one of sickness absence. They moved from being the worst, to among the bestperforming Health Boards in mainland Scotland.

Increased confidence for managers

79% of staff using the Physio Plus self-referral physiotherapy service at Sheffield NHS Hospitals Trust report it prevented them having to take time off work. 69% of those off work said it helped them return more quickly. Staff and managers said it increased their confidence in dealing with sickness absence.

High return on investment

100 London Fire Brigade staff with chronic musculoskeletal conditions followed a programme provided by Crystal Palace Physio Group including work-specific exercises. There was an 85% reduction in time off work, and £27 return on every £1 spent.

Staff self-referral

Powys physiotherapy service responded to data from the health and wellbeing team demonstrating MSK conditions were in the top three reasons for sickness absence at Powys Teaching Health Board. Staff now fast-track themselves into the service for assessment, self-help advice and management of their condition.

Summary

Referral to physiotherapy can help people to work. For those already in work, physiotherapists can help to prevent sickness absence in the first place, and facilitate sustainable return to work following sickness absence. For those not working, physiotherapy can enable individuals to take opportunities to work. Early access to physiotherapy benefits individuals, workplaces and the economy.

References

1.    Waddell G, Burton KA. Is work good for your health and well-being? Norwich: TSO; 2006. https://www.gov.uk/government/publications/is-work-good-for-your-health-...

2.    Black C, Frost D. Health at work: an independent review of sickness absence. Norwich: TSO;
https://www.gov.uk/government/publications/review-of-the-sickness-absenc...

3.    HM Treasury. Spending review and autumn statement 2015. Norwich: TSO; 2015.
https://www.gov.uk/government/publications/spending-review-and-autumn-st...
2015-documents

4.    Department of Work and Pensions. Fitness for work: the Government response to ‘Health at work – an independent review of sickness absence’. London: Department of Work and Pensions; 2013. https://www.gov.uk/government/publications/government-response-to-
the-review-of-the-sickness-absence-system-in-great-britain

5.    National Institute for Health and Care Excellence. Workplace health: management practices London: National Institute for Health and Care Excellence; 2015.

6.    The Chartered Society of Physiotherapy. Self referral. 2015. http://www.csp.org.uk/professional-union/practice/self-referral

7.    Health and Safety Executive. Work Related Musculoskeletal Disorder Statistics (WRMSDs) in Great Britain 2014/15. London: Health and Safety Executive; 2015. http://www.hse.gov.uk/statistics/causdis/musculoskeletal/index.htm

8.    The Chartered Society of Physiotherapy. Physiotherapy works - the evidence. http://www.csp.org.uk/professional-union/practice/your-business/evidence...

9.    The Kings Fund. Disease and Disability. http://www.kingsfund.org.uk/time-to-think-differently/trends/disease-and...

10.  The Chartered Society of Physiotherapy. Association of Chartered Physiotherapists in Occupational Health and Ergonomics. 2015. http://www.acpohe.org.uk/

11.  The Royal College of Physicians. Work and wellbeing in the NHS: why staff health matters to patient care. London: Royal College of Physicians; 2015. https://www.rcplondon.ac.uk/guidelines-policy/work-and-wellbeing-nhs-why...

12.  NHS England. Five Year Forward View. London: NHS England; 2014. https://www.england.nhs.uk/ourwork/futurenhs/

13.  The Kings Fund. Long term conditions and multi morbidity. http://www.kingsfund.org.uk/time-to-think-differently/trends/disease-and...

Physiotherapy Works - Easy & Early Access

The benefits of early appropriate access to Physiotherapists for patients with musculoskeletal disorders is no longer disputed. Research evidence is overwhelming in confirming it is both clinically and cost effective for patients to consult a Chartered Physiotherapist with their back neck or limb complaints. Patients can self-refer in most places in Scotland and two-thirds of Wales, but only three of 10 CCGs in England offer that option in any form and there is one pilot scheme in Northern Ireland.

However, with primary care under enormous pressure and seeking new models of care that put patients in control, the case for making physiotherapists the first point of contact for back, neck, limb problems - whether working alongside GPs or in more traditional outpatient settings – has never been stronger

Creating capacity

§  Giving patients the choice to be assessed by a physiotherapist as their first point of contact frees up GPs for other often more acute cases

§  Musculoskeletal conditions alone account for up to 30% of consultations in GP surgeries each year – more than 100 million appointments.

§  When other conditions, such as frailty and women’s health, are taken into consideration, the potential impact for the HSE and all public health services is enormous

Saving money

§  Self-referral for an MSK problem cuts costs for the NHS by an average of £33 per patient

§  This represents a saving of up to 25%

§  Savings also come through fewer investigations, such as scans and x-rays, and lower levels of prescribing

 Improving patient outcomes

In Torbay, North Devon, introducing self-referral cut waiting times from 10 weeks to within three days for 90% of patients with musculoskeletal complaints

§  Self-referral helps prevent acute problems from becoming chronic and reduces long-term pain and disability

§  It reduces the time people are off sick from work

§  It is also shown to reduce waiting times and improve patient satisfaction

Putting patients in control

§  Self-referral is an important route into advice and treatment for the growing numbers of people with at least one long-term condition

§  It enables individuals to feel confident to more effectively manage their own condition and live independently

§  Giving patients the responsibility for their own referral is shown to cut did-not-attend rates and improve adherence to treatment plans

Putting self-referral into practice

Working alongside GPs

In West Wakefield physiotherapists are the first point of contact for patients with musculoskeletal pain and dysfunction.

The service, which has been running since late 2014 following a successful pilot, has expanded to six GP practices in West Wakefield and receives on average 900 referrals a month.

