The needs of MS patients and what
AHP’s can provide
Nicola Condon
Senior Physiotherapist
Acute Neurology
Patient needs….?
Dependant on many factors;
• Type of MS and its fluctuating / variability in nature influencing disability over time
• Experienced differently by individuals in variable personal circumstances
• Needs vary at different stages of disease trajectory
QOL is diminished by physical, emotional and cognitive symptoms – impaired
mobility, limb weakness, poor coordination, sensory problems, fatigue, depression,
pain, spasticity, cognitive impairment, sexual dysfunction, bowel and bladder
dysfunction, vision and hearing problems, seizures, swallowing and breathing
difficulties.
Patients needs can be physical, health related, psychological, financial,
employment/leisure, information/knowledge about their condition.
Considerations…
• NICE MS Clinical Guidelines
• NSF introduced 2005 for long term neurological conditions – 11 quality requirements
to improve the quality of care and putting patients at the centre
• Benchmarking study 2010, National Audit Office 2012 – Reviewed Needs and
experiences of services by individuals with progressive neurological conditions
(MND, MS, PD)
KEY FINDINGS
• Person Centred / co-ordinated services – Mixed experiences; 36% single health or
social care professional co-ordinating their care; 22% aware of a care plan (not up
to date); 27% felt given support with self management strategies
• Vocational Rehabilitation – vast majority not in paid work in the last 3 years
• Carers – 21% received a formal carer assessment
• 31% increase in admissions to hospitals from 2004-2005 to 2009-2010; 14% readmitted within 28days
AHP’s
• Shared AIM – ‘allow people to achieve the highest level of function and
independence, through assisting people to restructure their lives, learn new skills,
re-learn tasks and make significant emotional adjustments in their lives’
Prevention of secondary complications which would otherwise increase burden of care,
reduce QOL and accelerate disability
Work across different care settings and geographical boundaries
• Hospitals Primary care – in or out-patients, isolation or MDT’s
• Community Secondary care – in or out-patients, mental health, in isolation, MDT’s
• Tertiary centres – Regional Rehabilitation centres
• Local authorities social services
Patient needs
Focus on self-management – Engagement with health
services
OCCUPATIONAL
THERAPIST –
Patient centred
assessment Workplace
assessments, Assist
employers in job
redesign, Fatigue
management
strategies, equipment
needs
PHYSIOTHERAPY –
Specialist
assessment,
Individual exercise
programme, Fitness,
Education
EDUCATION /
PATIENT
INFORMATION –
Information days for
newly diagnosed
patients, Fatigue
management Course
Newly
Diagnosed
patient
DIETICIAN –
Healthy eating,
weight
management,
address bowel
management
Focus on avoidance of acute admission Supporting self management
• Prevent
unscheduled
emergency
care
• Available on
request
• Periodic
assessment
and advice =
anticipatory
intervention
COMMUNITY
PHYSIOTHERAPY
– Rapid
assessment of
aids, Falls risk
assessments, Reablement
COMMUNITY
OCCUPATIONAL
THERAPY –
Timely home
assessment,
provision of
equipment,
Liaison with
Social Services
SOCIAL CARE –
care needs, carer
support
CRISIS –
Patient falling
at home
?emergency
admission
Facilitating discharge and access to rehab services
•
•
•
•
Reduced length of
stay and
preventing readmission.
Reducing
disability through
early
interventions.
Improving QOL
Ongoing support
and rehab
PHYSIOTHERAPY
– Specialist
assessment and
rehabilitation, Goal
setting, Discharge
planning
SOCIAL
SERVICES –
modifications /
equipment, ensure
carers approach is
‘therapeutic
support’
ORTHOTIST
– Assessment
for orthotics
Relapse
requiring
acute
admission
Occupational
Therapy – Specialist
assessment and
rehabilitation,
Cognitive screening,
Goal setting, Home
or access visits,
Equipment or
adaptations
SALT –
Assessment of
swallowing
function /
speech,
recommendation
s
Complex disabilities – coordinating specialist services
• Regular reassessments
of needs
• Secondary
complication
prevention
LOCAL
COMMUNITY
SERVICES
EXPERT V
NONSPECIALIST
REGIONAL REHABILITATION UNITS
-MS CLINICS
- SPASTICITY SERVICES
- SPLINTING / ORTHOTICS
- SPECIALIST SEATING / WHEELCHAIRS
- ACT SERVICES
- PSYCHOLOGY SUPPORT
SOCIAL CARE
PROVIDER
Complex
Disabilities
Challenges facing AHP services
• Difficult to quantify economic benefits & impact on social care costs
• Which Outcome measurements?
• Inflexibilities in the Tariff system – focus on episodic care rather than meeting
needs
• Rising patient expectations / referrals – increased caseloads, waiting lists
• Crossing boundaries – communication between services, barrier
• Need for further research – low quality evidence
References
• Defining the value of Allied Health Professionals with expertise in Multiple Sclerosis MS
TRUST 2013
• NHS Tariff, 2013-2014, category 3 investigations with category 1-3 treatment or category 3
investigation with category 4 treatment
• Beer et al (2012) Rehabilitation interventions in multiple sclerosis: an overview Journal of
Neurology 259 (9) pp. 1994-2008
• Rietberg et al (2004) Exercise therapy for multiple sclerosis Cochrane Database of
Systematic Reviews Issue 3
• Department of Health – National Audit office, Services for people with Neurological
conditions 2012
• Naci et al Economic burdon of multiple sclerosis: a systematic review of the literature.
PharmacoEconomics 2010;28(5):363-79
• McCrone et al Multiple sclerosis in the UK;Service Use, Costs, Quality of Life and Disability.
PharmacoEconomics 2008;26(10):847-60
• National Service Frameworks 2005