Presentation on theme: "The Health Roundtable “Burdening the Shoulder? Don’t Shoulder the Burden!” Presenter: Judy Chen Hospital Code Name: The Prince of Wales Hospital Innovation."— Presentation transcript:
The Health Roundtable “Burdening the Shoulder? Don’t Shoulder the Burden!” Presenter: Judy Chen Hospital Code Name: The Prince of Wales Hospital Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012
The Health Roundtable KEY PROBLEM ↑ referrals for ongoing shoulder dysfunction ↑ waiting list → restriction of 1-1 sessions Patients discharged with limited improvement Re-referred for further 1-1 treatment Staff frustration ↑↑ waiting list
The Health Roundtable AIM OF THIS INNOVATION Empower patients Self management strategies Avoid protracted course of therapy Improve quality of life Decrease utilisation of health services
The Health Roundtable BASELINE DATA High prevalence of ongoing shoulder pain with ageing population (Chard et al 1991; Chakravarty & Webley 1990; Vecchio et al 1995) > 30% still has shoulder pain after 2-3 years (Linsell 2006; Winters 1999; Zheng 2005) POW QA Survey of Referrals for Shoulder Dysfunction: 1993: 10% shoulder referrals 2008: second largest group of all referrals 2009: 50%
The Health Roundtable KEY CHANGES IMPLEMENTED Chronic care model: 8 week twice weekly group program Inclusion criteria: One-on-one treatment Chronic shoulder pain- after 4 sessions Exhausted allocated sessions Achieved maximum benefit after 1-1, need further education/ exercise to prevent recurrence Education (goal setting, shoulder anatomy, treatment options, shoulder specific/general exercise, joint care, healthy living etc) Exercise (neuromuscular control exercises, general fitness exercises) Use existing staff, cost-neutral (Plan: RCT for patients on waiting list for shoulder surgery)
OUTCOMES SO FAR NO RE-REFERERALS No “Frequent flyers” re- presenting Fig 1 Improvement (higher score) in lifting ability over time. Fig 2 Measurement of active shoulder range of motion- flexion and hand-behind-back (HBB) reach. A high score in flexion indicates improvement whereas a decrease in HBB indicates improvement. Fig 3 Physical function tests- 6 minute walk test (distance walked in 6 minutes -in metres), and stair climbing (steps climbed in 2 minutes). Fig 4 Outcome of SF36 quality of life questionnaire- both physical component score (PCS) and mental component score (MCS) demonstrates improvement in all domains of physical and mental function. Fig 5 Patient self-perceived improvement in pain measured on an 11-point visual analogue scale. 0 = no pain; 10 = the worst pain imaginable.
LESSONS LEARNT Great for team building Worthwhile problem- solving process Recruitment of participants Upskill staff in program delivery & exercise prescription Refine recruitment process (information brochure, explanation to patient) Consider entry to Exercise program while waiting for commencement of educational program Involve all staff to ensure continuity