O79 A survey of physiotherapists’ confidence in treating patients following shoulder surgery and their behaviour surrounding seeking support

Published Date: 08th February 2022

Publication Authors: Hodson K

 

Purpose
A prior service evaluation of physiotherapy musculoskeletal provision was conducted at a five hospital site, single trust, multi-surgeon service of all elective shoulder surgery patients. The data analysis from this revealed wide variation in the number of treatment sessions between, and within, subgroups of surgeries. The current study aimed to investigate and understand the reason for treatment number variation by establishing confidence levels in treating patients after shoulder surgery, understand behaviours surrounding seeking support, and engage with staff to identify areas for training. The intention was to reduce overtreatment and introduce a local standardised Therapy Management Pathway to identify when patients require senior review.

Methods
Approval was gained from the Clinical Audit Department at the Trust prior to commencing the project. A staff engagement exercise was conducted across all hospital sites via online survey. This was distributed by email to musculoskeletal physiotherapists of varying experience and seniority, involved in the post-operative treatment of elective shoulder surgery. Both multiple choice and free-text questions were included. Questions sought to identify staff confidence in treating post-operative shoulder surgery, at what number of treatment sessions and from who they would seek advice for patients not meeting functional milestones, and preferences for future training needs and delivery. The results were disseminated at a staff meeting.

Results
The response rate was 92.1% (35/38). Most respondents (82.8%, 29/35) indicated that they felt confident in treating shoulders, with only 5.7% (2/35) stating that they were not. Respondents (45.7%, 16/35) felt that arthroplasty, closely followed equally by rotator cuff repair and stabilisation, were procedures that take longer to rehabilitate (42.8%,15/35). Most respondents (42.8%, 15/35) would seek advice if there had been limited clinical improvement after 2-4 treatment sessions, whilst only 2.8% (1/35) would continue until 7-8 treatments before senior escalation. The majority of respondents 88.6% (31/35) would seek support from multiple sources for advice with the most frequent source of this advice would be a senior physiotherapist (71.4%, 24/35). The preferred method of training and support was local team training (68.6%, 24/35), followed by Band specific training (62.8%,22/35). Only 14.2% (5/35) preferred 1:1 teaching sessions. Three recurring themes from feedback became evident to improve staff confidence: 1) review of current protocols 2) regular training 3) staff requested training in setting realistic patient expectations following surgery.

Conclusion(s)
The results demonstrate that most respondents were confident in treating post-operative shoulder surgery patients. Reasons for some patients receiving greater numbers of treatments than the average include the perception that some surgery subgroups take longer to rehabilitate than others. Training needs and preferred methods of delivery were identified and are being implemented to support staff. Current variations in treatment numbers can impact on patient outcomes and duration of care. Providing support to encourage earlier patient escalation with clinical direction will improve both clinical efficiency and staff confidence.

Impact
With ongoing staff engagement, a local standardised Therapy Management Pathway has been developed and implemented, incorporating realistic patient target setting and agreed treatment numbers to trigger prompt escalation if a patient is not meeting agreed milestones.

 

Birchall, D; Hodson, K; Roy, B. (2022). O79 A survey of physiotherapists’ confidence in treating patients following shoulder surgery and their behaviour surrounding seeking support. Physiotherapy. 114 (Suppl 1), E62-63

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