Small steps and big changes

Case study Reablement & physio, Patient experiences 09th Jan 2023

Progress was easy to see, as each time Pat could do more than the previous visit, which was only a few days earlier. By the final session she was able to walk to her front door and back, without a frame.

In Autumn 2022 Lewisham Adult Therapy Team (LATT) referred Pat (not her real name), aged 65 to HomeLink Healthcare for six 45-minute sessions of physiotherapy, including an initial assessment. She had just been discharged from hospital with Type 2 respiratory failure. Furthermore, she had a complicated medical history including breast cancer, obstructive sleep apnoea, type 2 diabetes, asthma, and a TIA that weakened her left side. When discharged from hospital Pat was bedbound.

Samantha Rusike, a HomeLink Healthcare Physiotherapist, says:

“Pat was in hospital for three and a half weeks, and HomeLink Healthcare saw her after discharge from hospital. Pat was in a downstairs room with a hospital bed, a walking frame, a commode, a wheelchair and a new sleep apnoea machine. She could get up and sit on the edge of the bed and stand up onto the walking frame at this point her daughter was doing strip washes for her mother in bed. Pat wanted to walk independently and get to the downstairs bathroom.”

During the initial assessment session Pat could walk with her frame for about two metres if somebody followed her with a wheelchair. She would then become very tired and would need to rest and use her inhaler before moving again. The HomeLink Healthcare Physiotherapist, Samantha, worked with Pat, and together a co-produced physiotherapy programme was developed to build up Pat’s exercise tolerance. As well as practising in the sessions, Pat was given exercises to do in her own time. Pat’s daughter was encouraged to attend most of the sessions and supported her mother to do the exercises in between sessions.

In many physiotherapy services, a patient is seen once and given some exercises, and then not seen again for sometimes up to a month. The impact of the physiotherapy depends a lot on whether the patient can maintain the exercise plan. In this case, twice weekly visits helped establish a rapport between Pat, her daughter and Samantha. At each session Samantha encouraged Pat to walk further and do more exercises. Progress was easy to see, as each time Pat could do more than the previous visit, which was only a few days earlier. By the final session she was able to walk to her front door and back, without a frame. She was also showering, with her daughter’s support.

Samantha says: “When patients have one session a month and then don’t do much, it’s hard to monitor and see the progress. When they are seen twice a week it is easy to see if someone hasn’t done their exercises or if they are struggling and need their programme modified.”

As part of the initial referral, HomeLink Healthcare was asked to assess what extra equipment Pat needed. For example, she wanted a bed lever so she could pull herself up. But by the end of the sessions she didn’t need this or any extra equipment. She was more confident moving about the house and more independent with washing.

Pat says:

“When Samantha came she helped me walk much further than I had walked in 4-5 years. My daughter is trying to carry on Samantha’s great work. Some days I am really tired, but my daughter and my two-year old granddaughter egg me on to do the exercises. Having encouragement makes you want to do things. I’m much better at walking now – I can do lots of things myself. I can get up from the bed by myself (no help needed) and I can use the commode on my own (in hospital I had to use a bed pan).”

Pat’s daughter adds:

“Samantha was really encouraging and patient with mum. When mum reached a small goal, she added something else. The small encouragement meant a lot.”

These changes in Pat’s life might seem like small steps, but they have had a big impact on her independence and wellbeing. Pat reflects “I nearly died when I was in hospital and I am so grateful to everyone at the NHS and HomeLink who helped me to get to where I am today. That’s why I want everyone to see my story and how the NHS and HomeLink Healthcare helped me” she says.

Within a few weeks Pat got to the stage where she could be discharged from the community physiotherapy team’s list. The impact on patient flow would be significant if that outcome were multiplied across many more people.

Samantha concludes:

“We have very few patients coming back for a 2nd time because of the level of initial input we can give. HomeLink Healthcare can help with these patients over five or six sessions, so that they don’t have to come back again.”

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