By upskilling reception staff to identify appropriate patients to be seen by physiotherapists, significant GP time has been saved.

The GP's view

Self-referral was rolled out across the Plymouth area in February 2015 after a successful trial.

Dr Gary Lenden, a GP from Plymouth and Clinical Lead for the Western locality of Northern, Eastern and Western Devon Clinical Commissioning Group, said:

'Being able to self-refer makes patients feel empowered, because they have the chance to say exactly what symptoms they are experiencing and how it is affecting them.

'It also means people can be seen quicker, which is more convenient for them and prevents chronic issues developing.

'Hopefully this will reduce the need for prescriptions and expensive diagnostic tests. Allowing patients to self-refer also reduces the overall musculoskeletal workload for GP practices, which frees up appointment slots in busy clinics.'

The rapid access service

Patients refering themselves by telephone in the Torbay and Southern Devon Health and Care NHS Trust are offered an appointment with a physiotherapist within 72 hours.

The waiting time prior to the introduction of rapid-access/self–referral was up to 10 weeks. The service cut DNAs by at least 70% and reduced the number of follow-up appointments by more than 18%.

The drop-in clinic

Abertawe Bro Morgannwg University Health Board set up a walk-in clinic in November 2009 for immediate, face-to-face musculoskeletal assessment and advice.

The service runs for two hours each weekday morning and has led to a significant reduction in the volume of follow-up appointments and an overall patient satisfaction rating of 9.6 out of 10.

A ‘Physio Direct’ telephone service has since been established alongside the clinic for an hour a day to provide early advice and management for people with MSK problems.

Telephone triage

Self-referral is long–established in Scotland and all health boards offer either a full or partial service.

Telephone triage is central to that, although many patients can also access services electronically.

NHS Tayside trialled the Musculoskeletal Advice and Triage Service (MATS), offering a telephone assessment by a physiotherapist to patients diverted from the national NHS 24 helpline.

By cutting the number of face-to-face follow-up appointments needed, the 39-week trial is estimated
to have saved the equivalent of 182 working days for the service.

It halved waiting times and achieved high patient satisfaction levels.

Mythbusters

Won’t self-referral lead to a surge in referrals?

No. The evidence shows that unless there was a previously unmet need in the area, referrals do not increase significantly in the early stages of implementation and later level off.

Indeed, self-referrers are shown to need fewer appointments so activity levels can actually reduce.

A rise in referrals can also reduce demand in the longer-term if patients with minor problems seek treatment sooner before they can become chronic.

 Aren’t there safety concerns?

No. Physiotherapists complete extensive training to identify red flags and would always refer a patient back to a GP if they had concerns.

Low numbers of complaints about physiotherapists to their regulator, the Health and Care Professions Council, demonstrate their high level of professionalism.

Self-referral has also been the primary route in to private treatment for decades, further demonstrating the safe, effective nature of the model.

The patient voice

Patient satisfaction was recorded as high during the Department of Health’s pilot scheme in England and feedback was positive.

'"Cost-effective in terms of my time and commitments.'

'I was pleased at the speed with which my self-referral was dealt with.'

'Constructive advice for self-help and management for living with arthritis.'

'In-depth consultation in a relaxed and unhurried way.'

'This service should continue to be offered for all patients.'

'Most appreciative of my 'personal exercise programme' given to me and explained.'

Recommendations for implementing self-referral

Understand existing referral patterns from local GPs

Establish baseline data for activity, cost and outcomes

Reduce waiting lists in preparation for direct access

Ensure all staff in the pathway understand and support the self referral scheme

Identify appropriate opportunities to signpost to self referral

Engage with development and design with online referral systems to allow self referral

References

1.    The Chartered Society of Physiotherapy, Freedom of Information Audit, 2014

2.    British Orthopaedic Association. Getting it right first time (GIRFT): improving the Quality of Orthopaedic Care within the National Health Service in England. London: British Orthopaedic Association; 2015. URL: www.gettingitrightfirsttime.com/report

3.    The Chartered Society of Physiotherapy. Musculoskeletal physiotherapy: patient self-referral. London: The Chartered Society of Physiotherapy; 2012. URL: www.nice.org.uk

4.    Holdsworth L, Webster V, McFadyen A. What are the costs to NHS Scotland of self-referral to physiotherapy? Results of a national trial. Physiotherapy. 2007;93(1):3-11

5.    Department of Health. The musculoskeletal services framework : a joint responsibility: doing it differently. London: Department of Health; 2006. URL: webarchive.nationalarchives.gov.uk

6.    Nordeman L, Nilsson B, Möller M, et al. Early access to physical therapy treatment for subacute low back pain in primary health care. Clinical Journal of Pain. 2006;22(6):505-11

7.    Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP services. London: Department of Health; 2008. URLs: webarchive.nationalarchives.gov.uk
webarchive.nationalarchives.gov.uk

8.    Torbay and Southern Devon Health and Care NHS Trust. Information supplied to CSP

9.    West Wakefield Health and Wellbeing. Information supplied to CSP

10.  NHS Tayside. Information supplied to CSP

11.  Abertawe Bro Morgannwg University Health Board. Information supplied to CSP

12.  Northern, Eastern and Western Devon Clinical Commissioning Group. Information supplied to CSP

13.  NHS London. Allied Health Professions MSK toolkit. 2012. ‘A significant saving to patients was experienced as they attended far fewer appointments which resulted in lower personal cost and less inconvenience’. MSK framework Assessment/Diagnosis p.28. URL: www.nras.org.uk

14.  The Chartered Society of Physiotherapy. What is physiotherapy? The Chartered Society of Physiotherapy URL: www.csp.org.uk