We must do more to ensure no-one misses out on rehab

Professor Karen Middleton is Chief Executive of the Chartered Society of Physiotherapy. Karen is a Fellow of the Society of Orthopaedic Medicine, and, in that capacity, has taught physiotherapists and GPs on a national and international basis. Here she discusses the report Recovering after a hip fracture:
helping people understand physiotherapy in the NHS.

It’s the overwhelming feelings of regret and loss that get me. Every time. Whenever I hear a family member say they ‘can only wonder what might have been’ or a patient talking about what they can no longer do.

Whenever I see our Rehab Matters film I know that the fictional story it depicts is playing out in real life, behind closed doors, in homes across the country. It cuts deeply, as a physiotherapist, to hear these stories of how a lack of access to rehabilitation has changed a life.

It makes me burn at the injustice of so many people missing out. Because I know how access to high-quality rehabilitation can change a life for the better – how it can return a person to the things they love, and to the things they do with the people they love. How it can restore independence and a sense of self-worth. How it can restore a life; how it can save a life. 

Why rehabilitation must be part of acute care

Kenneth Rockwood is Professor of Medicine (Geriatric Medicine & Neurology) and consultant geriatrician at Capital Health in Halifax, Nova Scotia, Canada and Honorary Professor of Geriatric Medicine at the University of Manchester.

Many older people leave hospital frailer than when they started. Some of that is preventable, but much of the damage done by acute illness is baked in to how frailty works. Some of it is reparable. That is why rehabilitation must be part of acute care: if we cannot prevent damage, we should at least treat it, especially damage that we inflicted unnecessarily.

The gist of it is easy enough. When frail patients are unwell enough to come to hospital, they typically are not thinking, functioning and moving like they were before they became ill.  That is usually why they come. That, and whatever other symptoms (breathlessness, pain, something red or swollen) signal a problem.  Even when fixing the precipitants, modern care often does nothing to address the worse thinking / mobility / function in which the problems were packaged.  Such complexity of need defines frailty.

Care homes for older people and access to outdoor mobility and spaces

Amanda King is an Occupational Therapist currently working in Nottingham, UK and tweeting at @Alk768.  She has used a recent Masters in Research Methods to investigate rehabilitation in the context of outdoor mobility for care home residents. Here she describes her research journey to date.

I am an NHS Occupational Therapist working in a multi-disciplinary service which provides physical rehabilitation to promote the functional recovery, well-being and independence of older people living in the community. One of the reasons I chose to work with older people, once qualified, was due to spending time in care homes as an undergraduate student. I developed a project, Care Homes Activities Team (CHAT), which involved persuading twenty six occupational therapy students to volunteer to design and deliver a range of activities to the residents of six different care homes, over a period of three months. This experience allowed us to develop our activity provision skills and promote occupational therapy in care homes. It also provided valuable additional resources to the care homes whose staff and residents were very appreciative of the time and energy given by the students.  

Low grip strength is common among older people undergoing rehabilitation and living in care homes

Dr Helen Roberts is a Senior Lecturer in Academic Geriatric Medicine at the University of Southampton.

Older (and middle-aged) people with low muscle strength are at risk of poor current and future health. Grip strength is often used as a proxy for general muscle strength and is most easily measured using the maximum grip strength a participant can generate when asked to squeeze the handle of a small hand held device (see photograph) with each hand while seated, using a standard protocol (see our research paper).  Research among people living in their own homes has shown that low grip strength, defined as < 20kg for women and < 30kg for men, is associated with a higher risk of frailty, difficulty walking, falls and fractures, more admissions to hospital, poor quality of life and an increased risk of death.  This is costly to both the individual and to society. However the grip strength of people who need rehabilitation or live in care homes has been little studied.