News and Events
“What I did with my CAHPR funding”
Reports from previous recipients of funding from CAHPR
Julie Reid:
Evaluating quality of life and survivorship following major head and neck cancer surgery at the QEUH Glasgow
Project Team: Julie Reid, Band 6 Physiotherapist, Surgical, Critical Care & Oral & Maxillofacial Services, Elaine Ross, MacMillan Head and Neck Cancer CNS
Why we undertook the work: The physical, functional and psychological problems following head and neck cancer surgery and treatment are considerable and multi factorial. In light of the evidence of the symptom burden post treatment, and improving survival rates, there is significant focus now on addressing survivorship and quality of life (QOL) in this vulnerable patient group. Although patients are very closely followed up by an MDT at the QEUH, quality of life is not formally evaluated. We hoped that the information gained could help shape service delivery for the whole MDT.
What we did: Eligible patients who were 12-18 months post surgery were invited to complete the EORTC 30 & 35 outcome measures, which are head and neck cancer specific tools addressing physical, functional and emotional symptoms and general QOL. The scores were generated in an algorithm to provide information on quality of life, function and symptom burden.
How we used the bursary funds: The funds were used to allow the principle investigator clinical time to issue the outcome measures, collect and analyse data.
What we found: We found similar outcomes to those reported in the literature. Role and social functioning scored lower when compared to general and a comparable head and neck reference population. In terms of general symptoms, pain, fatigue and insomnia gave the highest burden. For head and neck specific symptoms dry mouth, mouth opening, use of painkillers, sexuality social eating, social contact and sticky saliva scored highest. 32% were limited in work activities or ADLs, 38% had difficulty eating in front of others, 49% would have difficulty taking a long walk, 30% had difficulty with social contact and 27% said that their appearance bothered them.
What this means: The symptom burden and factors impacting on quality of life in this patient group are similar to what is reported in the literature. The long term implications are of relevance to the whole MDT. AHP input in the longer term recovery is warranted in this patient group, with many of the symptoms being inter related.
What’s next: The results have been shared with the MDT at the QEUH, and there has been a proposal for physiotherapy input at follow up clinics, watch this space!
Top tips for anyone else applying to the CAHPR Bursary or conducting research in practice: Do it! Find something you believe in, no matter how small, or how impossible it seems to start it. Do something that could make a difference, increase your knowledge or push you out of your comfort zone!
Find Julie on X: @juliereid81
Shona Bellward:
Evaluation of Care Home training Sessions on the Management of Postural Deformity for Care Home Residents
Principal Investigators:
Shona Bellward Band 6 Physiotherapist inphysio@Home service, NHS Lothian
Kelly Russell Band 6 Physiotherapist at Edinburgh Community Stroke service, NHS Lothian
Andy Peters AHP Research and development facilitator
Gemma Cockburn- Pittner clinical support worker
Why we did the work:
Kelly and I both worked in care homes throughout Edinburgh for a number of years and received referrals for patients with postural deformity. These referrals were often very complex and included patients with severe contractures and pressure areas. From our experience it is difficult to implement solutions when severe contractures have already developed. Therefore, if we could teach the care home staff when to refer to our service and to begin some simple positioning techniques early this may have a positive impact on the management of these patients.
We also realised that, for any intervention we were going to implement, the carers needed to understand why we were doing it and what the implications would be if they didn’t carry through with postural advice. We wanted to know if the training of the staff increased their knowledge and understanding, increased their confidence and decreased their concerns and resulted in better outcomes for the residents.
What we did:
We chose 5 Care homes within the City of Edinburgh. These were a mix of local authority and private care homes. Thirty three care home staff members in total took part in the training. This included a 2 hour teaching session - 1 hour power point presentation ( which was adapted from the Postural Management link workers group) and 1 hour practical session. We compiled a questionnaire and asked the participants to complete this before the training, immediately after the training, 3 months after and 12 months after to see what effect it had on knowledge and understanding, confidence and concerns. For the 3 and 12 monthly questionnaires we also asked if here was a change in behaviour also ie earlier referral to physio or implementation of basic postural management by staff in the care home.
The results from the questionnaires were statistically analysed and compiled in a poster which has been presented at several conferences such as the NES presentation day and NHS Lothian NMAHPPS conference.
What we found:
Ninety one % of the group worked with someone with Postural deformity but only 13% had received previous postural management training.
We chose 4 questions for our poster:
Knowledge of Postural Management indication scores increased from 75% pre-training to 87.5% post-training. This was maintained at the 3 month follow up questionnaire as shown on below graph
Confidence in starting to use basic PM increased form 3.5 (on a 5 point scale) pre-training to 5 post training. It then decreased to 4 at 3months but still higher than the beginning.
Concern about not having enough knowledge of PM decreased from 3 (on the 5-point scale) pre-training to 2 post training and then 1 at the 3 month follow up.
Concern about doing more harm than good decreased from 3 (on the 5-point scale) pre-training to 2 post-training and stayed at 2 at 3 months follow up.
There was also very positive feedback from all of the groups and all wanted more!!
What this Means:
Staff reported that their knowledge and understanding and their confidence in implementing postural management increased following the training – potentially this will greatly benefit the residents they look after.
It is a largely hidden issue and only 13 % of staff had previously had any training at all.
How we used the Bursary funds:
We used the funds to ring-fence time to dedicate to the development of this project. The funding allowed us time to prepare our presentation, develop our questionnaire, analyse the results and put together our poster. The funds also allowed our colleague Gemma to spend time inputting the results in our statistical analysis software programme.
What’s Next:
We plan to present our poster at more conferences over the next year.
There are no plans to expand on this project at present but plenty of potential for other similar research projects to be carried out.
Top tips for anyone applying to the CAHPR Bursary or conducting research in practice:
The bursary money was hugely beneficial as it allowed us time to develop the project outwith our working schedule which we are grateful for.
We developed this project during Covid time we had to wait to deliver the training in person to the care homes .
The research always takes longer then you anticipate!
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