1. Specialist Physiotherapist
PREP : Taking innovative rehabilitation into the community for people with a life limiting illness
Nicola MacKinnon
Specialist Physiotherapist
June 2019

2. PREP : The start of an exciting opportunity

3. Proactively engage patients in interventions to improve and maintain their physical activity
Partnership with the community to provide patients with activities that are accessible and familiar, promoting community engagement
Promote a wider understanding of rehabilitation within the hospice setting and reduce barriers to accessing services
PREP :
3 Key Drivers

4. PREP : The Vision
The aims of the service are to empower palliative patients to maximise their physical activity in order to promote an active lifestyle and develop resilience in managing the impact of their conditions

5. PREP : Paced Rehabilitation and Enablement Programme

6. PREP : Engagement Delivery Sustainability Patients
Organization (Finance, HR, clinical teams)
Setting
Clinical Team
Funding
Delivery
Hospice Senior Management Team
Commissioners
Referrers
Partnerships (Local Council, Hospital)
Sustainability

7. PREP : Delivery and Development
Phase One
Initial Assessment with Physiotherapist
Mondays at 2pm, 2 hours per week for 8 weeks at Leisure Centre
One to one sessions with Occupational Therapist at Week 2 or 3
First Hour Exercise – Led by Level 4 Gym Instructor or off site gym
Second Hour – Formal Education and discussion
Opportunity to use café afterwards
Ongoing review and final review week 8
Phase Two
Moved from the Leisure Centre to the Hospice
Reduced times from 2 hours to 1.5 hours per week
Reduced from 8 weeks to 6 weeks
Exercise session Led by Physiotherapist or Rehab Nurse

8. PREP : Challenges
“As rehabilitation in Palliative Care is advocated and the evidence base for it’s provision is growing, inappropriate beliefs about referrals need to be explored and challenged”
Nelson, Hasson and Kernohan (2012)

9. Volunteer Rehabilitation Assistant
PREP : Successes
Clinically: Average increase in performance status of 10% within AKPS, all achieved their goals & all patients were maintaining their physical activity based on personal aspirations at 3 and 6 months.
Therapeutically: Transition between health and non-health in promoting long term activity and resilience is key to the clinical successes ; the setting, the staff and the contents.
Organisationally: PREP has enabled Willen Hospice to establish and promote a rehabilitation ethos focusing on the benefits of therapy-led intervention. PREP was specifically commended in our CHKS Accreditation Inspection.
Locally: Very supportive collaboration of local services including local council. Involved with council in promoting activity across the city and walking groups.
Anna
Volunteer Rehabilitation Assistant

10. PREP: A Real Privilege
Rehabilitation in Palliative Care is
“Never Easy, often challenging but always rewarding” Doyle (1997)

11. References
Tiberini R and Richardson H (2015). Rehabilitative Palliative Care: enabling people to live fully until they die – A challenge for the 21st century. Hospice UK. Nelson LA, Hasson F, Kernohan WG (2012). Exploring district nurses’ reluctance to refer palliative care patients for physiotherapy. International Journal of Palliative Nursing Vol 18, No 4 p